scope, role, are you underutilized? how to evaluate np role …€¦ · review and understand the...
TRANSCRIPT
39th National Conference on Pediatric Health CareMarch 19-22, 2018
CHICAGO
Scope, Role, Are You Underutilized?
How to Evaluate NP Role vs. Scope of Practice
NAPNAP Session 317 | March 21, 2018
Disclosures Financial
No relevant financial relationships exists.
Nonfinancial
No relevant nonfinancial relationship exists.
Learning Objectives
1. Review and understand the definition of Scope of Practice
and be able to identify how to find any state practice
environment.
2. Three strategies for seeking clarification and asking
questions to understand how the role and scope of practice
is defined in any work environment.
3. Receive a framework for creating a nurse practitioner job
description that fully utilizes a nurse practitioner in a specific
practice environment.
4. Identify a process to add a new nurse practitioner role in an
inpatient or outpatient practice environment to align within
the Scope of Practice.
Workshop Contributors
Joe Don Cavender, RN, MSN, CPNP-PC
Vice President & Associate Chief Nursing Officer
Children’s Health Dallas
Stacy Krause, PA-C
Director Advanced Practice Services
Children’s Health Dallas
Shannon Fitzgerald, ARNP, MSN
Chief, Advanced Practice Services, Seattle Children's
Hospital; Nurse Practitioner, Nephrology Department
Seattle Children's Hospital
Aimee Jennings, PNP - AC/PC
Manager, Critical Care And Cardiac Surgery Advanced
Practice Providers
Seattle Children's Hospital
Meredith Lahl-Foxx, MSN,MBA, APRN, PCNS-BC,
PPCNP-BC, CPON
Executive Director/ACNO Advanced Practice Nursing
Cleveland Clinic
April Kapu, DNP, RN, ACNP- BC, FAANP
Associate Chief Nursing Officer, Advanced Practice,
Vanderbilt University Medical Center
Carmel A. McComiskey, DNP, CRNP, FAANP, FAAN
Director, Nurse Practitioners and Physician Assistants
University of Maryland Medical Center
Courtney Robinson, RN, MSN, ARNP
Director, Advanced Practice Services
All Children's Hospital Johns Hopkins Medicine
Jill Gilliland, MBA
President
Melnic Consulting Group
Scope of Practice Survey SOP
• Primary Question: Are Advanced Practice Providers
(APPs) practicing to their full SOP?
• Hypothesis: State SOP, hospital bylaws, a formal APP
leader structure, and APP reporting structure will impact
the alignment with the APP role and the SOP.
• Process: Developed questions, received IRB waiver of
consent, and administered survey.
Definition of Full SOP
Definition of Full SOP
• Provide primary and specialty care services and health
maintenance for individuals of all ages
• Diagnose, treat, evaluate and manage intensive, acute, and
chronic illness and disease
• Perform health histories and provide complete physical
examinations
• Order, perform, and interpret diagnostic studies
• Prescribe medications and other therapies
• Counsel and educate patients on health behaviors, self-care
skills, and treatment options
• Refer patients to other health professionals as needed
CLINICAL
Definition of Full SOP
Definition of Full SOP • Professional development
• Quality and safety projects
• Research
• Committees
• Education
NON-DIRECT CARE ACTIVITIES
About the Scope of Practice Survey
24 Scope of Practice Questions
Hospital APPs Surveyed: 2,211 | Response Rate 44% (974)
• University of Maryland Sent 200
• Children’s Health Dallas 359
• Seattle Children's 277
• Cleveland Clinic 1000
• Vanderbilt 375
Role
• Acute Care Adult NP, Acute Care Pediatric NP, Pediatric NP, Adult NP, Neonatal NP, Geriatric NP, and Family NP, APP Leader, CRNA, Nurse Midwife, CNS
Population
• Lifespan, Neonatal, Pediatrics, Adult, Geriatrics
Setting
• Inpatient, Outpatient, or Both
Areas of Specialty
Definition of Full SOP
Top of License Questions
• Conduct H/Ps
• Develops differential diagnosis
• Assigns a diagnosis
• Perform invasive procedures
• Orders diagnostic tests and therapies
• Interpret and evaluate tests and therapies
• Coordinates care and delegates appropriately
• Provides consultation
• Counseling to patients and families
• Initiate referral
• Manage clinical emergencies
• Rx authority
• Bills independently
• Do you have a DEA Certificate?
• Does the physician see your patient the same day you do?
CLINICAL
Definition of Full SOP• Based on hospital privileges, are the charts required to be signed by
the physician?
• Does the physician document in the medical record?
• Do both the physician and APP document in the medical record?
• Does the attending physician link to the APP note for purposes of split
or shared billing?
• Does the APP document in the medical record?
CLINICAL
NON-DIRECT CARE ACTIVITIES
• Participates in quality/safety initiatives
• Participates in organizational research
• Serves on organizational committees
• Teaches to interprofessional team
You can access the data hereLogin URL: https://www.melnic.com/top-of-license-survey-results/Username: TopOfLicensePassword: topOfLicense!@#$2018A
Top of License Questions
Take the Survey!
