Professional Nursing and State-Level Regulations The state and regional boards of nursing have the mission to give protection to the public through the regulation of the nursing practice. These boards

Professional Nursing and State-Level Regulations

The state and regional boards of nursing have the mission to give protection to the public through the regulation of the nursing practice. These boards do so by setting up standards for safe nursing care as well as giving licenses to people who want to practice nursing. The major mission of the state boards is to ensure that the nursing practice is safe and clinically skilled. They also target to provide a tool for evaluation of nurses by themselves to promote proficiency in the clinical sector (Mee, 2017).

             There is an APRN board of nursing regulations in my state (Virginia) which show comparison with those of the neighboring state in the roles they play in their respective states. In my state, there is the Certified Nurse Practitioner which plays significant roles in being held responsible and accountable for health promotion as well as preventing diseases (Bowblis & Lucas, 2017). Another APRN is the Clinical Nurse Specialist which covers the patient, nurse, and nursing practice as well as treating diseases in the state, managing the diseases and finally preventing them.

            Texas is known to have an APRN board of nursing regulations that plays the same role as that of my state, which is promoting the health of all citizens. Texas also has its Certified Nurse Practitioner which is, however, more advanced and strict (Bowblis & Lucas, 2017). When it comes to the certification of a nurse in Texas, it has to align with education. The APRN board in Texas requires a midwife to seek certification form the Midwifery Board of Certification in America.  The specific exam that is used by the American Midwifery Certification Board should ensure that one qualifies to be a midwife prior to certification. This is opposed to Virginia where the state has been given the mandate to offer all practitioner exams through the Certified Nurse Practitioner, including midwifery exams (Scholes, 2018). The Clinical Nurse Specialist regulation in Texas ensures that the nurses are vetted and assessed to ensure that they are efficient in their areas of specialization. The rules in Virginia requiring specialization among the nurses are stricter than those in Texas. The government of Texas has established a shorter process of nursing specialization as compared to Virginia. One has to download the specialization forms from the official website of the Texas government (Scholes, 2018). In Virginia, a nurse willing to specialize in a given field has to undertake a training course and then attain accreditation after completion. Moreover, in Virginia, the nurses ought to attend a center of medicine to be a competent nurse but in Texas, a nurse can just attend a nursing school and get recognized as a reliable nurse. My neighboring state Alaska allows NP Full Practice Authority while my state does not.

The selected regulations can apply to APRNs who have the legal authority to practice within the full scope of their education and experience in various ways.  First, they ensure that APRNs are keen while handling patients thus ought to be competent in nursing care. Secondly, they build their self-esteem and self-confidence among APRNs as they understand that they are already qualified. Third, the regulations influence the APRNs to outperform in their areas of work so as to achieve a desirable level of performance. The APRNs get accountable for their actions and decisions made while handling their patients. Besides, the regulations influence the APRNs to tirelessly enlarge their knowledge through increased experience, continuing with education as well as getting the updates on the latest guidelines in the healthcare industry (Bowblis & Lucas, 2017).

 APRNs may adhere to the two regulations selected in various ways. The set regulations for nursing practice are used as a comparison tool to evaluate the care offered by nurses if the employer notices that the employer goes against the state and regional laws with regard to the healthcare industry. First, APRNs are supposed to identify areas that greatly require improvement in the clinical sector. Additionally, the regulation of nursing practice promotes trust and respect from the patients and the community at large due to the quality services offered in the healthcare sector. Finally, APRNs are supposed to be responsible for all their decisions and actions while handling patients (Mee, 2017).

You discuss that there is an APRN board of nursing regulations in your state of Virginia. You identify that Texas also has APRN board of nursing regulations with the same role as Virginia related to promoting the health of all citizens. Are there regulations that you think should be changed and if so, which regulations?  With the ongoing changes taking place in health care, what strategy will be most helpful to ensure that nurses keep up-to-date with changes as reflected in renewal regulations?

INSTRUCTIONS: The question above was asked from my discussion from “professionaln Nursing ans Statep-Level Regulations. I need help responding to this. Two sources are required.​​​​​​​

#2. 

