WEEK 5 and 6 CHAPTER.pptx

SSP 102 ENTREPRENEURIAL MIND WEEK 5 AN OVERVIEW OF ADVANCED PRACTICE NURSE PRACTITIONERS / CLINICAL NURSE SPECIALISTS  TOPICS A. Advanced practice nursing emerges B. Legislation C. Qualifications D. Work contracts E. Cost-effectiveness – the economics issue ...

SSP 102 ENTREPRENEURIAL MIND WEEK 5 AN OVERVIEW OF ADVANCED PRACTICE NURSE PRACTITIONERS / CLINICAL NURSE SPECIALISTS  TOPICS A. Advanced practice nursing emerges B. Legislation C. Qualifications D. Work contracts E. Cost-effectiveness – the economics issue  ENTREPRENEURIAL PRACTICE - is frequently linked to nurses with additional specialty in education as nurse practitioners (NPs), nurse midwives, clinical nurse specialists (CNSs) and nurse anesthetists, often known as advanced practice nurses (APNs).  ACCORDING TO ICN, "A nurse practitioner/advanced practice nurse” is a registered nurse who has acquired the expert knowledge base, complex decision- making skills and clinical competencies for expanded practice the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. APRNs include: - nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives - all play a pivotal role in the future of health care - APRNs are often primary care providers and are at the forefront of providing preventive care services to the public.  APRNs Practice Specialty Roles Nurse Practitioners provide primary, acute, and specialty health care across the lifespan through assessment, diagnosis, and treatment of illnesses and injuries. Certified Nurse-Midwives provide primary, gynecological, and reproductive health care. Clinical Nurse Specialists provide diagnosis, treatment, and ongoing management of patients; provide expertise and support to nurses caring for patients; help drive practice changes throughout the organization; and ensure use of best practices and evidence-based care to achieve the best possible patient outcomes. Certified Registered Nurse Anesthetists provide a full range of anesthesia and pain management services. SCOPE OF PRACTICE DEFINED IN NURSING The Nursing Scope and Standards of Practice describe: the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice. Who: Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) comprise the “who” constituency and have been educated, titled, and maintain active licensure to practice nursing. What: Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of Where: Wherever there is a patient in need of care. When: Whenever there is a need for nursing knowledge, compassion, and expertise. Why: The profession exists to achieve the most positive patient outcomes in keeping with nursing’s social contract and obligation to society. In 1914, Dr George Crile and nurse anesthetist Agatha Hodgins went to France to set up hospitals for the Allied Forces. Nurse-midwives from England travelled to the US in the 1920s, at the request of the Frontier Nursing Service. The British nurse-midwives had established an excellent record of positive patient outcomes in maternal child health. These were the first nurse-midwives in the US and, in addition to providing quality maternity services to patients in rural areas, they assisted in creating the first schools of nurse-midwifery (www.acnm.org). Although some would argue that midwives were the first clinical specialty, in much of the world the midwife did not become a nurse-midwife until more recently. In some countries today, midwifery remains a separate profession from nursing. (According to the National Sample Survey of Registered Nurses (HRSA 2008): in 2008 there were approximately 158,350 nurse practitioners, 59,242 clinical nurse specialists, 34,821 nurse anesthetists, and 18,492 nurse midwives out of a total nurse population of over 3 million. Working in clinics, nursing homes, hospitals, community centers or their own offices, nurse practitioners are qualified to handle a wide range of basic health problems. Most have a specialty, such as adult, family or pediatric health care. Clinical Nurse Specialists are experts in a specialized area of clinical practice such as mental health, gerontology, cardiac or cancer care. Besides delivering direct patient care. 54 Clinical Nurse Specialists work in consultation, research, education and  LEGISLATION In a country with a single national nurse practice act, an amendment to that act would probably be needed to authorize the practice of advanced practice nurses. There is also the subsidiary debate whether to secure that authorization in separate legislation, or as an amendment to current legislation. In the United States, it was necessary to pass legislation in each state, because each state regulates the professions practicing in that state. The essential documents from the profession serve as the foundation for legislation and regulatory policy-making that help assure the public’s safety. APRN practice is typically defined by the Nurse Practice Act and governed by the Board of Nursing, but other laws and regulations may impact practice, and other boards may play a role. For instance, in some states nurse-midwives are regulated by a Board of Midwifery or public health.  