What does the course instructor mean by integrative abilities? Provide evidence to support your response.

Week 1 discussion
Discussion Part One
Mary, a baccalaureate prepared registered nurse, has been
practicing for fifteen years. Throughout her nursing career, she worked in
pediatric, surgical, and emergency departments. She worked as a floor nurse,
charge nurse, and was recently offered a position as a nursing supervisor. A
stipulation for becoming a nursing supervisor is that Mary must attain a Master
of Health Administration degree within 2 years of accepting the position. The
offer prompted Mary to contemplate her career. She is interested in returning
to college, but she realized that she does not want to pursue working in
administration and away from patients. Mary decided to become an Advanced
Practice Nurse (APN). Mary knows that working as an APN will allow her the
opportunity to make a larger contribution to individuals, environment, health,
and nursing. She researched graduate nursing programs and discovered that there
are four roles of the APN. Mary must
choose one role and apply to a program, but she is unsure about the different
roles and their individual scopes of practice.
Discussion question:
How would you decide? Develop a pros and cons list to assist
Mary in making her decision. Include each role of the APN on the list and be
certain to provide appropriate rationales and citations.

Discussion Part Two
A clear definition for the various roles of CNM, CNP, CNS,
and CRNA has been convoluted by various state definitions that confuse the
roles and often obscure their intended meaning. Such state definitions reveal
further confusion with regard to role separation, competency, emphasis,
approach, and variation. This misunderstanding extends to nurse educators,
providers, reimbursement, and even the public. The lack of clarity regarding
initial role preparation versus current certification serves to further frustrate
accreditors, consumers, and employers alike.
Discussion question:
How does your state define the role and scope of the CNP?
Provide a correctly formatted citation for your reference resource.

Discussion Part Three
Mary expressed that she wants to work directly with
patients. She is familiar with working in a large hospital system, and prefers
to remain in her current town when she graduates. She has considerable clinical
experience in pediatric, surgical, and emergency nursing.
Discussion question:
Based on Marys experience and interests, which role would
you choose for her, and why?

Week 2 discussion
Discussion Part One
Mary, a registered nurse, decided that she wants to become a
CNP. She applied and was accepted to the Family Nurse Practitioner program at
Chamberlain College of Nursing. She
received a course curriculum which outlined the courses necessary to complete
her degree. One of the early courses in the program curriculum is NR-501
Theoretical Basis for Advanced Nursing Practice.
You are a student colleague of Marys enrolled in the same
class. On the class Q & A discussion board, Mary posted, I took nursing
theory classes fifteen years ago in my bachelors program. I dont understand
why I need to take theory classes again.
Discussion Question:
How would you respond? Develop a logical response to Marys
post. Provide evidence to support your arguments.
Discussion Part Two
Mary wrote, All nursing theories are the same and certainly
there is no connection to APN practice.
Discussion Question:
How would you respond? Develop a logical response to Marys
post. Provide evidence to support your arguments.
Discussion Part Three
The following response on the discussion board was posted by
the course instructor:
The advanced
practice roles of CNM, CNP, CNS, and CRNA require an intensive set of clinical skills,
understandings, and integrative abilities that synthesize advanced practice
nursing knowledge.
Discussion Question:
What does the course instructor mean by integrative
abilities? Provide evidence to support your response.