 Advanced Practice Registered Nurses (APRNs) are in a unique position to assist in the Primary Care Physician (PCP) shortage the country is experiencing.  According to Frasier and Melillo (2018), an APRN is capable of approximately 90% of the medical care provided by a PCP.  Studies show that by 2025 there will be nearly 250,000 Nurse Practitioners providing quality care to the American population (Neff, et al., 2018). APRNs will be in a position to alleviate the strain the public feels with the physician shortage, but there are some restrictions to the APRN scope of practice. 

            Although APRNs are trained to provide most of the care provided by a PCP, APRNs do not necessarily have the authority to provide that care.  Many state laws require that services provided by Nurse Practitioners be supervised by physicians (Frasier, Melillo, 2018).  In the state of Missouri, an APRN may be delegated the authority to prescribe Schedule III, IV, and V controlled substances in collaboration with a PCP and for purposes other than sedation or anesthesia (Missouri Scope of Practice Policy, 2019).  APRNs in California are allowed to prescribe Schedule II and III medications according to a protocol that is patient specific and set by a PCP (California Scope of Practice, 2019). So different states have slightly different regulations governing the prescribing of controlled substances by Nurse Practitioners.

            Along with differences in prescribing authority, many states have slightly different education requirements for APRNs as well. An APRN in Missouri is required to have a degree from an accredited university concentrating on advanced practice nursing in a clinical specialty area including theory and clinical practice and a minimum of 500 hours of faculty supervised clinical experience (MO Scope, 2019).  In California APRNs are required to hold an RN license, a master’s or graduate degree in nursing or a clinical field related to nursing, and completion of a board approved NP program (CA Scope, 2019).  Each state has a slightly different process for preparing APRNs for practice.

            Regulations for APRN practice in Missouri and California are broad in nature.  According to the Texas Board of Nursing Bulletin (2018), regulations governing the practice of APRNs are written broadly in order to apply to all nurses in all settings and don’t necessarily address specific settings or issues.  This is so the practice scope can be determined in a way that best meets the needs of patients in each care setting (2018). The state regulations are there to guide APRN practice and allow for individual needs or patients in a variety of health care settings.

#3. 

For the purpose of this discussion, I have chosen to compare two APRN regulations specified for the state of Texas. It is important to be aware of the state regulations as the National Coalition of State Boards of Nursing notes that the ability of APRNs to practice to the full extent of their education and training is inextricably tied to the state-level scope of practice, laws and regulations (Bosse, Simmonds, et. al., 2017).

In Texas, APRNs are required to submit a request for prescriptive authority to be granted the privilege of writing prescriptions. APRNs in Texas are responsible for maintaining an active license with prescriptive authority, a valid controlled substance registration from the Department of Public Safety, a physician delegation that is registered with the Texas Medical Board and a valid Federal Drug Enforcement registration (Watson,n.d.). In comparison, Oklahoma regulations prohibit APRNs from prescribing Schedule II narcotics (FDA upscheduling of hydrocodone disadvantageous to APRNs, 2018).

Prescriptive authority is vital to APRNs as it supports full practice authority. As previously stated, an  APRN would need to ensure that this designation is registered with the appropriate bodies so it is not a task that would act as a barrier to APRNs performing at full scope of their practice. In those states where APRNs have been granted this ability, fewer prescriptions for drugs commonly linked to overdose deaths has been reported (Bosse, Simmonds, et.al., 2017).

Licensure is another element of APRN regulations. In both Texas and Oklahoma, various applications must be completed to the appropriate board for review. APRNs in Texas will be allowed to receive a temporary permit that lasts for a period of six months and cannot be extended. Oklahoma has a similar regulation, but their policy / guideline does not specify for a time period for which the permit will be enforced. The requirements and criteria for licensing examine all aspects of an APRNs education, training, and national certification so it supports full practice authority for APRNs as well.

With respect to  licensure, APRNs in Texas must start the renewal process a year before their licensure expires and present continuing education hours with a portion of the hours allocated to pharmacotherapeutics and their specialty.