As ICN Has Recommended, The Elements Of The Country’s Specific Regulatory Mechanisms Include Such Issues As: The right to diagnose The authority to prescribe medications The authority to prescribe treatments The authority to admit patients to hospitals The right to make referrals to other providers  Legislation to confer and protect the title "Nurse Practitioner/Advanced Practice Nurse" Legislation or some other form of regulatory mechanism specific to advanced practice nurses Officially recognized titles for nurses working in advanced practice roles.  APNs in the US - have authority to prescribe medication in all 50 states, and only two states do not grant the authority to prescribe controlled substances. In several states, a variety of restrictions on controlled substances prescribing remains. - the co-signature of a collaborating physician is not required in any state on any prescription that an NP is authorized to write (www.medscape.com)  QUALIFICATIONS - Advanced practice nurses graduate from an accredited basic nursing education program and then complete post- registration or post-graduate study. - The overwhelming trend is to educate APNs at the master's level, but some shorter certificate programs exist. - Graduate level education is certainly useful in light of the increasing complexity of health care and the intricacies of patient care needs. - However, the standards of practice and training capacities in each country will help to determine the educational requirements for independent practice.  WORK CONTRACTS - APNs working within a physician practice or who practice independently within a national health system may have a contractual relationship. - APNs might be partners with physicians or function more as employees. In a partnership situation, a formal partnership agreement may be drawn up detailing profit participation, protection in the case of disability, opportunities for advancement, and conditions regarding selling all or part of the practice. - The elements of a given work contract would be similar to those required for nurse entrepreneurs.  COST-EFFECTIVENESS – THE - ECONOMICS The United States ISSUE has the longest tradition of nurse entrepreneurs in advanced practice, and 30 years of experience with the provision of high quality, cost- effective care. - Initially most of the evidence was anecdotal, and nursing's inability to show cost savings was a barrier to obtaining direct reimbursement. - The need for "proof" of equivalent, cost-effective care by APNs was necessary to be accepted by public and private reimbursement systems. - Therefore, research was conducted around quality issues, outcomes, and cost- effectiveness. An important review of advanced practice nursing by Safreit (1992) found that : - nurse practitioners are a proven response to the evolving trend toward wellness and preventive health care driven by consumer demand, federal and state regulation, and private payers. - Health promotion services increase the effectiveness of recovery and reduce the number of repeat episodes of illness. A study published in the British Medical Journal found that: - patients were more satisfied with care by a Nurse Practitioner than a physician, and no difference in health status was found. - Quality of care was in some ways better for NP consultants (Horrock, 2002). - A landmark study by Mundinger (2000) published in the Journal of the American Medical Association, indicates that NP quality of care is equal to that of physicians. The randomized trial study showed that patients in an ambulatory care setting who received care from both physicians and nurse practitioners reported the same level of satisfaction with both physicians and NPs, and had the same health outcomes. This study is unique in that it examined NP outcomes in a practice run autonomously by NPs who had the same authority, responsibility and patient population as physicians in comparable practice settings. It is evident that advanced practice nurses are providers of cost-effective quality health care. The acknowledgement of this reality, or the refusal to recognize it, may be related to the relative newness of advanced practice nursing, or to discrimination of a predominately female profession, or to disagreements over control of practice.  Nurses Involved In Clinical Practice, Administration, Education, Policy Making, And Research Can Use Principles Of Economics Provide nursingto: care in the least costly manner Protect the scope of nursing practice by demonstrating the quality and value of nursing services in relation to other professionals Develop opportunities to expand settings for nursing practice by demonstrating the cost and quality of nursing interventions Understand what purchasers and consumers want from nursing and take steps to satisfy these needs and demands  Promote health system change to expand access, improve the quality, and ensure more equitable distribution of health care resources Integrate nursing-specific quality measurement systems and concepts into larger organizational quality improvement initiatives that are largely controlled by non-nurses (Bolton, Donaldson, Rutledge, Bennett, & Brown, 2006; Buerhaus, 1992) 1. When research shows that patients are just as satisfied with care provided by a Nurse Practitioner as with an MD, one wonders why NPs are not providing the majority of primary care worldwide. 