Week 3 discussion
Discussion Part One
You are a Family Nurse Practitioner (FNP) employed as a
contact employee in a busy primary care practice for two years. The providers
in the group include one physician, who is also the owner of the practice, and
two other nurse practitioners. The owner of the practice recently made comments
about the need to produce more revenue. You relate with his concerns and feel that
you have several strategies that could be helpful. Your contract is up for
renewal in three months. You are highly satisfied with your job and want to
stay in the group. You see 20 patients per day on average, and take call every
third weekend.
Discussion Question:
What negotiation strategies should you use to propose a
contract renewal? Use logical reasoning and provide evidence based rationales
for your decisions. Keep in mind that your negotiation terms and conditions
must be within the legal scope of practice for an ANP.
Discussion Part Two
As revenue generators, NPs must be aware of how their work
contributes to the overall revenue of the clinical practice. You see 20
patients per day on average, and take call every third weekend. According to
Buppert (2011), an NP who sees 15 patients per day at $56 per patient visit, on
average, brings in $840 per day. Allowing 1 week off for continuing education,
1 week off for illness, and 4 weeks off for vacation, this NP will bring in
$193,200 a year, potentially. However, not all bills are paid. With a 90%
collection ratea reasonable collection rate for an efficient practicethis NP
actually will bring in $173,800 per year. An NP who sees 24 patients per day
will bring in $1344 per day, or $309,120 per year in accounts receivable. With
a 90% collection rate, this NP will bring $278,208 to the practice (Buppert,
2011).
Discussion Question:
In this scenario, what are you worth to the practice? Use
logical reasoning and provide evidence based rationales for your decisions.
Keep in mind that your negotiation terms and conditions must be within the
legal scope of practice for an ANP.
Discussion Part Three
Establishing a salary can be a challenge for NPs. Deducting
40% of the NPs gross generated income for overhead expenses (rent, benefits,
continuing education, supplies, malpractice, lab expenses, and depreciation of
equipment) leaves $104,280 for the 15-patient-per-day NP and $166,925 for the
24-patient-per-day NP. Further deducting 15% of that figure to pay a physician
for consultation services leaves $88,638 in salary for the 15-patient-per-day
NP and $141,887 in salary for the 24-patient-per-day NP. Deducting 10% for
employer profit leaves $79,775 in salary for the 15-patient-per-day NP and
$127,699 for the 24-patient-per-day NP (Buppert, 2011).
Discussion Question:
What salary would you propose for the contract renewal? Use
logical reasoning and provide evidence based rationales for your decisions.
Keep in mind that your negotiation terms and conditions must be within the
legal scope of practice for an ANP.

Week 4 discussion
Discussion Part One
You are a Family Nurse Practitioner employed in a busy
primary care office. The providers in the group include one physician and three
nurse practitioners. The back office staff includes eight medical assistants
who assist with patient care as well as filing, answering calls from patients,
processing laboratory results and taking prescription renewal requests from
patients and pharmacies. Stephanie, a medical assistant, has worked in the
practice for 10 years and is very proficient at her job. She knows almost every
patient in the practice, and has an excellent rapport with all of the
providers.
Mrs. Smith was seen
today in the office for an annual physical. Her last appointment was a year ago
for the same reason. During this visit, Mrs. Smith brought an empty bottle of
Amoxicillin with her and asked if she could have a refill. You noted the
patients name on the label and the date on the bottle was one week ago. You
also noted your name printed on the label as the prescriber. The patient
admitted that she called last week concerned about her cough and spoke to
Stephanie. You do not recall having discussed this patient with Stephanie, nor
do the other providers in the practice.
Discussion Question:
What is your next logically sound course of action? Provide
evidence to support your response.
Discussion Part Two
Upon further investigation, you learn that Stephanie spoke
with the patient and called the medication into the patients pharmacy without
consulting with a provider. Stephanie claimed that the patient was insistent
about needing a prescription. Since Mrs. Smith was coming into the office the
following week for an appointment, she didnt think you would mind if the
patient received the prescription early.
Discussion Question:
What are the ethical-legal concerns associated with this
situation? Provide evidence to support your response.
Discussion Part Three
Due to the incident, you are concerned with office policies
and procedure. Upon investigation, you find there isnt a policy in place to
address non-urgent patient requests for prescriptions.
Discussion Question:
What quality improvement strategies might you implement as
an APN in this practice to safeguard your role and assure patient safety?
Provide evidence to support your response.