• QUESTIONS 2 ANS 3 I NEED TO GIVE FEEDBACK TO THSES DISCUSSIONS BY ADDING ADDITIONAL/COMMENTS INFORMATION, OR ASKING QUESTIONS. TWO RESOUCES ARE REQUIRED. 

Outline the concept of professional accountability as it pertains to nursing. Provide examples of how a nurse demonstrates professional accountability in clinical expertise, the nursing process, and e

Outline the concept of professional accountability as it pertains to nursing. Provide examples of how a nurse demonstrates professional accountability in clinical expertise, the nursing process, and evidence-based practice.  

Professional nursing accountability is when a nurse takes responsibility for their   actions, judgments, and omissions when caring for patients .      Professional accountability  is also having the responsibility of remaining competent and up to date in all nursing and health care practices   (Green, S 2018).   Nurses should also have  integrity  that is always maintained ,  through their  actions, practices, and attitudes which  they  display to their patients  and interdisciplinary team.   

A nurse can demonstrate professional accountability in clinical expertise  for example by  ensuring that  they are always  properly giving blood products to a patient.  Using their clinical expertise, they know they need to have an order, consent, two licensed professionals to verify the blood products and the patient before administration, and to stay with the patient for the first fifteen minutes of the transfusion. Doing this is  advocating for  the patient to get the correct products safely and  requires a  certain professional attendanc e.   

In the nursing process, a nurse can demonstrate professional accountability  by using safe practices.  S uch  as  educating the patient of signs and symptoms of a transfusion reaction, to notify staff if they have any questions and concerns during the transfusion  immediately and  reporting  and intervening if there is a reaction.  

P rofessional accountability can be shown in the evidence-based practices (EBP).  A nurse being educated and up to date on educations such as EBP and using it to help improve action and promote better patient outcomes.      

References  

HSA 535 Mid Term Part 2 (All are correct)

Question 1

Which of the following is not usually an aim of epidemiology?

Answer

To describe the health status of the population

To fund new public health programs

To explain the etiology of disease

To predict the occurrence of disease

To control the distribution of disease

Question 2

Which of the following activities characterizes a clinical approach (as opposed to an epidemiologic approach)?

Answer

Description of specific signs and symptoms in a patient

Description of seasonal trends in disease occurrence

Examination of disease occurrence among population groups

Demonstration of geographic variations in disease frequency

Question 3

Which of the following activities characterizes an epidemiologic approach (as opposed to a clinical approach)?

Answer

Description of a single individual’s symptoms

Surveillance of a population

Treatment of a patient with diagnosed illness

A and C

Question 4

The Epidemic Intelligence Service (EIS) is responsible for (give the best answer):

Answer

tracking down unusual disease outbreaks in the United States and foreign countries.

collecting routine epidemiologic data for local health departments.

printing epidemiologic reports for members of the community.

reporting suspicious bioterrorism agents to governmental agencies.

Question 5

Cyclic variations in the occurrence of pneumonia and influenza mortality may reflect:

Answer

seasonal variations in cases of influenza.

the fact that influenza is a disappearing disorder.

long-term changes in mortality trends.

both A and B

Question 6

John Snow, author of Snow on Cholera:

Answer

was the father of modern biostatistics.

established postulates for transmission of infectious disease.

was an early epidemiologist who used natural experiments.

argued that the environment was associated with diseases such as malaria.

Question 7

In the Yearly Mortality Bill for 1632, consumption referred to:

Answer

dysentery

tuberculosis

smallpox

edema

Question 8

Indicate the level of prevention that is represented by nutritional counseling for pregnant women Answer

Primary Prevention Active

Primary Prevention Passive

Secondary Prevention

Tertiary Prevention

Question 9

In 1900, the death rate per 100,000 members of the population for influenza and pneumonia (I & P) was 202.2; it was 22.4 in 2003. How much did the death rate due to I & P decline?

