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Global healthcare stands poised for a period of change. However this change should come with positive impacts and outcomes to the people of the world rather than negative and harmful impacts. There have been several conversations among global leaders in regards to healthcare. So many organizations, leaders and even religious societies have come together in the recent years to make sure that human beings` mortality rate has increased significantly. Therefore, the main focus of all individuals is to expand the access to free primary health care services. If this is put in place, there will be improved health outcomes. At the same time, there will be continuous practice of preservation of resources. To make these dreams come true, there have been continuous emphases on the construction of several medical homes and the employment of nursing practitioners and other medical physicians in these medical homes. Though they have been there in the previous years, only a few people have come to understand the full meaning and role of medical homes. Medical homes are healthcare centers that offer regular, continuous primary and preventive care for the people that visit the place and are served by the people employed there to give assistance” (Hawkins & Groves, 2011)
Admittedly, the most renowned people that are seen to carry out most of the assistance operations given to patients in the medical homes are nurse practitioners (NPs). In other countries such as in the USA, nurse practitioners are also known as Advanced Practice Nurses (APNs) or Advanced Practice Registered Nurses (APRNs). In a detailed account, NPs are nurse that are registered under or by a common union, prepared and given a kind of advanced education and clinical training so as to apply this knowledge and skill in order to give preventive and health care services to all individuals despite the age, gender or race. As a matter of fact, healthcare units are some of areas where assistance is offered to all individuals without any form of discrimination.
Since the increase in the demand for primary healthcare, most of the nursing practitioners globally have been involved in the training and practice in primary care. NPs are given special training so as to have the ability, knowledge and expertise in order to provide care to patients from inception to death. NPs are also given special training that emphasizes on health maintenance, good rapport and good partnerships with clients who most of the times are patients. Just like other professional jobs like those of lawyers, teachers and doctors among others, in order to be allowed to perform their duties, NPs must acquire licenses from the state or local authorities depending on the system of government in a particular country. The acquired licenses will thus propagate their duties of assessing, diagnosing and treating patients in medical homes. However, in their line of duty, nursing practitioners face several challenges that prevent them from achieving their goals. Since the health sector is very critical and delicate, any interference with the NPs rights could lead to severe cases such as deaths of patients in health institutions. One of the challenges that nursing practitioners face are variant legislations that are usually from state to state or from country to country. In addition, NPs often face disparities in reimbursements. (Naylor & Kurtzman, 2010). To help come up with solutions to the above challenges, nurse practitioners should be involved participate in the conversations on health care reforms. This will help them to establish strong positions in the control of the global health sector.
To that end, this paper offers an argument concerning the role of nurse practitioners. Therefore, this paper will provide a detailed discussion of the complexities that the nurse practitioners face while on duty. It will also be realized that the roles of nurse practitioners should carefully be implemented in medical homes if at all good outcomes are to be achieved. Thus, this paper will also look at the methods of implementing the roles of nurse practitioners in medical institutions. Besides, the implementation process of the roles of nursing practitioners in medical institutions is often accompanied by several barriers of which will be discussed in this paper. Apart from the incorporation of the faith and knowledge theory of nursing, this paper will also focus on how the role of nursing practitioners has improved the patient care and the effect of the current care environment on the same role of NPs.
Complexities of the role of nurse practitioners
The role of nurse practitioners has faced and still continues to face several complexities or rather challenges. These complexities if not addressed might cause severe negative impacts on the healthcare sector. One of the complexities that the role of nurse practitioners faces is the rise in patient demand for healthcare services. The increase in healthcare demand by patients is one question that has not been answered for a long time. In fact, health care providers, policymakers, and payers have really had a difficult time in coping with the ever increasing patient demand for healthcare services (Hawkins & Groves, 2011).
The other complexity that is faced in the health sector in their struggles to stabilize the roles of the nurse practitioners is the shortage of primary care doctors and nursing practitioners who can treat newly insured persons. As said earlier on, there is an increase in the number of patients. However, the struggle to counteract this is becoming futile as the number of doctors and NPs decrease day in day out. Considering the global population growth and more aging patients who require treatment, the probability of finding enough practitioners to attend to the patients will be very minimal, in fact, it may become an even more daunting challenge.
