Scope of practice and regulations Flashcards
Nurse Practitioner core competencies
Scientific Foundations Leadership Quality Practice Inquiry Technology and Information Literacy Policy Health Delivery System Ethics Independent Practice
The nurse practitioner advanced practice specialized competencies
The specialty competencies are designed for entry level psych NPs.
They are meant to be used along side the NP core competencies.
The specialty competencies address people all across the lifespan, families, and populations.
As changes occur in the world, the competencies will change too
Leadership competencies
Participates in community and population-focused programs. These programs promote mental health and reduce risk.
Advocates for people’s rights
Works interprofessionally to advocate, reduce disparities, and improve outcomes for populations.
Quality competencies
Evaluates if restraints and seclusions are used appropriately
Policy competencies
Influences policies so that stigma is reduced
Independent practice competencies
There are too many to list.
It’s any competency that you need in your own practice, like, “ safely prescribes medication, teaches clients,” etc.
Things that are helping the NP role to grow
Consumer demand for services
Acceptance of NPs
Decreasing stigma
Emergence of the NP role
Emphasis on integrated care
Things that are preventing the NP role from growing
Competition in the job market
Problems getting reimbursed by Medicare and other insurance companies
Overlapping scope of practice with other NPs
Concern about fraud and abuse (issues with coding and billing)
Scope of practice and needing to be supervised by a physician
Nurse Practice act for each state:
Provides title protection (who can be called an “NP”)
Defines what advanced practice is
Defines the scope of practice (what the NP is allowed to do)
Places restrictions on what you can’t do and decides on disciplinary actions
Sets the NP credentialing requirements
Things that you could do to get a disciplinary action
Practicing without a license, falsifying records, medicare fraud, not using good judgement, not following the standards, not completing the documentation
Statutory law
It differs between states
Sometimes the statutory law further defines scope of practice and practice requirements
It also might provide restrictions for practice
Licensure means that you are allowed to practice, and also that
others without a license are NOT allowed to practice
Credentialing
Process used to protect the public by ensuring a minimum level of competence
Certification
It does a lot of the same things that we’ve already talked about:
Certification is a credential that provides title protection.
Determines scope of practice
It says that you are not only licensed, but you also meet further criteria.
Assures the public the you know what you’re doing
The ANCC
It’s the only certifying body. It’s a subsidiary of the ANA
Scope of practice
Defines the NP role
Identifies the competencies that all NPs in a specific role should have
Varies between states
Standards of practice
It says what is the standards of quality
Can be used in legal situations
It can include very specific protocols or very general things
Confidentiality
It is protected under the Medical Record Confidentiality Act (not HIPAA)
Providers have to get written permission to release info.
HIPAA includes 4 patient rights:
To be educated about HIPAA
To have access to their own records
To request that their record is amended if they want to
To require permission to disclose their information
Health Information Technology for Economic and Clinical Health Act (HITECH)
Incentive payments for sharing specific information from EMRs
Incentives for meaningful use (meaningful use is using EHRs in a way that is meaningful because it benefits patients and providers)
An example of how EHR can be beneficial is
Using physician order sets
Telehealth
Must include provisions for what you’ll do if the patient has an emergency
Exceptions to confidentiality
Information given to attorneys/courts
Meeting state requirements for mandatory reporting of diseases
Tarasoff Principle (warning a vicim who is in danger from the patient)
In cases of child or elder abuse
Who has the right to informed consent
Adults and emancipated minors
Informed consent includes
discomforts of the treatment
alternative treatment
diagnosis and prognosis
Risks/benefits of NOT doing the treatment
Justice
what is fair
Beneficence
doing good
nonmaleficence
do no harrm
Fidelity
Being true and loyal
the Code of Ethics for nurses has 9 provisions:
- Practice with compassion/respect for the dignity that all people have
- Your primary commitment is to the patient
- Promotes, advocates, and protects the patient
- You have the authority and responsibility to make decisions and promote health
- You have a duty to care for yourself just like you care for the patients, and also to continue your education
- Make your work place ethical and safe
- Contribute to the profession through research and policy
- Maintain social justice
Ethics
Deontological theory
Judging the action by itself, it doesn’t matter what the outcome is
Ethics
Teleological theory
An action is judged based on it’s consequences (ends justify the means)
Ethics
Virtue Ethics
Choosing the action based on moral virtues, or the character of the person
Americans with Disabilities Act
Companies with at least 15 employees can’t discriminate against people with disabilities
Malpractice insurance
Coverage from negligent actions.
Does not protect you from things that are outside of your scope.
It gives you your own legal representation.
The 4 elements of malpractice
Duty- you had a duty to care for the patients
Breach of duty- You didn’t follow the standard of that duty
Proximate cause- Not following the standard of care caused harm to the patient
Damages- The harm is substantial
Competency
It’s a legal, not a medical term
You are considered competent until a court says otherwise
If you court rules that you are incompetent, the court will appointment a guardian to make decisions for you
Commitment (aka involuntary commitment)
It has to be a situation where treatment is likely to actually help the person
The timeframe and other rules vary according to the state
Scholarly activities that NPs should be a part of
Publishing
Lecturing/presenting
Preceptorship
Continuing education
Client advocacy includes several obvious things. The less obvious part of advocacy is:
Promoting mental health by joining organizations like the ANA and other organizations
Overall goal of Case Management
Promote quality and cost-effectiveness
Risk management is self explanatory. One part of it that is not obvious is
reducing claims against healthcare providers
Advanced directives include 2 things:
Durable power of attorney (aka healthcare proxy)
Living will
Durable power of attorney (aka healthcare proxy)
Legally binding in 50 states
Not limited to terminal illness
You might want to use it as part of planning for relapses
Living Will
It’s prepared while the client is competent, and says what he wants to happen if he becomes incompetent (as opposed to someone else making the decision)
Culture bound syndromes
Specific behaviors related to a person’s culture and not linked to a psych disorder
Ethnicity
Self identified race, tribe, or nation. It influences your beliefs and behavior
Community
A group of families, often sharing similar traits, who have beliefs/behaviors that are not shared by others
The majority of homeless families are headed by
a single mother
How common is mental illness in the homeless
50% (Schizophrenia is the most common)
Strategies for reducing homelessness: Outreach
Offering services in a variety of settings and forming therapeutic relationships to provide treatment
Strategies for reducing homelessness: Integrated care/Colocation
Providing mental health and other services in the same site
Strategies for reducing homelessness: What are the 4 strategies
Outreach
Integrated Care (colocation)
Supportive services for persons in housing
Prevention (it starts with discharge planning)
Migrants verse seasonal workers
Migrants might keep moving to different locations, whereas seasonal workers have a pattern that is seasonal
Facts about migrants and seasonal workers
there are about 3 million in the U.S.
They are at greater risk for mental illness
It’s important to have an empathic rapport
What kind of attitude should the provider have when dealing forensic/corrections patients
Be neutral and objective, be self-reflective
Definitions of Forensics, Forensic sciences, Forensic nursing
Forensic- applying science to legal problems
Forensic science- Using technology (like microscopes) to research evidence
Forensic nursing- Nursing patient in the legal system
Forensic vs Correctional nursing
Forensic- the nurse-client relationship is based on the crime committed and investigating that crime
Correctional- the nurse-client relationship is based on his current mental health, not the crime that was committed
Forensic risk assessment vs Risk assessment
Forensic risk assessment is protecting the public from a violent patient
Risk assessment is an evaluation done after the person is arrested but before they are sent to jail