Answer

100%

1000%

90%

9000%

Question 10

Indicate the level of prevention that is represented by screening for breast cancer

Answer

Primary Prevention Active

Primary Prevention Passive

Secondary Prevention

Tertiary Prevention

Question 11

Using epidemiology for operational research involves:

Answer

study of community health services

study of risks to the individual

study of disease syndromes

study of disease symptoms

Question 12

The difference between primary and secondary prevention of disease is:

Answer

primary prevention means control of causal factors, while secondary prevention means control of symptoms.

primary prevention means control of acute disease, while secondary prevention means control of chronic disease.

primary prevention means control of causal factors, while secondary prevention means early detection and treatment of disease.

primary prevention means increasing resistance to disease, while secondary prevention means decreasing exposure to disease.

Question 13

Indicate the level of prevention that is represented by half-way houses for persons recovering from addiction

Answer

Primary Prevention Active

Primary Prevention Passive

Secondary Prevention

Tertiary Prevention

Question 14

Indicate the level of prevention that is represented by pasteurization of milk

Answer

Primary Prevention Active

Primary Prevention Passive

Secondary Prevention

Tertiary Prevention

Question 15

An epidemiologic survey of roller-skating injuries in Metroville, a city with a population of 100,000 (during the midpoint of the year), produced the following data for a particular year:

Number of skaters in Metroville during any given month 12,000 Roller-skating injuries in Metroville 600 Total number of residents injured from roller-skating 1,800 Total number of deaths from roller-skating 90 Total number of deaths from all causes 900

The cause-specific mortality rate from roller-skating was:

Answer

90/600 × 100,000

90/100,000 × 100,000

90/1,800 × 100,000

90/900 × 100,000

Question 16

Blood pressure measurements on adult males 30-39 years of age were obtained in a survey of a representative sample of Twin Cities households. To compare the frequency of hypertension in the white and non-white population surveyed, the most appropriate measure is the: Answer

incidence rate

prevalence

race-specific incidence rate

race-specific prevalence

race-specific age-adjusted prevalence Question 17

Determining workload and planning the scope of facilities and manpower needs, particularly for chronic disease. Is this a use for incidence or prevalence data? Answer

This is a use primarily for incidence data.

This is a use primarily for prevalence data.

This application could apply equally for both incidence and prevalence data.

This is a use for neither incidence data nor prevalence data.

Question 18

Estimating the frequency of exposure. Is this a use for incidence or prevalence data?

Answer

This is a use primarily for incidence data.

This is a use primarily for prevalence data.

This application could apply equally for both incidence and prevalence data.

This is a use for neither incidence data nor prevalence data.

Question 19

The risk of acquiring a given disease during a time period is best determined by: Answer

the mortality rate from that disease in the 0-4 age group.

a spot map that records all cases of the disease in the past year.

the period prevalence for that disease during the past year.

the incidence rate (cumulative incidence) for that disease in a given period of time.

Question 20

To express the burden or extent of some condition or attribute in a population. Is this a use for incidence or prevalence data?

Answer

This is a use primarily for incidence data.

This is a use primarily for prevalence data.

This application could apply equally for both incidence and prevalence data.

This is a use for neither incidence data nor prevalence data.

Question 21

The fundamental tool for etiologic studies of both acute and chronic diseases. Is this a use for incidence or prevalence data?

Answer

This is a use primarily for incidence data.

This is a use primarily for prevalence data.

This application could apply equally for both incidence and prevalence data.

This is a use for neither incidence data nor prevalence data.

Question 22

Beach City has a rising population of 500,000 robust, fertile males and 450,000 robust, fertile females. If there were 4,000 live births, 3 fetal deaths, and 40 maternal deaths, what is the crude birth rate?

Answer

4,000/500,000 × 1,000

4,000/450,000 × 1,000

4,000/950,000 × 1,000

4,003/950,000 × 1,000

3,997/950,000 × 1,000

Question 23

Age-specific and age-adjusted mortality rates by sex in the United States generally show the following sex differences:

Answer

Rates for males are higher than rates for females from birth to age 85 and older.

Rates for females are higher than rates for males from birth to age 85 and older.

Rates for males are higher than rates for females from age 6 to age 85 and older.

Rates for males are equal to rates for females during the first 5 years of life.