The other complexity of the role of nurse practitioners is the poor choice and plan for careers (Bodenheimer & Pham, 2010). This has resulted in the education sector especially the higher education institutions producing nurses and physicians who are not well qualified for the job. The impact that this has on the health sector is very big and it could result to fatal accident and increased instead of decreased cases of diseases. According to previous researches that have been done, approximately twenty five percent of medical-school graduates plan careers as primary care physicians. Besides, the researches indicate that state scope-of-practice laws place have placed limits on the clinical boundaries of advanced-practice registered nurses (APRNs), many of whom are often involved in the provision of primary healthcare services to patients in various medical or healthcare institutions.
Another complexity of the role of nurse practitioners is that the nurse practitioners are often forced to manage patients of all types, some with even more complex cases. Despite the big number of patients their salaries are controlled by the employer. Nursing Practitioners spend their time with patients and at the same time, they focus on chronic disease management, promotion of health and management of self-care of the patients (Bodenheimer & Pham, 2010).
As proven by other researchers, nursing practitioners are the most occupied employees in the global job market. It is acknowledged that NPs spend more time with patients attending to them, cleaning them and offering any physical assistance to them. However, nursing practitioners are believed to spend more time with the patients than the physicians and this is a great challenge to the nursing fraternity. As a matter of fact, in terms of the primary health care aspect, nursing practitioners perform the health related duties even well than the doctors and other employees in the healthcare settings. The nursing practitioners also spend so much of their time engaging in free services such as provision of guidance and counseling to the patients. Although guidance and counseling is a free-of-charge service, the NPs usually face a lot of challenges and complexities while trying to get information from the patient. As compared to the physicians and the challenges they go through, physicians usually do not take so much of their time to attend to the patients. Instead, they take a few minutes. It sometimes takes a few visits to attend to all the ailing patients hence this is not as great a challenge to the doctors as compared to the physicians.
In all settings, NPs expected that they would have a physical space in which to practice and do everything so as to improve their skills, knowledge and expertise however, this has become a complexity in the role of the nursing practitioners as they have very minimal space I which they are allowed to do all that pertains to the development of their nursing skills. Therefore, in order to help solve this complexity, struggles and measures should be put in place so as to take care of the nurses` need for physical space which is often very rare in most institutions.
Methods of implementation
Implementation is a term that can differ from one setting to another. For example, the implementation of the role of nursing practitioners cannot be the same across all medical institutions. Therefore, in this study of the role of nursing practitioners, implementation can be a simple term defined as the process that is used by the health care authorities in order o bring into board healthcare officials such as nursing practitioners and physicians in medical homes. It is known that the employment or rather recruitment of employees in the healthcare sector is very sensitive and complex. Besides, the employment of new employees in the health sector such as the nursing practitioners is influenced by various factors. When employing nursing practitioners in any kind of health care setting, there are certain outcomes that are often looked at in the long run. Of course, good personal skills and good relations with patients is the main issue that is put on the fore front during recruitment of nurses. The implementation of the role of the nursing practitioners in various healthcare systems must involve or rather engage the healthcare system. This is accredited to various reasons for example, the implementation of the role of NPs might not occur well when the system is isolated. Besides, there are some environmental issues that without doubt must influence the implementation process of the role of nursing practitioners in a healthcare setting. Therefore, the involvement of the healthcare system in the implementation process of the role of the nursing practitioners is very important (Hawkins & Groves, 2011).
There are several methods through which the implementation of the roles of nursing practitioners is done in healthcare settings. As a matter of fact, it will be worth noting that the factors that facilitate the implementation process could become barriers in the long run as will be discussed later on. This due to the fact that the facilitating factors at times are not addressed satisfactorily. Admittedly, the facilitating factors may influence role implementation and the long-term sustainability of the role of nursing practitioners in various healthcare settings. It will be very important to understand the implementation process and the methods of implementation.
During the implementation of the role of nursing practitioners in various medical homes, there are various methods that are involved. The various methods if employed during the implementation process will influence the process in one way or the other. There are three methods: intention, involvement and acceptance. To begin with, the intention method can be defined in a detailed manner as it focuses on the role of the nursing practitioners and the expectations or goals of employing them in a particular health setting. Just like in other settings, in order to achieve any goal, the individual that is recruiting employees must have a good intention so as to enhance positive outcomes (Hawkins & Groves, 2011).