2. Nurses and nursing organizations have learned that it is not enough to ‘be right’. It is necessary to document the elements of nursing practice, the quality patient outcomes, and the cost-effectiveness of professional nursing practice As social scientists, health economists seek to answer four basic questions (Santerre & Neun, 2004): 1. What combination of nonmedical and medical goods and services should be produced in a general economy? 2. What medical goods and services should be produced in the health economy? 3. What specific health care resources should be used to produce the final medical goods and services? 4. Who should receive the medical goods and services?  VIDEOS 1. https://www.youtube.com/watch?v=OsMUAP73X48 2. https://www.youtube.com/watch?v=XBAnZgb6drw 3. https://nursekey.com/economic-issues-in-nursing-and-health-care/ 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491992/ 5. https://www.nursingworld.org/practice-policy/advocacy/state/aprn-state-law-and-regulation/ WEEK 6 THE ROLE OF NATIONAL NURSES ASSOCIATIONS  TOPICS 1. Areas for NNA action 2. Standards of education and practice 3. Legal legitimacy 4. Social credibility 5. Work conditions 6. Educating policy makers 7. Professional structures for nurse entrepreneurs 8. Addressing unmet needs 9. Other areas for action  The Role Of National Nurses Associations The social, legal, cultural and economic context of a country will be very determinative of the relevance and prevalence of nurse entrepreneurs providing nursing service. It should be remembered that a comprehensive public health system does not exclude the existence of nurse entrepreneurs. The NNA has a responsibility to protect the public and defend nurses in this crucial negotiation keeping in mind that international agreements facilitating the mobility of natural persons will increasingly play a more important role in professional regulation (UNCTAD Social credibility - surveys show that many consumers continue to regard nurses as dependent employees, usually within a hospital environment. - expectations are changing, however, and the NNA must further develop information campaigns that will project the true role of the nurse in society and reveal the many facets of the nursing profession. Nursing entrepreneurship - manifests itself in various ways and does not inevitably lead to the privatization of the health system. Recognition of this fact will assist NNAs in analyzing the relevance of nursing entrepreneurship in their health system, developing their position on nursing entrepreneurship and determining the related professional services  NNA RIGHTS AND OBLIGATIONS members who are nurse entrepreneurs; members who are nurse intrapreneurs; members who are nurses employed by nurse entrepreneurs; and consumers of health services (i.e. public good).  AREAS FOR NNA ACTION Standards of education and practice - the standards of education and practice evolve and a list of fundamental competencies. - The NNAs need to be present and actively involved in the definition process as well as the creation of a regulatory agency. Legal legitimacy - once the ability to practice is determined according to professional competencies as stated above, legislation or regulations must settle the right to practice. - The competent authorities will provide legal legitimacy to individual nurse entrepreneurs as well as the regulatory body that will monitor their professional activities legislation will be required to legitimize relations between nurse entrepreneurs and various categories of health personnel (e.g. physicians, pharmacists, physiotherapists). - The content of legislation will depend on the national/state context and the power of the diverse lobbying groups involved. Work Conditions - while the actual work environment may be said to rely primarily on the wishes and constraints of the nurse entrepreneur, payment for services rendered may depend on case-by-case negotiations with the client. - to allow nursing entrepreneurship to reach its full potential however, some system of third-party reimbursement will be required. - The NNA must ensure that fees are included for health promotion and illness/accident prevention activities so that these fundamental aspects are not neglected NNAs that run employment agencies for nurses will need to develop and implement sound labour policies, Educating Policy Makers - The NNA needs a strategy for furthering the understanding of these issues by the public and by policy makers. - Building on the experience of NNAs in countries that have integrated advanced practice and entrepreneurial nurses into their health systems, the association needs to consider a marketing plan in order to achieve their goals.  