response week 6

RESPOND A PARAGRAPH TO EACH POST 1. Case Study One: Selecting the Certification Exam for your specialty. Mary is in the last two months of her program of study. She is trying to decide whether to take the American Association of Nurse Practitioner Credentialing Exam or the American Nurses Credentialing Exam. What happens when FNP courses are complete? Credentialing, licensing, and certification During the last quarter/semester of the MSN FNP program the student should decide which certification exam to take. The FNP student has a choice between the American Association Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP) examination (TBON). A passing score on either exam will allow the examinee to apply for state licensure and prescriptive authority (Midlevelu, 2015). The AANP examination is more focused on clinical information such as assessment, diagnosis, treatment plans, and evaluation, while the ANCC examination contains clinical questions as well as questions on professional issues such as policy, ethics and research (Midlevelu, 2015). Application for state licensure and prescriptive authority can be done early, but are not granted until the applicant passes either the AANP or the ANCC examination. The credentials awarded are determined by the exam taken; the AANP credentials are NP-C, and the ANCC credentials are FNP-BC (AANP, 2016) (ANCC, 2016). Scope of Practice (Acute Care, Family Practice and Adult Gerontology) In Texas, the scope of practice for the NP is broad and is based on the educational preparation, continued advanced practice experience and accepted professional practice in a particular specialty (Texas nurse practitioners). The acute care nurse practitioner receives education to support competency in assessing, diagnosing, treating and evaluating the acutely ill patient; clinical experiences are in the acute care setting; this may include the use of invasive and noninvasive technologies, intervention, and procedures and skills (AACN scope and standaards for acute care nurse practitioners, 2012). Practice settings may include hospital-based settings including emergency and intensive care but also may include any setting that meets the needs of the acutely ill patient (AACN scope and standaards for acute care nurse practitioners, 2012). The family nurse practitioner is prepared by education to care for the individual across the lifespan. The focus is on health promotion, disease management and prevention (, 2016). Practice settings may include primary care clinics, retail care clinics, and hospitals (, 2016). The adult-gerontology primary care nurse practitioner (AGPCNP) is clinically and didactically prepared to provide care for the adult-older adult age spectrum during wellness and illness (American association of colleges of nursing, 2011). This includes promotion and protection of health, disease prevention, and management of the care of the adult-older adult (American association of colleges of nursing, 2011). Practice settings may include but are not limited to nursing homes, and adult-older adult primary care practice. All three nurse practitioner designations are qualified to assess, diagnose, evaluate and treat. The nurse practitioner is responsible for knowing which patients are appropriate in their scope of practice (Texas nurse practitioners). Education on new skills that the nurse practitioner possesses must be documented as proof of ability (Texas nurse practitioners). References AACN scope and standaards for acute care nurse practitioners. (2012). Retrieved from American association of critical nurses: AANP. (2016). AANP certification. Retrieved from AANP: American association of colleges of nursing. (2011). Adult-gerontology primary care nurse practitioner competencies. Retrieved from American association of colleges of nursing: ANCC. (2016). Family nurse practitioner. Retrieved from ANCC: (2016). Family nurse practitioner (FNP). Retrieved from Midlevelu. (2015). Comparing AANP to ANCC. Retrieved from Midlevelu: TBON. (n.d.). National Certification Examinations recognized by the texas board of nursing. Retrieved from TBON: Texas nurse practitioners. (n.d.). Important scope of practice information. Retrieved from Texas nurse practitioners: Introduction At this point in our careers, we have 100’s of questions facing us on a daily basis. What certification to take, which one is best, what setting are we working in after graduation, how much experience do we need to practice alone, are we qualified to work in the hospital setting. The list goes on and on, and there is not solid answer for every individual. Each question must be answered separately and on a personal level. So let’s begin and see what we can find to assist us all in answering a few of these questions. Qualified This question is one that is touchy to many people in the medical field. We have multiple sides involved, and all have a different opinion. For instance, Dr. Gene Dorio answered the question of should nurse practitioners (NP) be limited from practicing in hospitals with the following comment “I do not believe so, as long as adequate training and oversight is maintained” (Dorio, 2013). Dr. Dorio went on to say that through proper training within the hospital setting the NP could be an asset to the patient population and increase quality and perfection. In my opinion, I feel that we should gain experience before diving into the ER, OR or hospitalist setting. I have an extensive background in emergency medicine, and I would not like to step into the ER setting straight out of school. As a registered nurse (RN) I’m am perfectly fine in any situation, you throw at me however when you are making the decisions all alone you need to feel completely confident. In my opinion, the only way to build that confidence is through experience. Case Study Two Amy, FNP-BC has recently graduated from an accredited Family Nurse Practitioner Program. She decides to relocate from her home state of Tennessee to Missouri and practice in a rural area. She is very excited about her new role and new position. Relocating