Proposal for Rural Advanced Practice Nurse



Proposal for Rural Advanced Practice Nurse

Jill Collins, RN BSN

Washburn University

NU 510 Professional Role Development

Dr. Ellen Carson

June 29th, 2010

Abstract

Many smaller communities are really struggling to provide primary care to their residents. Jackson County is one community that has been deemed an area of shortage for primary care providers. Utilization of nurse practitioners to fill these shortages is becoming increasingly more effective. This paper is a proposal for the addition of a nurse practitioner position to the staff of a primary health clinic within the county.

Proposal for Rural Advanced Practice Nurse

Introduction

Our healthcare system, as we know it today, will see many changes in the future with the recent implementation of national healthcare reform. Now, more than ever, our communities will see an increased need for primary health care providers. Many communities will have this need met by nurse practitioners as the number of primary care physicians decreases and the need for primary providers increases.

People often want to know if a nurse practitioner can meet the healthcare needs of the public on the same level as that of a physician. Research has shown that patients derive more satisfaction from encounters with nurse practitioners than with physicians and there are virtually no significant differences between nurse practitioners and physicians in prescriptive practices. Patient outcomes for nurse practitioners are as good as, and sometimes better than, those for physicians (Horrocks, Anderson, & Salisbury, 2002). According to the American Academy of Nurse Practitioners (AANP), more people are choosing nurse practitioners because “they provide individualized care, focusing on not only problems, but also on the effects health problems have on people and their families; they explain the details of health problems, medications and other topics to help people fully understand how to take care of themselves; and they ask about people’s worries and concerns about their health and their health care” (Flanagan, 1998).

With the above in mind, my proposal is to approach a rural health clinic, in Jackson County Kansas, which currently serves the Native American population and propose the addition of myself to continue to provide care to this population as well as opening up services to the non-Native American population.

Personal Mission Statement

One of the most important elements in selling yourself or business is a mission statement. A mission statement describes the essence of the person or organization and is central to the purpose, goals and work of the person or business (Nagelkerk, 2006, p.118). It is my mission to make a difference in the lives of others by utilizing my knowledge of and experience in evidence based advanced nursing practice.

Product/Service to be Offered

In the case of nurse practitioners (NP), the product or service is generally the nurse practitioner themselves. However, the individualization depends on the specific area of practice. NPs provide a full range of primary and acute health needs/services with a holistic patient and family focus (Stanley, 2005, p.236-237).

As a nurse practitioner in this clinic, I would provide many services for the community. I would provide general health care in regard to health maintenance and acute illnesses for all age ranges. The services I would provide would include, but not be limited to: well-child check-ups, routine history and physicals, school and sports physicals, visits for acute illnesses, suturing, gynecological exams, prenatal care, family planning, ordering and interpreting x-rays and laboratory tests, nursing home visits, on-call coverage and some dermatological procedures. I would also propose my sponsoring physician in this clinic and I seek admitting privileges to the local community hospital for continuity of care and to support the local facility. If this were to occur, I would also help with emergency room coverage at that facility.

I am very interested in holistic care and integrative healing. These would be elements incorporated in my practice and would also be a selling point to potential clients. Holistic care puts emphasis on the whole person, individualized care, and a partnership that empowers the client and is based on mutuality and presence in order to promote self-healing and growth (Leddy, 2006, p.27). The Native American culture has a strong spiritual component to healing (Yurkovich & Lattergrass, 2008) and I believe utilizing holistic care will benefit not only the Native American population but will benefit other members of the community as well.

Lastly, I would provide extensive education to my clients in regard to overall health and wellness as well as disease management. I would also provide and/or coordinate continuing education for staff to keep all employees up to date on the best evidenced based practices.

Role Description

As a nurse practitioner, my primary role would be as a clinician. It is important that providers of healthcare stay informed of the most recent evidence based practices and utilize these practices to care for their clients. According to the Institute of Medicine’s (IOM) 2001 publication Crossing the Quality Chasm, the healthcare delivery system is in need of fundamental change and healthcare today harms too frequently and fails to deliver its potential benefits (IOM, 2001). As a clinician, I would be continually educating myself to stay up on the evidence based best practices.

The IOM has established six aims for the 21st century healthcare delivery system which include providing care that is safe, effective, patient-centered, timely, efficient and equitable (IOM, 2001). It will be the responsibility of me, and every other provider, to ensure these aims are met with every client encountered. I know that I will encounter many different clients with many different needs on a daily basis and it will be my job as a clinician to decipher exactly what the client needs consist of and ensure all those needs are met, all bases are covered and in the end, every client has received the highest quality care.

