Scope of Practice - Based on legal allowances in each state, individual state nurse practice acts providing guidelines for nursing practice Key elements of the NP role include - integration of care across the acute illness continuum with collaboration and coordination of care; research based clinical practices, clinical leadership, family assessment, and discharge planning Standards of Advanced Practice are delineated by... - American Nurses Association which measure quality of practice, service, or education State Practice Acts - Authorize Boards of Nursing in each state to establish statutory authority for licensure of RNs State Practice Acts - authority includes: - use of title, authorization for scope of practice including prescriptive authority, and disciplinary grounds States vary in practice requirements, such as - certification Prescriptive authority - Ability and extent of NPs ability to prescribe meds DEA has ruled that nurses in advanced practice may obtain.. - registration numbers, state practice acts dictate level of prescriptive authority allowed Credentials encompass... - required education, licensure and certification to practice as an NP Credentials establish... - minimal levels of acceptable performance Credentialing is necessary to: - ensure that safe healthcare is provided by qualified individuals; comply with federal and state laws r/t APN Credentials also... - acknowledges the scope of practice of NP, mandates accountability, enforces professional standards for practice Licensure - establishes that a person is qualified to perform in a particular professional role Licensure is granted as defined by rules and regulations set forth by - a governmental regulatory body (ie. state board of nursing) Certification - Person has met certain standards that signify mastery of specialized knowledge Certification is granted by nongovernmental agencies such as - ANCC, AANP Admitting privileges to hospitals (non physican) were granted - 1983 by JC Credentialing and privileging - process which an NP is granted permission to practice in an inpt setting Credentialing with hospital privileges is granted by a - Hospital Credentialing Committee Pt Medical Abandoment - When caregiver-pt relationship is terminated w/o making reasonable arrangements w an appropriate person so that care can be continued Determination of pt abandonment depends on factors such as: - Whether NP accepted pt assignment, whether NP provided reasonable notice before termination, whether reasonable arrangements could have been made Following do not constitute pt abandonment - NP refuses to accept responsibility for pt assignment when NP has given reasonable notice to proper authority that NP lacks competence to carry out assignment; NP refuses assignment of a double shift or addtl hrs beyond posted work schedule when proper notification has been given..latter phrase can be controversial Risk Mgmt - Systematic effort to reduce risk begins w formal written risk mgmt plan that includes: organizations goals, delineation of program's scope, components, methods; delegating responsibility for implementation and enforcement; demonstrating commitment by the board; confidentiality and immunity from retaliation for those who report sensitive info Most common method of documentation for risk mgmt - incident reports Policies regarding incident reports should address: - ppl authorized to complete report; ppl responsible for review of a report, immediate actions needed to minimize the effects of the event; ppl responsible for follow up; plan for monitoring aftermath; security/storage of completed report Risk mgmt - Satisfaction surveys - Important for identifying problems before they develop into incidents or claims; for pts and employees Risk mgmt - Complaints: Risk mgmt plan should delineate tracking, analyzing, and managing complaints by clearly identifying: - ppl notified after receiving complaint; ppl responsible for responding; ppl responsible for monitoring follow up Action taking initiatives: - Prevention, correction (corrective steps must be monitored and audited), documentation, education, departmental coordination Medical Futility - Interventions that are unlikely to produce significant benefit for pt - "Does the intervention have any reasonable prospect of helping this pt?" Two kind of medical futility: - Quantitative futility: likelihood that intervention will benefit pt is extremely poor Qualitative futility: quality of benefit an intervention will produce is extremely poor Informed consent - competence (decisional capability) - state that pt is able to make personal decisions about their care