This discussion is an excellent example and perception of the nursing scope of practice. Often, nurses understand what is within their scope of practice, and never think of what they are not allowed to do within their scope of practice pertaining to the setting they work in. While administering medications to patients is within our scope of practice, having the knowledge of why we are administering it and if it is appropriate to administer is also our responsibility.
Scope of Practice NP’s scope of practice can vary depending on which state they are licensed in. It is extremely important that the NP is aware of the laws and regulations that their state has implemented. Understanding the scope of practice allows you to understand what you can and cannot do as an NP. In Arizona, NP’s are board certified and are now required to take a national certifying exam (Buppert, 2015). NP’s in Arizona have an expanded scope of practice, they can assess, manage, diagnose, and prescribe medications to patients.
Alternatively, in an emergency, urgent and acute prescribing circumstances, supplementary prescribing is not suitable because the clinical management plan needed to be agreed in-between Independent Prescriber, Supplementary Prescriber and the patient before prescribing (DOH, 2006). However, Nuttall and Rutt-Howard (2011) argued that for long term conditions, non-medical prescribers are able to make an independent prescribing decision. Additionally, they stated that for long term conditions, patients are typical, predictable and their response to treatment is straightforward. But they also suggested that if a patient is presented with a condition in which they are competent to prescribe, then non-medical prescribers should be confident and competent to treat patient. ). Nuttall and Rutt-Howard (2011) states that nurses, midwives and pharmacists are capable to prescribe independently, but allied health professionals are able to prescribe only as a supplementary prescribing who needs a CMP to be in place for the patient they want to prescribe.
Advanced practice nurses (APN) have a vital role in the future of health care, especially since the enactment of the Affordable Health Care Act. With more citizens having health insurance coverage they will be seeking health care providers, and there are not enough physicians to care for them all. According to Letiziam (2014), advance practice nurses are licensed autonomous health care providers that have been trained to evaluate, diagnose, and treat patients and their conditions. Advanced practice nursing is an umbrella that covers four separate roles of nurses, this includes: the certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), certified nurse practitioner (CNP), and certified nurse specialist (CNS).
Advanced Practice Competencies There are many roles and areas of practice available to graduates with a master’s degree in nursing. Changes in healthcare resulting from the passage of the Affordable Care Act offer new and innovative roles for nurses. Among these roles are direct care practice roles as a Nurse Practitioner (NP) in family care, gerontology or adult health. Indirect care roles as a Nurse Educator, Nurse Administrator, or Nurse Informaticist are also options graduates of master’s program may choose. Regardless of the path chosen, there are core competencies that must be met for each, in addition to specific competencies related to the area of practice chosen.
The Board of Registered Nursing (BRN) regulates advanced nursing practice and licensure for the NP. According to the Nurse Practice Act (2018), in order to apply to become a NP, the advanced practice nurse must hold an active Registered Nurse License and possess a master’s of science in nursing from a NP program approved
In care settings the currently legislations, guidelines policies and protocols relevant to the administration of medication would be: - The misuse of drugs act 1971 - The Medicines Act 1968 - Care Standards Act 2000 - The Health and Social Care Act 2001 The Control of Substances Hazardous to Health Regulations 1999 - The RPS Handling Medicines in Social Care Guidelines The recording, storage, administration and disposal of medication must be adhered by employees in accordance with the current policies and procedures. The policies are in place to protect everyone - training must be undertaken or up-to-date before support workers can administrate any medication.
According to the Georgia board of nursing Chapter 410-11 Regulation of the advanced practice registered nurses “The prescribing APRN will need a protocol agreement that specifically addresses prescription writing. The delegating physician is to be one who has a comparable specialty area. Forms and instructions are available from the Georgia Composite Medical Board” Georgia board of Nursing (2018). Georgia APRN laws are restrictive.
mends the Controlled Substances Act to increase the number of patients that a qualifying practitioner dispensing narcotic drugs for maintenance or detoxification treatment is initially allowed to treat from 30 to 100 patients per year. Allows a qualifying physician, after one year, to request approval to treat an unlimited number of patients under specified conditions, including that he or she: (1) agrees to fully participate in the Prescription Drug Monitoring Program of the state in which the practitioner is licensed, (2) practices in a qualified practice setting, and (3) has completed at least 24 hours of training regarding treatment and management of opiate-dependent patients for substance use disorders provided by specified organizations.
This provision allowed those in good standing with sufficient experience to become medication-certified barring successful completion of a training course and exam. The aim of this designation was not to replace the RN/LPN but to create a functional care partner. While this collaboration is an endeavor to improve patient outcomes, there are caveats. The purpose of this paper is to narrowly examine the usefulness of this role and
In the world today registered nurses are expected to know about the drugs they administer, their indications, contradictions and adverse effects and correct doses. Any RN can rattle off the correct procedure for safe drug administration. Although, despite this knowledge the incidence of drug errors remain high (Tindale, 2007). A common drug error that occurs is between Amphetamine, which is a CNS stimulant and Propranolol, which is a beta blocker.
Physicians in the US are given the autonomy to prescribe to patients without restriction of drug indication as long as the prescribe drug is given to the patient to help with their ailment in good faith. Physicians give the prescription to the patient to get filled in the pharmacy. The retail pharmacist does not have instant access to their medical records to verify the indication. The pharmacist can verify the drug and the intent of the phycisian. Once confirmed, the pharmacist can fill the prescription regardless of efficacy of the drug on the patient.
Staff work with the same residents day after day, and the CMs know what the residents take for medications every day. An intervention for preventing the medication error from happing again is implementing a better system in which the medications are administered. First, the medication administration record (MAR), could become computerized. This way it makes it difficult for the CM to sign off all the medications at once for the residents when setting them up. This would alert the nurse that all the residents were getting their medication at the same time, which is impossible.
To create an environment where these errors are a rare occurrence, all healthcare professionals must dedicate themselves to implementing QSEN's six core competencies each and every day. These professionals must also speak up when they see room for improvement in their workplace. Regardless of the healthcare setting or demographic of patients, safe outcomes are the purpose of providing patient-centered care. Since nurses are the largest subgroup of healthcare professionals, their ability to make strides towards improved medication administration is undeniable. As the nursing code of ethics states, nurses have the duty to protect the health and safety of those in their care (Winland-Brown, Lachman, O'Connor Swanson, 2015).