A second role I will fulfill as an advanced practice nurse is that of an educator. I think the correct guidance and proper education on acute illnesses, chronic conditions and general health and wellness would lead to fewer emergency room visits, hospital stays and clinic visits and improve the overall health of clients as well as the overall “health” of the healthcare system itself. Another important education point for clients is how to navigate the healthcare system. Clients may be well educated on how they can manage their health conditions, but without knowing how to access the things they need as well, just knowing what to do doesn’t always solve the problem.

There are two other educational opportunities as an advanced practice nurse which I would need to fulfill. The first is education of staff working under the supervision of myself. As a practitioner, I may know best practices but unless my staff members are practicing in the same manner with the same knowledge and expectations, the best outcomes cannot be achieved. I also consider it my responsibility to provide public education as often as possible. Again, if we can start in inform and educate about health problems and concerns before they become problems, it could eliminate many of the burdens on the healthcare system.

Lastly, a large part of my job as a nurse practitioner will be collaboration. Collaboration involves a commitment to caring for clients which goes beyond a single approach to care and represents a synergistic alliance that maximizes the contributions of each participant (Hamric, Spross, & Hanson, 2009, p.287). I will be collaborating with my sponsoring physician as well as other members of the organization and many outside organizations and providers in order to provide high-quality care for clients. Not only will I be collaborating with other providers but will be spending a majority of my time collaborating with clients to establish and implement a plan of care which will meet all of their needs holistically. Effective collaboration results in more comprehensive, patient-focused care (Bodenheimer & Wagner, 2007)

Customer Base/Documented Need for Service

According to the Rural Policy Research Institute in 2007, Jackson County Kansas was designated as a Health Professional Shortage Area for primary care. Lack of primary care tends to put a burden on the healthcare system because it often leaves people seeking primary care down inappropriate avenues such as the already overcrowded emergency departments. Seeking primary care in the emergency department is not only more expensive but begins a vicious cycle. The acute illness that brought the person to the emergency department is treated, but again there is no follow-up and patients often wait until they are very sick to return. This often results in hospitalization and increases the amount of money needed to cover the illness. Many of these episodes could be effectively managed in a primary care office which would ease the monetary burden on the patient and the healthcare system not to mention the amount of time and frustration that often results from visits to the emergency department.

Recent demographic information for Jackson County shows the population to be 13,240. Of this population, nine percent are Native American (KS Kids Count, 2008). A majority of this population is managed by one full-time and two part-time physicians and one part-time nurse practitioner. There certainly seems to be an apparent need for another full-time practitioner. The Native American population would be my primary customer base until I am able to build a client base outside of the Native American population. The closest primary care offices for this population would be about fifteen to thirty minutes away depending on where a person seeks care. Though this doesn’t seem far, in can be quite inconvenient for the elderly and others who have restricted access to transportation.

Conclusion

Primary health providers are in shortage in many areas and nurse practitioners are a great resource for filling the gaps in shortages. I think that my skills as an advanced practice nurse could be greatly utilized in my community. This is why I am making this proposal of adding an advanced practice nurse into an existing primary care system.

References

Institute of Medicine (IOM), Committee on Quality Health Care in America. (2001). Crossing

the quality chasm: A new health system for the 21st century. Washington, D. C.:

Academies Press.

Bodenheimer, T., & Wagner, E. H. (2007). Understanding health policy: A clinical approach.

New York, N Y: Lange/McGraw/Hill.

Flanagan, L. (1998, October). American Academy of Family Physicians. Retrieved June 28th,

2010, from

Hamric, A. B., Spross, J. A., & Hanson, C. M. (2009). Advanced Pratice Nursing: An Integrative

Approach. St. Louis, MO: Saunders Elsevier.

Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic Review of whether nurse

practitioners working in primary care can provide equivilant care to doctors. British

Medical Journal , 819-824.

KS Kids Count. (2008). Retrieved February 14th, 2010, from KS Kids Count web site:



Leddy, S. K. (2006). Integrative Health Promotion: Conceptual Bases for Nursing Practice.

Sudbury, MA: Jones and Bartlett Publishers.

Nagelkerk, J. (2006). Starting Your Practice: A Survival Guide for Nurse Practitioners. St.

Louis, Missouri: Mosby Elsevier.

Stanley, J. M. (2005). Advanced Practice Nursing: Emphasizing Common Roles. Philadelphia,

PA: F. A. Davis Company.

Yurkovich, E. E., & Lattergrass, I. (2008). Defining health and unhealthiness: Perceptions held

by Native American Indians with persistent mental illness. Mental Health, Religion &

Culture , 437-459.

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