Possible NNA Strategies For Educating Policy Makers - Testimony at public hearings; - Meetings with Ministry of Health officials; - Articles in the local press about local advanced practice nurses and nurse-led businesses; - Educational meetings with community organizations; - Interviews with media about the benefits to patients and the system; - Informational sessions with citizens groups; - Meetings with physicians’ organizations to obtain support; - Guidance for legislators likely to be sympathetic; - Drafting of desired regulations or legislative language; - Position statements by the NNA can be very useful. They can address issues such as the delivery of primary care services and the role of the nurse practitioner or nurse entrepreneur; or perhaps nursing’s focus on the health  Professional structures for nurse entrepreneurs - The NNA has a responsibility to guard against personal and professional isolation by providing mechanisms to ensure ongoing contact with peers and role models. - Much of this can be web-based, and could include: - forums where ethical issues are discussed; - programmes that help maintain competency levels in acquired skills while exposing nurse entrepreneurs to advances being made in scientific knowledge, technology and skills; - educational programmes focusing on the business aspects of their work (areas not necessarily included Addressing unmet needs – The NNA could also conduct an analysis of unmet health care needs, followed by descriptions of services needed by the public. This provides the foundation for: - Assisting nurses to negotiate new roles in the healthcare system; - Legislative action to authorize advanced practice/independent practice; - Lobbying policymakers regarding nursing legislation; - Promoting research to support nursing's expanded roles; - Providing continuing education; - Collecting data regarding alternative practice arrangements. Keys to success include being prepared; sending a clear, consistent message; and making the issue visible to those in a position to create policy change (Underwood 2008). - Development of publications that cater to the communication needs of specialty groups and nurse entrepreneurs (web-based or not); - Educational programmes on innovative practice options; Seminars on intrapreneurship for specific groups of nurses; - Speakers from business organizations or business schools; - Articles in organizational publications regarding nurse innovators; - Development of guidelines for independent practice; - Compilation and distribution of directories of self-employed nurses; Establishing awards to acknowledge There are numerous examples in the Reference and Bibliography in addition to the following: The Royal College of Nursing (UK) established the RCN Practitioner Association to support nurse practitioners. The Nurses Association of Macau advocates advanced practice nursing as a mechanism to improve the health status of the people of Macau. With specialization of healthcare, the demand for nurses practicing in advanced roles with greater autonomy is increasing. The Association promotes the position that sophisticated technical and decision- making aspects of care necessitate advanced nursing degrees at post graduate level. The Korean Nurses Association has encouraged nurses’ involvement in operating children’s centers, postpartum care centers, nursing homes, mental rehabilitation centers and manpower training institutes. agencies that provide information and materials. WEEK 6 FUTURE IMPLICATIONS WHY IS ENTREPRENEURSHIP IMPORTANT IN THE FUTURE? Entrepreneurs can change the way we live and work. If successful, their revolutions may improve our standard of living In addition to creating wealth from their entrepreneurial ventures, they also create jobs and the conditions for a flourishing society  ADVANTAGES OF FUTURE NURSES 1. EntrepreneursENTREPRENEURS boost economic growth by introducing innovative technologies, products, and services. 2. Increased competition from entrepreneurs challenges existing firms to become more competitive. 3. Entrepreneurs provide new job opportunities in the short and long term. 4. Entrepreneurial activity raises the productivity of firms and economies. 5. Entrepreneurs accelerate structural change by  DISADVANTAGES OF FUTURE NURSES ENTREPRENEURS 1. Only a few people have the drive to become entrepreneurs. 2. Entrepreneurs face a substantial risk of failure, and the costs are sometimes borne by taxpayers. 3. In the medium term, entrepreneurial activities may lead to layoffs if existing firms close. 4. A high level of self-employment is not necessarily a good indicator of entrepreneurial activity. 5. Entrepreneurship cannot flourish in an over- regulated economy. - Nurses are facing a world in which global changes are affecting our industry and profession. - There are opportunities for innovation that did not previously exist. - There are opportunities for independent practice, private practice, joint ventures with physicians or other health professionals, consultancies, staffing businesses or invention of a new piece of equipment for patient care. - There are opportunities for personal and professional growth. - Nurses have the skills and expertise to deliver their services directly to the public, but many nurses have Most nurses around the world are employed by national health systems, and many are comfortable in that setting. There is nothing wrong with wanting to be an employee. Nurses should, however, not close their eyes to other opportunities. ---Nurses who choose to be employees can still support the nurses who decide to be self-employed, and vice versa. ---Nurse