Table of Contents
Permanent transformation of health care offers new possibilities for a nurse practitioner’s (NP) realization. Dynamic health care system contributes to the broadening of NP’s role in delivering patient-centered and holistic care. Particular situation determines the NPs’ awareness of the benefits, rewards, possible success and challenges, as well as the position in the health care professionals’ hierarchy. The interview with the NP enables to create the picture of the healthcare provider transforming the health care into the cost-effective and humanistic system.
The Benefits and Rewards of the Profession
The modern roles of the NP reflect the diversification of the health care services and comprehensive vision of caring thus predisposing the benefits and rewards of the profession. Being one of the most trusted ones in the U.S., this occupation contributes to the social mission and, hence, the NP’s self-acknowledgement. The interviewed NP emphasized the personal and financial benefits and rewards of the NPs career. To be specific, the issues of caring, honesty, trust, and communication refer to personal satisfaction as a result of a nursing mission to help. With this respect, Niezen and Mathijssen (2014) clarify that intrinsic rewards are caused by patient’s satisfaction with the services provided by NPs. The Affordable Care Act implementation, the Consensus Model for APRN regulation, and the IOM report reinforce the leading role of NP in eliminating the disparities in primary care. Hence, the greater diversification of clinical settings as well as the growing number of people covered by Medicare and underserved communities imply new possibilities for financial rewards and governmental grants for advanced nursing practice in new areas of exercise (Zywiak, 2013).
Success in the NP Position
The mentioned above benefits contribute to the permanent professional and personal development that induces achievements in the NP career. While evaluating success in the position of the NP, the respondent has underlined the continuous education as an essential component of enhancements. The latter can be achieved through the advanced academic education of the master and DNP level. Consequently, the broad range of professional research and practice skills as well as the communication and leadership excellence can be developed. Such high-quality preparation provides the basis for the research and practice integration so as to generate evidence-based solutions that fit the growing social diversity of patients (Niezen & Mathijssen, 2014). In addition, training programs in the clinical units and nursing organizations constitute another supportive tool for developing managerial and leadership excellence. The interviewed NP mentioned interprofessional collaboration and positive communication establishment as other accomplishments in her practice.
The NPs’ Efforts and Achievements in the Field
The advocating role in the quality of care and the NPs’ excellence has enabled them to become visible legislators and policy makers. The interviewed nurse practitioner stressed the emerging perspectives in the leadership activity available in the clinical units, nursing professional organizations, and governmental affiliations. In particular, while responding to the question regarding the achievements of past nurse practitioners, she mentioned the legislative and political initiatives. The studies by Kostas-Polston, Thanavaro, Arvidson, and Taub (2014) argue the professional obligation of a NP to become politically active while improving affordable care and the workplace conditions. These are the initiatives that resulted in the legislation of the full practice authority (FPA) in half of the U.S. states.
The Challenges in the NP Career
At the same time, the scope-of-practice limitations and increasing workplace exhaustion remain the primary challenges for exercise to the full extent of education and skills. The role of the NPs in the promotion of the care quality is still underestimated thus leading to the continuous legislative battles and insufficient integration into the field (Gutchell, Idzik, & Lazear, 2014). As for the challenges, the respondent considered legislative and financial limitations formed by unclear definitions of scope and roles to be primary barriers to efficient delivery of care. Another challenge refers to the workforce shortage in the primary care generating the additional pressure on the quality of services. In particular, the NP points the stressful and burnout environment in the clinical settings in addition to the increased attention to the errors in the advanced nursing practices. Frustration due to the stressful work conditions constitutes the organizational problem of primary importance (Pasarón, 2013).
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Consequently, a new graduate nurse practitioner will encounter the problem of the role identification by the public and providers’ communities as well as incorporation of interprofessional competencies. NPs will still have to prove the expert knowledge and advanced practice skills while integrating into the new clinical settings with traditional professional hierarchy. The respondent indicated the increasing need for family practice, where the NP will have to apply medical knowledge to assess, treat, and manage the health of all the family members. In addition, choosing the family setting, the NP will have to become an educator, an advocate, and a benefactor (Mcmullen & Philipsen, 2013). Such roles will require interprofessional preparation and the mastership in their application. The implementation and enhancement of FPA laws in the long term perspective will face the new graduates with higher responsibilities for the health care solutions in the independent practice. Furthermore, the future of effective patient-centered health care system will highly depend on the NP-physician collaboration.
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The NP-Physician Collaboration
The quality and the character of the NP-physician interaction remains the controversial issue in the health care system operation. In the majority of clinical settings, the traditional hierarchy of professional tasks still limits the application of the full range of the NP’s skills. The respondent recognized the necessity of collaboration with physician as a medical professional which basically concerns safer care due to the shared-decision making and the patient’s satisfaction. At the same time, the interviewed NP experienced difficulties in establishing equal and meaningful partnership with a physician. According to the findings by Hain and Fleck (2014), the ambiguity of primary care providers’ tasks leads to stricter payer policies. Notably, the incident-to payments appear the most common practice of reimbursements distinguishing the NP as a physician’s employee. As a result, the controversy manifests in the malpractice claims and identification of defendants. The restrictive policies also concern the prescription autonomy that, however, may lead to cost-efficiency of the services.
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Consequently, the expansion of prescription service for NPs determines further possibilities to access another critic field of care. The interviewed NP considered the reallocation of the task to be the appropriate solution for the management of chronically ill patients, especially in the home-based environments. The recent implementation of the prescriptive authority laws in 17 U.S. states contributed to the significance of advanced nursing practice flexible to the needs of socially diverse population (Ambrose & Tarlier, 2013, p.61). The respondent noticed that the new entering NPs often feel the lack of education and fear of disciplinary action for the substance-controlled drug prescription. Hence, there is a need for further training, professional support, and teamwork in the field.
The roles of NPs expand yearly reflecting the progress as well as disparities in the health care field. The diversity of services, competencies, skills, and caring attitude provide personal and financial benefits to the advanced nursing. Recent legislative and advocating efforts of the NPs’ organizations contributed to the expansion of the practice autonomy. However, the restrictive policies toward FPA continue to challenge the NP’s excellence and trigger the development of the NP-physician collaboration and the progress in the prescription procedure.