Week 5 discussion
Discussion Part One
You are a Family Nurse Practitioner working in an outpatient
primary care office of a large hospital system. The practice has been operating
for over 15 years, and many of the administrative and clinical staff were hired
when the practice opened. You have been in the practice for less than 3 months.
In that short amount of time, you have witnessed several of the clinical staff
have heated arguments with each other, sometimes in patient areas. Today, one
of the back office assistants didnt come to work. Unfortunately, this pattern
of behavior is not unusual in this practice. Your clinical schedule is
especially busy. Working without appropriate office staff will negatively
influence your ability to spend time with patients, impede the flow of patients
through the office, and could impact patient safety.
Discussion Question:
How should you logically respond in this situation? Provide
rationales and evidence to support your decisions.
Discussion Part Two
Leadership is not random. It is multifaceted and must be
communicated as a stated plan to effect a change. Organizational leaders
provide a vision and move others toward a common goal.
Discussion Question:
In this scenario, what evidence-based organizational
strategies and management skills might you employ to resolve co-worker
conflict? Provide evidence and rationales to support your decisions.
Discussion Part Three
According to Buppert (2011), quality improvement and patient
safety are inextricably intertwined. A work environment that supports
teamwork and respect for other people is essential to promote patient safety
and quality of care. Unprofessional
behavior is disruptive and adversely impacts patient and staff satisfaction,
the recruitment and retention of healthcare professionals, communication,
teamwork and undermines a culture of safety.
Unprofessional behavior is therefore unacceptable.
Discussion Question:
How does teamwork increase patient safety? Provide evidence
and rationales to support your decisions.

Week 6 discussion
Discussion Part One
You are attending a large continuing education conference
for primary care providers. In the audience are physicians, nurse
practitioners, and physician assistants from all over the country. Seated at
your table are physicians and nurse practitioners. Following the lecture on teamwork
and interdisciplinary collaboration, a debate ensues at your table. One
physician stated:
I am against nurse
practitioners who want to take my job. There is a huge difference in the two
professions. Primary-care physicians receive extensive and diverse medical
education and clinical experience. The nurse practitioner should not function
as an independent healthcare provider…they should only function in an
integrated practice arrangement under the direction and responsible supervision
of a practicing, licensed physician.
Discussion Question:
How would you respond to the physicians statements? Use
logical reasoning and evidence from the literature to support your response.
Discussion Part Two
A fellow NP at the table responded:
An increasing number
of practices are scrapping the traditional one-on-one doctor-patient
relationship. Instead, patients are receiving care from a group of health
professionals who divide up responsibilities that once would have largely been
handled by the doctor in charge. While the supervising physician still directly
oversees patient care, other medical professionalsnurse practitioners,
physician assistants and clinical pharmacistsare performing more functions.
These include adjusting medication dosage, ensuring that patients receive tests
and helping them to manage chronic diseases.
Discussion Question:
What are your thoughts on interprofessional collaboration?
Provide evidence to support your response.
Discussion Part Three
The Federal Trade Commission has weighed in on several state
battles over scope of practice, arguing that physician groups have no valid
reason for blocking such laws other than to thwart competition.
Discussion Question:
How does restraint of trade apply to NP practice
limitations? Provide evidence for your response.

Week 7 discussion
Discussion Part One
You have completed your nurse practitioner education, likely
one of the most challenging tasks you have ever undertaken. Several of your
graduated colleagues live in different states, including California,
Washington, and Illinois. After a year of primary care practice in your
respective states, you get together for a reunion and share your practice
perspectives. It is apparent that your experiences are not equal.
Discussion Question:
How do licensure, accreditation, certification, and
education (LACE) considerations differ for APN clinical roles for these three
states: California, Washington and Illinois? Provide evidence for your
response.
Discussion Part Two
Inconsistent regulation of APN role and scope prevent a
seamless healthcare system in which APN can practice.
Discussion Question:
What evidence-based strategies should be implemented to
achieve continuity between state regulatory boards? Provide evidence for your
response.
Discussion Part Three
Once a seamless entry into practice is achieved, it will
become more likely that independent practice will follow.
Discussion Question:
Is independent NP practice allowed in your state? Discuss
your opinion regarding independent NP practice. Provide evidence for your
response.

Week 8 discussion
Reflection on
Achievement of Outcomes
Reflect back over the past eight weeks and describe how the
achievement of the course outcomes in this course have prepared you to meet the
MSN program outcome #5, the MSN Essential IX, and the NP Core Competencies #2.
Program Outcome #5

Develop a plan for lifelong personal and professional growth
that integrates professional values regarding scholarship, service and global
engagement.
MSN Essential IX: Masters-Level Nursing Practice
Recognizes that nursing practice, at the masters level, is
broadly defined as any form of nursing intervention that influences healthcare
outcomes for individuals, populations, or systems. Masters-level nursing
graduates must have an advanced level of understanding of nursing and relevant
sciences as well as the ability to integrate this knowledge into practice.
Nursing practice interventions include both direct and indirect care
components.