The other method that is involved in the implementation of the role of nursing practitioners in various health care institutions is known as the involvement method. In a detailed explanation, involvement is a popular term that is usually used to refer to the active participation of the members of a particular team and their influence in the determination of the roles or functions of the nursing practitioners. Involvement method is very helpful in healthcare settings because, once all nursing practitioners are involved in the development of the particular health sector they are in, the running of the activities and operations in that healthcare institution will not be a major challenge.
The other method that is involved in the implementation of the roles of nursing practitioners in various health care settings is the acceptance method. In a detailed explanation of the meaning of acceptance, it is a term that relates to the recognition of the members of a particular team and their willingness to work with the nursing practitioners. Acceptance is very influential in the role of nursing practitioners as it is one of the motivating factors that encourages the NPs to embrace hard work in their daily operations. Acceptance will also mean that the patients and the nursing practitioners are in good relationships thus there will be no complications when implementing the roles of the NPs in any health institution.
Barriers of the implementation of the role of Nursing Practitioners in healthcare settings
Several researchers have tried to identify the barriers that accompany the implementation of the role of nursing practitioners in healthcare settings. The barriers that were identified by some researchers include restrictive legislation and regulation of the role, lack of role descriptions and understanding of the role, conflicting expectations, inadequate administrative and physician support and in-sufficient long-term human resource planning. In addition, there is the barrier of poor understanding of how the NP role interfaces with other members of the health team. To start with, there are regulations and legislations that, depending on the government or authorities in a particular country cannot allow certain operations to take place in health care institutions. For example, there are laws that do not allow nursing practitioners to attend to patients without the physical presence of a qualified physician. In addition, there are laws that control the payment of the salaries of the nursing practitioners. Although the legislations and restrictions affect the nursing fraternity either positively or negatively, they are barriers to the implementation of the free roles of nursing practitioners in health care institutions (Bodenheimer & Pham, 2010).
Lack of role descriptions and clear understanding of the roles is another barrier that greatly affects the implementation of the role of nursing practitioners. This problem is often brought about by the recruitment or rather employment of unqualified nurses who do not understand their roles. This problem often poses a great risk to the lives of the patients. As a matter of fact, when such NPs attend to patients in the absence of a physician, it is most likely that the patient will face some mess-ups (Bodenheimer & Pham, 2010).
The other barrier to the implementation of the role of nursing practitioners in health care institutions is the conflicting expectations. Most of the time, the employers of the nurses expect them to work tirelessly despite the poor payments. Besides, there are often conflicting expectations that are experienced between the physicians and the nursing practitioners. These conflicting expectations have adverse effects on the implementation of the roles of nursing practitioners in any particular healthcare setting (Bodenheimer & Pham, 2010).
The other barrier to the implementation of the role of nursing practitioners is inadequate administrative and physician support. Proper and effective administration is an essential factor that determines the success of a particular institution. In this case, poor administration of healthcare institutions whereby funds are misappropriated is a major setback to the implementation of the roles of nursing practitioners. The poor relationships between the physicians and nursing practitioners also result in withdrawal of physician support and this is a major setback in the implementation of the roles of nursing practitioners in any healthcare institution.
The other barrier faced in the implementation of the role of nursing practitioners is in-sufficient long-term human resource planning. Planning is an important aspect that often determines the success of a particular operation. In several healthcare institutions, there is insufficient long-term human resource planning and this causes a great challenge in the struggle to effectively implement the roles of nursing practitioners in healthcare settings.
Although there are several barriers to implementation of the roles of nursing practitioners as identified above, there are also factors that facilitate the roles of nursing practitioners in healthcare settings. Just to mention but a few, the facilitating factors include the provision of manager and physician support and knowledge of the Nursing Practitioner role, the NP`s prior work experience and level of education, trust and acceptance by team members, and patient satisfaction with the NP. Without doubt, managers and administrators in healthcare settings can facilitate implementation of the role of nursing practitioners by helping team members to understand the reason for adding the role, by supporting them as they experience the stresses of change that occur with the addition of the new role, and by helping to incorporate the NP into the team in the healthcare setting.