employees can still develop innovative practice ideas and become intrapreneurs within Nurse innovators can change the public perception of nursing. Although nurses have the respect of the public and are often rated at the top of the list in public opinion polls, most people perceive the nurse in a dependent role. Changing that public perception paves the way for changing the perception of policy makers. This new look on nurses would be positive for the entire profession and the public. The nursing profession has always been concerned with unmet needs of patient populations. Forecasting and responding to health care needs and gaps in services have been the motivating force driving the scientific advances and professionalization of nursing. The health sector environment has increasingly encouraged competition between providers which in turn has facilitated the development of entrepreneurship as well as intrapreneurship ventures. The principles that provide the framework for effective entrepreneurs and intrapreneurs are very similar and can be adapted to fit the needs of both. The focus of nursing is health promotion and disease prevention, while medical practice in general has a focus on the treatment of pathology. Nurse-owned businesses delivering wellness services can be a mechanism to educate the public about nursing's unique contributions to health care  THE NEED FOR A FUNDAMENTAL TRANSFORMATION OF THE NURSING PROFESSION During its deliberations, the committee formulated four key messages that inform structure its recommendations for transforming the nursing profession: 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. 4. Effective workforce planning and policy making require better data collection and an improved information infrastructure. 5. These key messages speak to the need to transform the nursing profession in three crucial areas—practice, education, and leadership—as well as to collect better data on the health care ENTREPRENEURSHIP PROMOTES INNOVATION IN The healthcare sector HEALTH CARE has seen tremendous advancements in the past decade. These advancements have primarily been in the area of improved diagnosis and treatment, the cost- effectiveness of the system, and the integration of information technology. With these advancements, the need for competent professionals has increased. In the words of Anne Wilson (2012), it is entrepreneurial and intrapreneurial nurses that have been able to fill up the void. As it stands, the health care sector requires intelligent nurse professionals who can think out of the box when it comes to swift treatment and diagnosis. ENTREPRENEURSHIP PROMOTES INNOVATION IN HEALTH CARE Health care facilities across the world are inclined towards handing over unique roles to entrepreneurs. This is because of the awareness of the health care system about the essentiality of employing nurses who can contribute to a wide scope of practice. ENTREPRENEURSHIP ERADICATES THE FEELING OF POWERLESSNESS In the most conventional setting, a nurse feels powerless and loses self-confidence. As a result, he/she is never able to justify his/her potential. Favorably, entrepreneurship provides a way for nurses to recognize their competence. It facilitates the germination of motivation that dominates “decreased respect”, “job security”, and other obstacles to a stress-free mind.  NURSES ARE GOOD AT COMMUNICATING Nurses comfort numerous patients from diverse backgrounds and age groups. They listen, listen and listen. The same goes for nurses of the modern-day, something that makes them ideal professionals for pursuing entrepreneurship.  NURSES HAVE EXCELLENT SELLING APTITUDE. A nurse is selling 24X7 when he/she is convincing the patient to adhere to a schedule, to take a test, to have faith, etc. This is precisely what makes nurses the entrepreneurs of the forthcoming decade.  NURSES ARE HIGHLY ADAPTABLE AND FLEXIBLE NURSES ARE true entrepreneurs, they have been flexible, dedicated, and adaptable. Nurses are 100 percent in every work — Well, a recognition that he/she can do wonders by understanding that his/her work highly resembles that of an entrepreneur. With the ever-advancing healthcare domain and more educated nurses entering this field, it is time that we comprehend our place in the healthcare society. It’s right at the top.  VIDEOS 1. https://www.nationalnursesunited.org/videos/national-nurses-united-founding  ACTIVITY I. 1. What inspire you as future nurse? Give 3 scenarios in your life that you pursue nursing? 2. How can you apply entrepreneurial mindset to your future career? 3. What is your future goal as a nurse? 4. How do you plan to achieve your career goals as a nurse? 5. Which traits would you use to be a successful nurse and how? 6. What difficulties you experiences since you started nursing? 7. What are your strength and weakness since you started nursing a. Strengths- how would you enhance it more to be a successful nurse in the future? b. Weaknesses- how would you counteract this that it wont affect you being a successful professional nurse in the future? II. Updates on Nursing Entrepreneurship in the Philippines. Write the summary of such and Cite the article and link where you found this updates.