Week 1 discussion Discussion Part OneMary, a baccalaureate prepared registered nurse, has been
practicing for fifteen years. Throughout her nursing career, she worked in
pediatric, surgical, and emergency departments. She worked as a floor nurse,
charge nurse, and was recently offered a position as a nursing supervisor. A
stipulation for becoming a nursing supervisor is that Mary must attain a Master
of Health Administration degree within 2 years of accepting the position. The
offer prompted Mary to contemplate her career. She is interested in returning
to college, but she realized that she does not want to pursue working in
administration and away from patients. Mary decided to become an Advanced
Practice Nurse (APN). Mary knows that working as an APN will allow her the
opportunity to make a larger contribution to individuals, environment, health,
and nursing. She researched graduate nursing programs and discovered that there
are four roles of the APN. Mary must
choose one role and apply to a program, but she is unsure about the different
roles and their individual scopes of practice.Discussion question:How would you decide? Develop a pros and cons list to assist
Mary in making her decision. Include each role of the APN on the list and be
certain to provide appropriate rationales and citations.Discussion Part TwoA clear definition for the various roles of CNM, CNP, CNS,
and CRNA has been convoluted by various state definitions that confuse the
roles and often obscure their intended meaning. Such state definitions reveal
further confusion with regard to role separation, competency, emphasis,
approach, and variation. This misunderstanding extends to nurse educators,
providers, reimbursement, and even the public. The lack of clarity regarding
initial role preparation versus current certification serves to further frustrate
accreditors, consumers, and employers alike. Discussion question:How does your state define the role and scope of the CNP?
Provide a correctly formatted citation for your reference resource.Discussion Part ThreeMary expressed that she wants to work directly with
patients. She is familiar with working in a large hospital system, and prefers
to remain in her current town when she graduates. She has considerable clinical
experience in pediatric, surgical, and emergency nursing. Discussion question: Based on Marys experience and interests, which role would
you choose for her, and why?Week 2 discussion Discussion Part OneMary, a registered nurse, decided that she wants to become a
CNP. She applied and was accepted to the Family Nurse Practitioner program at
Chamberlain College of Nursing. She
received a course curriculum which outlined the courses necessary to complete
her degree. One of the early courses in the program curriculum is NR-501
Theoretical Basis for Advanced Nursing Practice.You are a student colleague of Marys enrolled in the same
class. On the class Q & A discussion board, Mary posted, I took nursing
theory classes fifteen years ago in my bachelors program. I dont understand
why I need to take theory classes again.Discussion Question:How would you respond? Develop a logical response to Marys
post. Provide evidence to support your arguments.Discussion Part TwoMary wrote, All nursing theories are the same and certainly
there is no connection to APN practice.Discussion Question:How would you respond? Develop a logical response to Marys
post. Provide evidence to support your arguments.Discussion Part ThreeThe following response on the discussion board was posted by
the course instructor: The advanced
practice roles of CNM, CNP, CNS, and CRNA require an intensive set of clinical skills,
understandings, and integrative abilities that synthesize advanced practice
nursing knowledge.Discussion Question:What does the course instructor mean by integrative
abilities? Provide evidence to support your response. Week 3 discussion Discussion Part OneYou are a Family Nurse Practitioner (FNP) employed as a
contact employee in a busy primary care practice for two years. The providers
in the group include one physician, who is also the owner of the practice, and
two other nurse practitioners. The owner of the practice recently made comments
about the need to produce more revenue. You relate with his concerns and feel that
you have several strategies that could be helpful. Your contract is up for
renewal in three months. You are highly satisfied with your job and want to
stay in the group. You see 20 patients per day on average, and take call every
third weekend.Discussion Question:What negotiation strategies should you use to propose a
contract renewal? Use logical reasoning and provide evidence based rationales
for your decisions. Keep in mind that your negotiation terms and conditions
must be within the legal scope of practice for an ANP.Discussion Part TwoAs revenue generators, NPs must be aware of how their work
contributes to the overall revenue of the clinical practice. You see 20
patients per day on average, and take call every third weekend. According to
Buppert (2011), an NP who sees 15 patients per day at $56 per patient visit, on
average, brings in $840 per day. Allowing 1 week off for continuing education,