Text TOPOFLICENSE to 797979
We will share the results before the end of
this session.
State SOP? Not Necessarily Impactful
Barriers to Scope of PracticeState Nurse Practice Act
Hospital Bylaws –Per Department
Role
Definition
Barriers toScope of Practice
How do the Hospital Bylaws align with state SOP?
Hospital
Health System
University Med Center
State
SOP
Bylaws Align with State SOP
Vanderbilt Red The nursing bylaws primarily impact shared governance structure and
provisional status for non credentialed APRNs. The medical staff bylaws
guide the authority for clinical practice.
Children’s Health
Dallas
Red The bylaws are generally in alignment with the Texas Scope of Practice
for Nurse Practitioners in terms of delegated authority and individual
privileges. APPs are not members of the Medical/Dental staff.
Cleveland Clinic Yellow APPs practice to the most liberal state will allow.
University of Maryland Green The bylaws do affect the practice. APPs cannot admit patients to our own
name but only under an attending.
Seattle Children’s
Hospital
Green The bylaws align with State SOP. However, there are some limitations
with sedation practices (restrictions on use of propofol and ketamine). And
in subspecialty areas, there are nuanced limitations on role/activity.
RED YELLOW GREEN REDGREEN
Overall Survey Responses
RED YELLOW GREEN REDGREEN
Direct Patient Care Activities Above 90% for All Organizations
Non Clinical Activities
Activities out of SOP
RED YELLOW GREEN REDGREEN
Activities Below 90% for the Majority of OrganizationsDirect Patient Care Activities
RED YELLOW GREEN REDGREEN
Acute Care Pediatric Nurse Practitioners
RED YELLOW GREEN REDGREEN
Primary Care Pediatric Nurse Practitioners
• APP Leader: Director, Manager, Lead, Practice Administrator
• Physician
• Nursing Leader
• Collaborative Approach
• Nurse Practitioner
Who defines the role?
• What are the NP responsibilities
• What are NOT NP responsibilities
How is the role defined?
APP Role –Who decides the
operational SOP
How to move the organization to align the APP roles within SOP
• Align with organization and the needs of the APPs
• Use data to support your initiative
• Ask questions, understand your environment and the barriers to
change
• Build relationships; educate stakeholders; focus on building teams
• Advanced Practice Counsel: A tool for communication and change
• If you are in an environment that does not have APP Leaders, work
with administrative leaders, nursing and physician leaders
What impact do APP Leadership and Structure have on the role?
APP Leadership Structure and Opportunities
• Set up structure with APP Chief/Director
• APP Seat at the med exec table to lead the
organization partnering with physicians and nursing
• Formal reporting of leads and Managers
• Clear job descriptions
• Empowerment of managers to physician and
nursing leaders to build partnerships and support
the role within the SOP
What impact do APP Leadership and Structure have on the role?
• Physician and Nursing education and collaboration
regarding APP roles
• Ensure compliance, optimize productivity, set up processes
to develop the APP role
• APP development of formal job descriptions and
competencies to define the APP roles
• Align APP role with clear, measurable metrics
How Does APP Leadership Impact Engagement?
What does the NP want at the individual level?
• To Be Valued
• To Be Respected
• To Work to Top of License
• To Be Able to Have an Impact: Patient outcomes, projects,
research, community programs, professional development
How does the APP Leader Impact Creation and Implementation of New Roles that align with SOP
Identify key elements of change
• New teams, new role
• Same team, new role
Potential unfamiliarity with the role and
capabilities of an APP
Who are the key stakeholders?
How do you work collaboratively with key stakeholders?
What are the potential barriers,
assumptions, challenges?
What can you do about these barriers?
How to establish the value and trust of an APP in a new role?
6 Key Points to include in a Roadmap and Business Plan
SURVEY RESULTS
Panel Q&A
We hope you to seek clarify and ask questions until you fully understand what Full Practice Authority means for you and your practice.
• American Association of Nurse Practitioners. Issues at a Glance: Full Practice Authority. https://www.aanp.org/images/documents/policy-toolbox/fullpracticeauthority.pdf. Updated August 6, 2015. Accessed April 22, 2016.
• American Association of Nurse Practitioners website. State Practice Environment: States Categorized by Type. https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment/66-legislation-regulation/state-practice-environment/1380-state-practice-by-type. Accessed April 22, 2016.
• Institute of Medicine. The Future of Nursing: Focus on Scope of Practice. https://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Scope%20of%20Practice%202010%20Brief.pdf. Updated October 2010. Accessed April 22, 2016.
• Rand Corporation. The Impact of Full Practice Authority for Nurse Practitioners and Other Advanced Practice Registered Nurses in Ohio. http://www.rand.org/pubs/research_reports/RR848.html. Accessed April 22, 2016.
• American Nurses Association. Determining Scope of Practice for Advanced Practice Registered Nurses (APRNs). http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses/Scope-of-Practice-2/Scope-of-Practice. Accessed April 22, 2016