7/27/2019 Future Nursing
1/3
February, March, April 2012 Nevada RNformation Page
Future of NursingNurses Should Practice to the Full Extent of
Their Education and Trainin
Regulatory Barriers
Debra Scott, RN, MSN,
When taken on its face, it seems that therewould be no argument
against implementationof the first key message of the IOMs Future
ofNursing Initiative, that nurses should practice tohe full extent
of their education and training. Inruth, barriers do exist which
limit nurses scope
of practice, impair transition from education topractice,
decrease mobility, and undermine thenancial rewards of professional
practice.The IOM Report speaks to all levels of nursing,
rom advanced practice registered nurses, tocensed professional
nurses, to licensed practical
nurses. Endogenous and exogenous barriers serveo limit the
potential for nurses to be instrumentaln leading innovative
strategies to improve state,national, and international health care
systems.
First, we as nurses limit our own potential aseaders in health
care. Our education prepares uso identify a problem, in other words
to make a
nursing diagnosis, and then f ix it. As long as thenursing
profession sees itself as primarily in acuteare settings, we limit
our role in what healthcares becomingfocused on delivery of
healthcare inhe community rather than in hospitals. Nursingttitudes
must broaden to include utilization ofommunity resources and
collaboration amonghe health care team of providers that manage
anndividuals overall health care plan.
We are seeing truly future minded nursesmaking strides in health
care wellness andprevention, defining nursings role in
healthmaintenance rather than limiting our role toisease or symptom
management. We need to
reconceptualize nursings role by identifying healthaccess gaps
and bridging those gaps with whatnurses have always been able to
offera focus on
patient centered health care.Barriers must be identified,
defined, analyzed,
and removed.Regulation may limit scope of practice for
nurses. The diversity among states in regulatingadvanced
practice registered nurses (APRNs)impedes mobility and leads to
confusion in scopeof practice. Issues arise from the diversity in
thelevel of supervision/collaboration that is requiredfor APRN
practice. In addition, the authority toprescribe dangerous drugs,
and to a greaterdegree, controlled substances varies
amongstatesanother barrier to consistent standards ofpractice.
Reimbursement discrepancies may render an
APRN unable to receive financial compensationfor healthcare
services which are comparable toservices offered by other
compensated providers.Insurance companies must assess and
revise
their outdated policies to allow reimbursementservices offered
by the appropriate provider.
Interdisciplinary challenges to scope of pracwithout an
examination of the rigor of educatinor the evaluation of
competency, pose barrienurses professional practice.
The complexity of healthcare deliveryenvironments have created a
gap betweeneducation and practice which has resulted inbarriers to
professional development of the nuworkforce. Transition to practice
opportunitiesprovide a setting where new nurses can acquithe
knowledge and skill to practice to thefull extent of their
education. Integration ofexperiential learning provides new nurses
withcourage and skill to be instrumental in movingprofession
forward.
Finally, and most importantly, we, as nursesmust be at the
forefront of moving our profestoward overcoming the barriers to our
practicito the full extent of our education and trainingLets use
this groundbreaking report to do whawe know must be done to
transform the roleof nursing to provide greater access and
highequality health care to the citizens we serve.
refeences
Institute of Medicine, The Future of Nursing, Leading
Change, Advancing Health, Washington, D.C.; TheNational
Academies Press; 2011.
Spector, N. & Echternacht, M. (2010).A regulatory mod
transitioning newly licensed nurses to practice. Jou
of Nursing Regulation, 1(2), p18-25.
