Transcript Nurse Practitioners - Flight Nursing Program
Advanced Nurse Practitioner Education in the USA;Past, Present and Future
Christopher Manacci, MSN, ACNP The National Flight Nurse Academy Frances Payne Bolton School of Nursing Case Western Reserve University
Discuss the definition and educational requirements for becoming a Nurse Practitioner Understand the differences between Nurse Practitioners and other providers.
Discuss the Acute Care Nurse Practitioner scope of practice
Late 1950’s-Ingles/ Stead 1960-CNS Mid 1960’s-NP’s 1990 ACNP
Historical Perspective
• 1970-Neonatal NP • • Early 1990’s-NP required have master’s degree urban settings 1994-ACNP scope of practice • • 1997-Balanced Budget Act 2000-CTP passed • 2002-Prescriptive Authority fully implemented
Clinical Nurse Specialist Certified Nurse Midwife Certified Registered Nurse Anesthetist Certified Nurse Practitioner
Registered nurses who: ◦ Are master’s or doctoral prepared ◦ Has become an expert clinician in a specialty area. ◦ National certification is optional. The functions of the CNS include clinician, leader, educator, and change agent to improve quality of care.
Ohio Association of Advanced Practice Nurses, 2001
Registered nurses who: ◦ ◦ ◦ Have advanced training in Women’s health and midwifery. Have a master’s degree and Are nationally certified The functions of the CNM include labor and delivery, prenatal, postpartum, newborn and routine gynecological care Ohio Association of Advanced Practice Nurses, 2001
◦ ◦ Registered nurses who: Have critical care training Have a master’s degree in the delivery of anesthesia ◦ Is nationally certified CRNA functions include: administration of anesthetic agents/drugs for surgical, diagnostic procedures, and acute and chronic pain control Ohio Association of Advanced Practice Nurses, 2001
◦ ◦ ◦ Registered nurses who: Have a master’s degree or doctorate Are nationally certified Have advanced training and education in a specialized area of health care CNP functions include: management of acute and chronic illnesses and disease prevention to a variety of age ranges in a variety of care settings Ohio Association of Advanced Practice Nurses, 2001
Neonatal nurse practitioner Family nurse practitioner Adult nurse practitioner Acute Care Nurse Practitioner
Nurse Practitioner ◦ CNP works under his/her license ◦ Responsibility rests on competence of individual ◦ In collaborative arrangement, parties interact under mutual respect and authority.
Written guideline which defines responsibilities, accountabilities, and obligations of the specific CNP practice.
◦ ◦ ◦ ◦ Limited by: State legislation Standard Care Agreement Credentialing institution Collaborating Physician Scope of Practice
Physician licensed to practice medicine in Ohio who agrees to work with the Advanced Practice Nurse in order to mutually establish a procedure for patient care Ohio State Board of Nursing, 2001
Systematic formal guide for planning and evaluating health care.
State of Ohio Board of Nursing, 2001 Written agreement between CNP and collaborating physician regarding guidelines of care and scope of practice.
Nurse Practitioner
Clinical Research Educator Consultant Administrator
Rounds H&P’s/discharges Physical exams ◦ ◦ ◦ Evaluation/initiation of plan of care diagnostics pharmacotherapy multidisciplinary collaboration
Intubation Line placement: central, Swan, arterial Tube Thoracostomy Wound Closure Lumbar drain Subdural drain removal CSF specimens C-spine clearance Laceration repair VP shunt reprogram
Identify research opportunities Collaborate to develop research study/design Incorporate evidenced based practice Identify quality/performance issues Communicate specialty knowledge through professional publications
Prioritize patient/family learning needs Conduct formal/informal teaching Provide teaching to other health care disciplines or community agencies as requested
Clinical resource and continuity Quality assurance involvement Multidisciplinary contact to assist with patient flow/resource utilization
Formulary ACNP
• • • • • • • Approved for intravenous: Inotropes Nitrates Antiarrhythmics Vasodilators Beta blockers Antihypertensives Vasopressors
Family/Adult
• • • • • • • Approval for oral/ may not prescribe IV: Inotropes Nitrates Antiarrhythmics Vasodilators Beta blockers Antihypertensives Vasopressors
Blood Plasma Expanders Parenteral vitamins Parenteral electrolytes Systemic alkalinizers Anticoagulants IV-Aminoglycosides NSAIDS-prescription
Key elements of the acute care nurse practitioner :
•Advanced clinical expertise •Development of differential diagnoses •Use of medical diagnostic reasoning to formulate the plan of care •Order and prescription of pharmacologic and non pharmacologic therapy
Key elements of the acute care nurse practitioner :
• Planning and management of patient care across the acute care continuum • Utilization and performance of invasive and non invasive interventions and procedures to promote physiologic stability or obtain diagnostic information • Surveillance of care • Accountability and authority for patient care outcomes across settings and boundaries
Key elements of the acute care nurse practitioner:
• Evidence-and research-based clinical practice.
• Monitor, evaluate and refine care in a continuous fashion • Accountability and authority for patient outcomes across settings • Clinical leadership • Managing and negotiating health care delivery systems, • Prevention and promotion of health • Provide care for awareness of the uniqueness of the individual.
Formal Preparation
• • • • • Diagnostic reasoning Advanced pharmacology Invasive interventions In keeping with the standards of the nursing profession Introducing graduate level academic preparation for research and practice.
• Provide the highest level of care to those most in need.
• Create a mechanism for the distribution of research into clinical practice.
• Advance science and Nursing.
• Reduce cost by early intervention.
• Educate those already trained and meet today’s societal needs.
Advanced Practice Model
Potential Revenue Stream Funded Projects
Differential Diagnosis
Potential Revenue Stream Consultation
Data Collection Research Evaluation & Triage Outcome Evaluation Prescriptive Plan / Intervention
Potential Revenue Stream Clinical Mgt
Mobilization Resources
The First University Degree Program with Subspecialty in Flight Nursing
The Case Western Reserve University Frances Payne Bolton School of Nursing, in collaboration with our clinical partners:
Louis Stokes Cleveland VA Medical Center
Plan of Study
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Full-time study 48 semester hours
Synthetic Natural Environment
Headquartered at the Frances Payne Bolton School, the Flight Nurse Academy features environmental and human simulators for in-flight training.
Summer Camp
Synthetic Natural Environments
Human Simulation
Summer Camp
“Taking critical care from the bedside to the roadside”