1 week off for illness, and 4 weeks off for vacation, this NP will bring in
$193,200 a year, potentially. However, not all bills are paid. With a 90%
collection ratea reasonable collection rate for an efficient practicethis NP
actually will bring in $173,800 per year. An NP who sees 24 patients per day
will bring in $1344 per day, or $309,120 per year in accounts receivable. With
a 90% collection rate, this NP will bring $278,208 to the practice (Buppert,
2011).Discussion Question:In this scenario, what are you worth to the practice? Use
logical reasoning and provide evidence based rationales for your decisions.
Keep in mind that your negotiation terms and conditions must be within the
legal scope of practice for an ANP.Discussion Part ThreeEstablishing a salary can be a challenge for NPs. Deducting
40% of the NPs gross generated income for overhead expenses (rent, benefits,
continuing education, supplies, malpractice, lab expenses, and depreciation of
equipment) leaves $104,280 for the 15-patient-per-day NP and $166,925 for the
24-patient-per-day NP. Further deducting 15% of that figure to pay a physician
for consultation services leaves $88,638 in salary for the 15-patient-per-day
NP and $141,887 in salary for the 24-patient-per-day NP. Deducting 10% for
employer profit leaves $79,775 in salary for the 15-patient-per-day NP and
$127,699 for the 24-patient-per-day NP (Buppert, 2011).Discussion Question:What salary would you propose for the contract renewal? Use
logical reasoning and provide evidence based rationales for your decisions.
Keep in mind that your negotiation terms and conditions must be within the
legal scope of practice for an ANP.Week 4 discussionDiscussion Part OneYou are a Family Nurse Practitioner employed in a busy
primary care office. The providers in the group include one physician and three
nurse practitioners. The back office staff includes eight medical assistants
who assist with patient care as well as filing, answering calls from patients,
processing laboratory results and taking prescription renewal requests from
patients and pharmacies. Stephanie, a medical assistant, has worked in the
practice for 10 years and is very proficient at her job. She knows almost every
patient in the practice, and has an excellent rapport with all of the
providers. Mrs. Smith was seen
today in the office for an annual physical. Her last appointment was a year ago
for the same reason. During this visit, Mrs. Smith brought an empty bottle of
Amoxicillin with her and asked if she could have a refill. You noted the
patients name on the label and the date on the bottle was one week ago. You
also noted your name printed on the label as the prescriber. The patient
admitted that she called last week concerned about her cough and spoke to
Stephanie. You do not recall having discussed this patient with Stephanie, nor
do the other providers in the practice.Discussion Question:What is your next logically sound course of action? Provide
evidence to support your response.Discussion Part TwoUpon further investigation, you learn that Stephanie spoke
with the patient and called the medication into the patients pharmacy without
consulting with a provider. Stephanie claimed that the patient was insistent
about needing a prescription. Since Mrs. Smith was coming into the office the
following week for an appointment, she didnt think you would mind if the
patient received the prescription early.Discussion Question:What are the ethical-legal concerns associated with this
situation? Provide evidence to support your response.Discussion Part ThreeDue to the incident, you are concerned with office policies
and procedure. Upon investigation, you find there isnt a policy in place to
address non-urgent patient requests for prescriptions.Discussion Question:What quality improvement strategies might you implement as
an APN in this practice to safeguard your role and assure patient safety?
Provide evidence to support your response.Week 5 discussion Discussion Part OneYou are a Family Nurse Practitioner working in an outpatient
primary care office of a large hospital system. The practice has been operating
for over 15 years, and many of the administrative and clinical staff were hired
when the practice opened. You have been in the practice for less than 3 months.
In that short amount of time, you have witnessed several of the clinical staff
have heated arguments with each other, sometimes in patient areas. Today, one
of the back office assistants didnt come to work. Unfortunately, this pattern
of behavior is not unusual in this practice. Your clinical schedule is
especially busy. Working without appropriate office staff will negatively
influence your ability to spend time with patients, impede the flow of patients
through the office, and could impact patient safety.Discussion Question:How should you logically respond in this situation? Provide
rationales and evidence to support your decisions.Discussion Part Two Leadership is not random. It is multifaceted and must be
communicated as a stated plan to effect a change. Organizational leaders
provide a vision and move others toward a common goal.Discussion Question:In this scenario, what evidence-based organizational