When relocating from state to state as an NP, you need to focus on multiple things from the authority under a physician to prescriptive authority. For the purpose of this discussion, we will look at Amy’s case study. She is currently a Board Certified (BC) NP in Tennessee and wants to move to Missouri to practice. Tennessee has lenient rules in regards to the NP when compared to Tennessee. For instance, the following is a brief run down of the regulations in regards to physician authority in Tennessee: The supervising physician must be available for consultation with the NP at all times. The supervising physician must have experience or expertise in the same area of medicine. A written practice protocol must be in place outlining an acceptable standard of patient care. Once every ten business days, the supervising physician must review the nurse practitioner’s charts if medically indicated. The supervising physician is responsible for examining at least 20% of the NP’s charts every 30 days. The supervising physician’s name and contact information must be listed on any prescriptions written by the nurse practitioner. NP’s are allowed to prescribe narcotics at their discretion (MidlevelU, 2013) While in Missouri the NP must adhere to the following sets of rules: Work under a collaborative practice agreement with a physician. The NP must practice on site with the collaborating physician for a minimum of 30 days. The NP must practice within 30 miles of the physician in a non-health professional shortage area. The physician must sign at least 10% of all charts and 20% of charts were controlled prescriptions were written. Patients must have a “well-defined condition” or must be seen by the primary physician within two weeks. NP’s are not allowed to prescribe narcotics over a class III and only then under the collaborative agreement. (MidlevelU, 2015) Issues We as Advanced Practice Registered Nurses (APRN) must understand that we are not beginning a profession, but we are starting over with a new scope of practice and a new set of rules. In the beginning, we must decide if we will take the American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners Certification Program (AANPCP). When will we begin the application process? Who will hire us? Will we have to relocate? What will we be paid? After we decide all of the answers to these questions, we have to deal with the first patient, the first day, first week, first month and first-year jitters. Scope of Practice There are three primary routes to becoming certified for the purpose of this discussion Acute care (ACNP), Family practice (FNP), Gerontology (GNP) each one focuses on a different aspect and works within their scope of practice. Here is a brief breakdown of each. ACNP – “Focuses on restorative care that is characterized by rapidly changing clinical conditions and provides care for unstable chronic conditions, complex acute illnesses, and critical illnesses” (National organization of nurse practitioner faculties, 2011). FNP – “Focuses chronic, continuous care characterized by a long-term relationship between the patient and FNP” (National organization of nurse practitioner faculties, 2011). The FNP provides care over the spectrum of life and refers patients for services that are beyond their scope of practice. GNP – “Will deal with health issues that impact older adults and their resultant consequences on physical, cognitive, psychological and social function” (Gerontological Advanced Practice Nurses Association, 2012). Each state may slightly differ in regards to the authority under a physician to the NP working alone in practice. The prescriptive authority is different in most states as well. As of now there are no national guidelines that cover all Nurse Practitioners Settings Both the FNP and AGPCNP have seen work in settings such as family clinics, fast track in hospital emergency rooms, large retail pharmacy offices, governmental agencies and major corporations. The practice for both specialties is very broad as long as the NP remembers that it is their duty to work within their scope of practice. Credentialing Exams American Nurses Credentialing Center (ANCC) or the American Association of Nurse Practitioners Certification Program (AANPCP), which test, is the best? It is a personal preference to the individual. Here is a breakdown of the two. Comparison By the Numbers ANCC AANPCP How long to test once receive authorization? 90 days 120 days Number of Exam Questions** 175-200 150 Exam Time Limit** 3.5-4 Hours 3 Hours Test Items on Exam (Not Scored) 25 15 Immediate Notification of Pass/Fail? Yes Yes Credential* NP-BC NP-C Renewal Period 5 Years 5 Years AANP Student member cost $290.00 $290.00 Specialty certifications 9 3 2012 Family Nurse Practitioner Pass rate 86% 87.3% (Advanced Practice Partners, 2015) Conclusion Becoming an NP is not an easy task. After completing all of your classes and clinical you are then faced with the most difficult test, you will ever take. From deciding to go to school to become an NP to deciding which exam to take and what state to practice in we as future NP’s have a duty to give the best evidence-based car we can provide to our patients. References Advanced Practice Partners. (2015, April 29). ANCC vs. AANP: Your certification exam questions answered! – Np2Be. Retrieved July 04, 2016, from Dorio, G. U. (2013, April 12). Increasing the role of nurse practitioners in the inpatient setting. Retrieved July 03, 2016, from Gerontological Advanced Practice Nurses Association. (2012, June). Clinical practice of gerontological nurse practitioners. Retrieved July 4, 2016, from MidlevelU. (2013, May 20). Nurse Practitioner scope of practice: Tennessee. Retrieved July 03, 2016, from MidlevelU. (2015, September 16). Nurse Practitioner scope of practice: Missouri. Retrieved July 03, 2016, from National organization of nurse practitioner faculties. (2011, September). Statement on acute care and primary care nurse practitioners practice. Retrieved July 4, 2016, from

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