Nursing Leadership & Innovation in Nevada
The Nevada Tobacco Users HelplineElizabeth Fildes, EdD, RN, CNE,
CARN-AP
As one of the Centers for Disease Control and Prevention (CDC)
BestPractices for Comprehensive Tobacco Control Programs,
telephone-basedobacco cessation counseling has been identified in
research as an effectivend evidence-based approach to tobacco
cessation. Founded by a nurse
n 1997, the Nevada Tobacco Users Helpline (Helpline) has been
the Stateof Nevadas free tobacco quitline that provides
comprehensive, statewidenicotine dependence treatment for all forms
of tobacco (smoked andmokeless), and education available to all
Nevada residents 18 years and
older. The program is medically driven, research &
evidence-based, followsCDCs Best Practices guidelines, follows
Agency for Healthcare Research andQuality Guidelines (AHRQ), uses
FDA approved medications in the HelplineMedication Assistance
Program (MAP) and hires professional counselors for
reatment delivery. Although quitline services vary across
states, the Helplineoffers a longer, more intensive proactive
counseling protocol than any othertate quitline, with many users
receiving proactive counseling sessions for
f
Nevada NPs Make a Difference in theHigh-risk Senior Citizen
Population
With offices in Northwest and Southeast Las Vegas (LV),
CaremoreNurse Practitioners (NPs) are part of an innovative system
that began inthe late 90s and expanded to LV, in early 2010, from
Southern CaliforniaCaremores program uses an innovative
collaborative model where the loNPs at the Caremore Care Center
clinic work with seniors who have thediagnoses of HTN, COPD, CHF,
Tobacco Dependency, DM, CKD, Fall Riskand Anticoagulation
needs.
Currently staffed with two full time NPs, a part-time NP, and a
locumtenum NP, the Medicare Advantage patients go to the clinic
sometimesmultiple times in a week. This innovative prevention model
actuallydecreases cost by reducing patient hospitalizations.
A day in the life of a Caremore NP includes seeing a patient
whose
warfarin level is not in balance and prescribing dosages to
stabilize thepatients drug levels. The NP will see a new patient
for an hour longappointment to welcome them into the program.
Managing phone calls f
ti t h h it li k t th t l h d l t th NP if
7/27/2019 Future Nursing
2/3
Page 18 nevada Rnformatio February, March, April 2
with Caremores tobacco cessation program. Thenhe NP will manage
risk factors for patients withhronic kidney disease. An important
part of the
NPs job is to manage patients with diabetes,ncluding assisting
the patient with a glucose
monitor that can be downloaded during clinicvisits, and free
lancets and monitoring strips, pluseaching how to use both long and
short actingnsulins and providing wound care.
In addition to all the care provided by the NPshe Caremore
senior can go to the clinic to visit
with the extensivist, a physician director thatlso visits the
patient in the hospital, and sees the
patient in the clinic after the hospitalization. Therere also
visits at the c linic with a pulmonologist, a
podiatrist, and a psychiatrist, plus multiple diseaseocused
nutrition classes led by a dietician, allentrally scheduled on the
Caremore electronic
health record (EHR).To add to the value, the clinic includes a
senior
riendly gym called Nifty after 50 that guides
he patients in how to lose weight and increasetrength and
balance to help prevent falls; theyan also see a physical therapist
at the gym. Theocial aspects of the gym also help seniors who
may have slight depression due to isolation orpain. An RN Case
Manager, medical assistants, and Licensed Clinical Social Worker
round out thetaff in the clinics.
Caremore also employs two additional NPsn its Touch program. NPs
go out to assistedving facilities to help patients, providing
quality
healthcare with the convenience of not havingo leave home. A few
not so common perks theeniors receive are toenail trimming offered
in thelinic and drivers to assist them with getting to
ppointments or picking up prescriptions. To learnmore about
Caremore please see their website at:http://www.caremore.com
Model described by Diane McGinnis, DNP, APN-FNP, NP-C, the AANP
NV State Representative2010-2012. To contact Diane, please
email:[email protected]
Nevada NPs Make a
DifferenceContinued from page 13)
Professional Nursing Practice
Palliative Care NursingLeslie Hunter-Johnson, MSN, RN-BC, CCRN,
CNRN, CHPN
Palliative Care Coordinator, Sunrise Hospital and Medical
Center
Palliative care nursing is a new specialtythat is directed at
identifying and treating painand other symptoms for patients in
acute caresettings who are experiencing life-threateningand/or
chronic illnesses. The goal is toimprove the quality of life while
concurrentlyproviding curative treatment. There have
beenmisconceptions that palliative care equates toan anticipated
death. The results of a publicopinion survey conducted by the
Center to
Advance Pall iative Care (CAPC), confirmed thatphysicians
equated palliative care with hospicecare and were reluctant to
order referrals tothose facilities offering palliative care
services.
