After reviewing the course objectives and reflecting on them, I have an idea of how I think I can develop the skills needed to meet these course objectives.

DQ-1

After reviewing the course objectives and reflecting on them, I have an idea of how I think I can develop the skills needed to meet these course objectives. For the first course objective, I would like to achieve the ability to utilize evidence-based theory and research to treat adult-gerontological patients who are experiencing acute illnesses. I hope to take my previous experience as an ICU nurse and build on it with new knowledge obtained in this course, in order to begin thinking like a provider instead of a nurse. The knowledge I gain in this class from evidence-based theory and research I hope to be able to apply to patients in the ICU and throughout the hospital in order to treat them appropriately and be able to send them home at their prior level of functioning. 

The second course objective, synthesize data from a variety of health resources to treat adult-gerontological patients, actually has been a question on my mind lately. There are so many medical resources available that all provide an overwhelming amount of information that needs a skill set that allows for rapid dissemination of information that can be applied to the patient and how they are presenting. Even though the amount of information is helpful, it also can be hurtful as a information overload when quick decisions are needed. My plan is to become familiar with these resources, and how to use them appropriately in order to narrow down diagnosis and have evidence based research to back up my clinical decisions. 

The third course objective, analyze common acute care problems to develop prioritized differential diagnoses, make clinical judgments, and recommend appropriate treatments for adult-gerontological patients with acute illnesses, in my opinion is the most important course objective we have and the longest time to develop skills for. I realize that this goal is to be achieved by the end of this schooling year, but we need to be able to make large strides in developing this skill by the end of this course. My plan is to combine the previous two course objective skills in order to develop this skill appropriately. I hope to be able to explore each patient’s illness with the help of my preceptor and attempt to make differential diagnosis with their guidance. During these developments, I want to take what each preceptor says and teaches me in order to help me think like a provider and make appropriate diagnoses. 

I believe that these three are most important out of the five because they lay the foundation that we will build our expertise on. My plan is to build each one of these course objectives up as their own skill, then combine them into my overall skill, utilizing strengths from each one to help each individual patient. Just as popular nursing theories state that body systems are individual and part of a whole, the same can be said about this course’s objectives. 

DQ-2

Going through this course of ANP-650, I hope to achieve more hands-on experience in the clinical field in a supervised environment, get more acquainted with my transitioning role, and develop confidence in my skills needed for AGACNP in assessing, developing plans, and management of disease conditions using the treatment guidelines. Under the direct guidance and supervision and discussion with my preceptor, organizing my thoughts, and develop critical thinking, synthesizing all the necessary clinical information and personal assessment data to diagnose the condition on the specific clinical state. According to Dillon, Dolansky, Casey, & Kelley (2016), organizational support, communication, and leadership were the most important elements of a successful transition into a new acute care nurse practitioner (ACNP) role. I am longing to observe and shadow my preceptor in clinical procedures to gain and develop confidence and skills.

I am looking forward to developing a trusting relationship with my patients, collect all pertinent history, assessing my patients, locate all the required information from patient’s health records, learn to interpret tests results, develop a differential diagnosis and primary diagnosis, and accurate coding under my preceptor’s guidance. As studies showed that new nurse practitioners (NPs) felt most prepared in health assessment, evidence-based practice, and health teaching and least prepared for procedures, billing, and electrocardiogram/x-ray interpretation and they desire to transition into clinical practice (Hart, & Bowen, 2016). I know this is a learned skill and talent develop over time, practicing skills under supervision on my patients is one of my primary goal going through this course work and clinical experience. Another objective I hope to achieve is getting used to the evidenced-based knowledge and utilizing the evidence-based information on my patient’s specific clinical condition through discussion with my preceptor.

The last objective is to be comfortable around patients with various acute, emergent, and critical conditions, and chronic conditions in adult-gerontological patients. While managing their condition, assess the impact on their physical, psychological, financial, and social situation of patients and family, and able to address them within their faith, culture, and practices and promote healthy and positive behaviors. I hope to achieve skills in education guidance and counseling of patients on their disease state through motivational conversation, discussing the treatment options, recommendations, different levels of prevention and health promotion activities through lifestyle modification in collaboration with other disciplines.

Reference.

Hart, A. M., & Bowen, A. (2016). New nurse practitioners’ perceptions of preparedness for and transition into practice. The journal for nurse practitioners, 12(8), 545-552. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1555415516301076

Dillon, D. L., Dolansky, M. A., Casey, K., & Kelley, C. (2016). Factors related to successful transition to practice for acute care nurse practitioners. AACN advanced critical care, 27(2), 173-182. Retrieved from https://aacnjournals.org/aacnacconline/article-abstract/27/2/173/2337

DQ-3

On the Florida statutes website, the chapters and professional codes that dictate and regulate business practices under Title XXXII, and specifically under chapter 456 and 464 (Certification of advanced registered nurse practitioners; fees; controlled substance prescribing, 2018). These chapters go over health professions and occupations, general provisions, business practices, and abilities and limitations on their scope of practice (Certification of advanced registered nurse practitioners; fees; controlled substance prescribing , 2018).

In Florida, the Advanced Nurse Practitioner can act within two guidelines, one being from the Board of Nursing in Florida, and the other is outlined in their facility’s or supervising physician’s practice agreement (Certification of advanced registered nurse practitioners; fees; controlled substance prescribing , 2018). Nurse practitioners in Florida standards of care include the ability to order appropriate therapies for certain conditions, order diagnostic tests and physical and occupational therapy, order any medication administration to a patient in a facility licensed under chapter 395 or part II of chapter 400, manage selected medical problems, initiate monitor or alter therapies for certain uncomplicated acute illnesses, monitor and manage patients with stable chronic diseases, and establish behavioral problems and diagnosis and make treatment recommendations (Certification of advanced registered nurse practitioners; fees; controlled substance prescribing , 2018).

Since Nurse Practitioners have the ability to order any medication within the facility’s or supervision practice agreements, there are limitations to narcotics, such as only prescribing a 3 day supply with a referral to a pain management clinic (Controlled substance prescribing, 2018).

As far as the process goes for invasive procedures for invasive procedures in Florida, there is some ambiguity. The Board of Nursing states that the Nurse Practitioner can practice under a physician supervision agreement, and if that agreement includes the ability to provide invasive procedures, then the facility that they are both working in has to also have policies in place that dictate the protocol for the nurse practitioner’s procedure for the invasive procedure (Certification of advanced registered nurse practitioners; fees; controlled substance prescribing , 2018). However, it does not explicitly state what is within the Nurse Practitioner’s scope of practice as defined by the state regarding invasive procedures, it instead puts the responsibility onto the facility, physician, and nurse practitioner to create protocols (Certification of advanced registered nurse practitioners; fees; controlled substance prescribing , 2018).

The more and more I read into the Florida Statues, it seems that the Nurse Practitioner area is vague and incomplete. However, upon reading the proposed legislation for the year, it seems that there are a lot of proposed items that help define the Nurse Practitioner role both the FNP and ACNP, and their scope of practice. There is also a large push right now for Nurse Practitioner Full Autonomy, but I think that still has a long way to go before becoming a law.

References:

Controlled substance prescribing. (2018). The 2017 Florida Statutes. Retrieved October 22, 2020, from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute

Certification of advanced registered nurse practitioners; fees; controlled substance prescribing (2018). The 2017 Florida Statutes. Retrieved October 22, 2020, from http://www.leg.state.fl.us/statutes/index.cfm?mode=View+Statutes

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