How the role of Nursing Practitioners Improves Patient Care
Nurse practitioners are often involved in the day to day operations that help improve the patient safety and the health of the patients. The nursing practitioners often perform their roles in various settings such as Community clinics, health centers, Health maintenance organizations (HMOS), Home health care agencies, hospitals, hospital clinics, hospice cares, physician offices, nursing homes, private and public schools, universities and colleges, Retail-based clinics, Bedside nursing in hospitals and Walk-in clinics.
A nurse practitioner performs various roles in the above listed health institutions. To begin with, a nurse practitioner provides medical diagnose to patients. However, it should be noted that the medical diagnoses provided to the patients is instructed by physicians. The other role performed by NPs is that they provide treatment to the patients once instructed by physicians. The provision of treatment to the patients is very influential in improving the patient care in hospitals. The provision of treatment is very critical and should be done with care lest fatal accidents are caused (Bernstein et al, 2010).
Additionally, a nurse practitioner plays the role of obtaining medical histories and physically examines the patients. This is a common role of the nursing practitioners usually witnessed in various healthcare institutions. The conduction of physical examinations of patients is a very essential role of the nursing practitioners as it helps to enhance the safety of the patients in the healthcare institutions (Bernstein et al, 2010).
The other role that is played by nursing practitioners is the ordering and performing of diagnostic studies in the medical laboratories. The diagnostic studies include x-ray operations and several other kinds of check-ups such as EKGs. These operations are very essential as they help improve or rather enhance the health quality and safety of patients in the health institutions. The other role played by nursing practitioners in healthcare settings is doing a requisition of physical therapy, occupational therapy and other forms of rehabilitation treatments. Although these operations are done with the help of physicians, they are very influential in the improvement of patient care in healthcare institutions.
The other roles performed by Nursing Practitioners include prescription of drugs for acute and chronic illness, provision of prenatal care and family planning services, provision of well-child care that involves screening and immunizations, provision of primary and specialty care services and also health-maintenance care for adults which include regular physicals. NPs also take part in the provision of care for patients in acute and critical care settings, provision of assistance in minor surgeries and procedures, provision of guidance and counseling to patients on health behaviors, treatment options and self-care skills in agreement with occupational therapists and other individuals involved in the provision of healthcare to the patients. Therefore, with the above listed roles of the nursing practitioners, it is without doubt that they play a big role in the improvement and enhancement of the health and safety of patients (Bernstein et al, 2010).
The effect of the current healthcare environment on the role of nursing practitioners
The current healthcare environment has faced a lot of revolutions and changes and this has impacted both positively and negatively on the roles that are played by nursing practitioners in the various healthcare settings. To start with, the current healthcare setting faces a huge number of patient cases who report to various health institutions to obtain treatment. The increasing number of patients in global healthcare institutions has impacted both positively and negatively on the role of the nursing practitioners. On the positive side, the increasing number of patients has prompted the employment of more nurses so as to counteract the increasing number of patients. Employment of more NPs has lessened the work for the NPs as the workload is distributed among the employed NPs. However, on the negative side, the increase in the number of patients in health institutions has drastically increased the backlog for the NPs making it difficult for them to deal with all the situations at hand (Friedberg et al, 2010).
In addition, the current healthcare environment has seen the introduction of technology. For example, in many health institutions, there is the use of computers, X-ray machines and robotic technology (Friedberg et al, 2010). The introduction of technology has had both positive and negative impacts on the role of NPs in healthcare institutions. To start with, the introduction of technological advances such as robots has aided in medical operations such as surgical operations. Computers and x-ray machines have been used to perform duties that could not be performed in the early days. In essence, the introduction of technology has pushed the health sector to higher levels. However, technology has also come with negative impacts to the roles of nursing practitioners. Without doubt, the use of computers and robotic technology in healthcare settings has led to great unemployment. Therefore, the medical degrees obtained in the global higher education centers have gone to waste as a result of the introduction of technology in the medical world.
To recap it all, the global healthcare settings have done several things that have helped to improve the health of human beings. The evident fact is the thorough training that is given to the nursing practitioners in the health care institutions. It is worth noting that NPs are very important individuals in the health sector and good treatment and consideration should be given to them so as to achieve the global vision of a decrease in the mortality rate. Health is an important aspect among human beings and it needs to be reexamined.
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