Question 24

A null hypothesis is most similar to which of the following?

Answer

Positive declaration

Negative declaration

Implicit question

Explicit question

Question 25

Reasons for gender differences in mortality may include:

Answer

greater risk taking by women

greater frequency of smoking among men

higher prevalence of coronary-prone behavior among women

less frequency of smoking among men

Question 26

Lung cancer mortality among women is increasing faster than among men. What factor(s) would most likely account for this increased cancer rate?

Answer

Younger women are smoking more.

Older women are smoking more.

Women are smoking less.

Men are smoking more Question 27

Descriptive epidemiology has the following characteristics (Choose the incorrect option): Answer

provides the basis for planning and evaluation of health services.

allows causal inference from descriptive data.

allows comparisons by age, sex, and race.

uses case reports, case series, and cross-sectional studies.

identifies problems to be studied by analytic methods.

Question 28

Studies of nativity and migration have reported that:

Answer

admission rates of foreign-born persons to mental hospitals were lower than for native-born persons

diseases found in less developed regions are no longer a problem in the United States

immunization programs in developing countries have been highly successful

some migrants have inadequate immunization status with respect to vaccine-preventable diseases

Question 29

Which of the following statements most accurately expresses the downward-drift hypothesis for schizophrenia?

Answer

The conditions of life in lower-class society favor its development.

The conditions of life in upper-class society favor its development.

The illness leads to the clustering of psychosis in the impoverished areas of a city.

The illness is associated with increases in creative talents, which contribute to wealth-enhancing achievements.

Question 30

Which of Mill’s four canons suggests that there is an association between frequency of disease and the potency of a causative factor?

Answer

Difference

Agreement

Concomitant variation

Residues

Ethical and Legal Issues

Ethical and Legal Issues

Read the following case study and submit a 1- to 2-page essay in a Microsoft Word document using APA 6th edition in response to the questions.

Case Study:

Ann is a seventy-seven-year-old grandmother. She has one daughter and three grandchildren. Two years ago, she was diagnosed with moderately advanced Alzheimer’s disease, which causes her to have periods of confusion, frustration, anger, and obsessive thinking. When speaking, she is uncertain and her speech patterns are choppy. Before her mental deterioration, Ann was a woman of love, intelligence, and patience. Realizing they were getting older, she and her husband, Frank, discussed their wishes should anything happen to them. She told Frank that if there was no chance of survival, she would not want to be hooked to a breathing machine. They never got around to filling any papers.

Frank is a sweet and sensitive man. His wife’s state frightens him. Ann’s love for him has been the focus of his life for sixty years. His urgent desire for the best care for Ann shows his devotion and love. Their daughter, Sarah, is a businesswoman. She is a hard worker and a good mother. She is forty-five, successful, and intelligent. Although she loves her parents dearly, she lives ten hours away. She regrets not seeing much of them, especially recently. Frank feels his role is to take care of Ann. He has spent the past year with her, watching after her, cooking for her, cleaning the home, and witnessing her deterioration. Finally, Ann is unable to walk alone safely and he finds he must have her admitted to a long-term care facility. He calls Sarah to come and help with the arrangements. After having Ann admitted to a local nursing home, both Frank and Sarah remember the pleading look in Ann’s eyes as they walk away.

After three weeks in the nursing home, Ann starts to cough and run a fever. She is seen by doctors and diagnosed as having pneumonia. She is transferred to a local hospital, where she is given intravenous antibiotics. Although the progress of her pneumonia is halted by the antibiotics, she stops talking and refuses to eat. The physician calls Frank to insert a feeding tube. Frank calls Sarah to ask what to do. They wonder, Is a feeding tube equivalent to a breathing machine? Would it be possible to allow Ann to lie there and die of starvation? Is that murder? What would she want? What is the right thing to do? (Burkhardt & Nathaniel, 2008).

Respond to the following:

• Discuss the ethical decisions you would make.
• Discuss the legal decisions you would make.
• Explain, as a nurse, what advice would you give to Frank and Sarah.

Support your responses with examples.

Cite any sources in APA format.