strategies and management skills might you employ to resolve co-worker
conflict? Provide evidence and rationales to support your decisions.Discussion Part ThreeAccording to Buppert (2011), quality improvement and patient
safety are inextricably intertwined. A work environment that supports
teamwork and respect for other people is essential to promote patient safety
and quality of care. Unprofessional
behavior is disruptive and adversely impacts patient and staff satisfaction,
the recruitment and retention of healthcare professionals, communication,
teamwork and undermines a culture of safety.
Unprofessional behavior is therefore unacceptable.Discussion Question:How does teamwork increase patient safety? Provide evidence
and rationales to support your decisions.Week 6 discussion Discussion Part OneYou are attending a large continuing education conference
for primary care providers. In the audience are physicians, nurse
practitioners, and physician assistants from all over the country. Seated at
your table are physicians and nurse practitioners. Following the lecture on teamwork
and interdisciplinary collaboration, a debate ensues at your table. One
physician stated: I am against nurse
practitioners who want to take my job. There is a huge difference in the two
professions. Primary-care physicians receive extensive and diverse medical
education and clinical experience. The nurse practitioner should not function
as an independent healthcare provider…they should only function in an
integrated practice arrangement under the direction and responsible supervision
of a practicing, licensed physician.Discussion Question:How would you respond to the physicians statements? Use
logical reasoning and evidence from the literature to support your response.Discussion Part TwoA fellow NP at the table responded: An increasing number
of practices are scrapping the traditional one-on-one doctor-patient
relationship. Instead, patients are receiving care from a group of health
professionals who divide up responsibilities that once would have largely been
handled by the doctor in charge. While the supervising physician still directly
oversees patient care, other medical professionalsnurse practitioners,
physician assistants and clinical pharmacistsare performing more functions.
These include adjusting medication dosage, ensuring that patients receive tests
and helping them to manage chronic diseases.Discussion Question:What are your thoughts on interprofessional collaboration?
Provide evidence to support your response.Discussion Part ThreeThe Federal Trade Commission has weighed in on several state
battles over scope of practice, arguing that physician groups have no valid
reason for blocking such laws other than to thwart competition.Discussion Question:How does restraint of trade apply to NP practice
limitations? Provide evidence for your response.Week 7 discussion Discussion Part OneYou have completed your nurse practitioner education, likely
one of the most challenging tasks you have ever undertaken. Several of your
graduated colleagues live in different states, including California,
Washington, and Illinois. After a year of primary care practice in your
respective states, you get together for a reunion and share your practice
perspectives. It is apparent that your experiences are not equal.Discussion Question:How do licensure, accreditation, certification, and
education (LACE) considerations differ for APN clinical roles for these three
states: California, Washington and Illinois? Provide evidence for your
response.Discussion Part TwoInconsistent regulation of APN role and scope prevent a
seamless healthcare system in which APN can practice.Discussion Question:What evidence-based strategies should be implemented to
achieve continuity between state regulatory boards? Provide evidence for your
response.Discussion Part ThreeOnce a seamless entry into practice is achieved, it will
become more likely that independent practice will follow.Discussion Question:Is independent NP practice allowed in your state? Discuss
your opinion regarding independent NP practice. Provide evidence for your
response.Week 8 discussion Reflection on
Achievement of OutcomesReflect back over the past eight weeks and describe how the
achievement of the course outcomes in this course have prepared you to meet the
MSN program outcome #5, the MSN Essential IX, and the NP Core Competencies #2.Program Outcome #5Develop a plan for lifelong personal and professional growth
that integrates professional values regarding scholarship, service and global
engagement.MSN Essential IX: Masters-Level Nursing PracticeRecognizes that nursing practice, at the masters level, is
broadly defined as any form of nursing intervention that influences healthcare
outcomes for individuals, populations, or systems. Masters-level nursing
graduates must have an advanced level of understanding of nursing and relevant
sciences as well as the ability to integrate this knowledge into practice.
Nursing practice interventions include both direct and indirect care
components.

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