On September 1, 2011, The Joint Commission
released certification standards on AdvancedCertification for
Palliative Care. This informationshould help promote consumer
awareness of theavailability of palliative care in acute care
settings.The services are provided by specially trainedteams that
include physicians, nurses, and other
team members that work together toward thepatients goals. Along
with treatment of pain asymptom management, the patient is
treatedas a whole and not a defined disease process.This process
has a positive impact on the patiand family and promotes stress
reduction in aotherwise stressful situation.
As a palliative care nurse, I am very passionabout the patients
and families to whom I procare. The members of the team take the
timeto listen to those involved without constraintsof limited time.
We look at the patient and thesymptoms as a whole forest, and not
just a sintree. Recently, Nevada was upgraded from a to a B on the
provision of palliative care serv
due to the continuing efforts of palliative careproviders.
For more information on palliative care or toview the Public
Opinion Survey on Palliative Cavisit the Center to Advance
Palliative Care webat www.capc.org
Research HighlightsWallace J. Henkelman, Ed.D, MSN, RN
Assistant Professor, Touro University Nevada
Olive Oil and Stroke Risk
A recent study conductedin three cities in France(Samieri et
al., 2011)compared persons of ages65 and older with no historyof
stroke looking at, amongother things, dietary habits.Two specific
items studiedwere self-reported intakeof olive oil and plasmaoleic
acid levels (an indirect indicator of olive ointake). There were
7,625 individuals in the firsgroup and 1,245 in the second. After
adjustme
for demographic, other dietary variables, bodymass index, and
other risk factors for stroke, iwas found that intensive users of
olive oil had 41% lower incidence of stroke than those whodid not
use olive oil. Intensive use was definedas using olive oil for both
cooking and dressingThe participants with high oleic acid levels
we73% less likely to have strokes than those withlower oleic acid
levels. Oleic acid can, howeverincreased by dietary factors other
than olive oconsumption.
Perhaps in discussing diet with our c lients, wneed to suggest
the use of olive oil, particularclients with risk factors for
stroke.
refeence:
Samieri, C., Feart, C., Proust-Lima, C., Peuchant, E.,Tzourio,
C., Stapf, C., Barberger-Gateau, P. (2011).
Olive oil consumption, plasma oleic acid, and stroke
incidence Neurology 77(5) 418 425 doi: 10 1212/
New Treatment for Head Lice
Head lice are a persistent problem, particularlyin persons
living in crowded situations such asclassrooms. Traditional,
nonpharmacologicaltreatments such as applying petroleum jelly
andcombing are very time-consuming and tedious.Unfortunately, lice
have also been developingresistance to commonly used
pharmacologicalagents such as Nix (permethrin) making treatmentmore
difficult.
The FDA recently approved a new treatment forhead lice, spinosad
(Natroba Topical Suspension)for use on children age four and older.
It is moreexpensive, but clinical trials have shown it to more
effective than Nix (86% vs. 44% louse-free after14 days). It has
been shown to be ef fective afterjust one treatment without the
combing for nits.The nits appear to be unable to hatch after
thetreatment.
refeences
Binns, C. (2011). No more nit-picking? New FDA approved
treatment promises easier way to defeat lice. TODAY
Health@ TODAY.com.
U.S. Department of Health and Human Services. (2011).
FDA approves head lice treatment for children and
adults. Retrieved from http://www.fda.gov/NewsEvents/
Newsroom?PressAnnouncements/ucm240302.htm
Come join us in our beautiful facility
located in Elko, Nevada. Wonderful people,
majestic mountains, clean air and great
opportunities await you in our growing
community.
SEEKING RNs:Cardiac Care Coordinator
ER DirectorOB Director
Positions in OB, ER, and
Med/Surg/Peds
Competitive Beefits ad Pay
