Current Issues For Advanced Practice Nurses

Today people are living longer than ever. The discovery of new technology, innovative medicines, science, and research all play apart of that. An increase in aging population is one of the most dramatic demographic trends in the world today. Many elders present many complex diseases and require complex care and disease management. The challenge also presents many opportunities in the healthcare field and a shortage of providers in rural areas. The roles for advanced practice nursing (APN) have been introduced since the late nineteenth century till the present (Hamric, Spross, and Hanson, 2009, p. 3). These roles include certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), and nurse practitioners (NPs) (Hamric, Spross, and Hanson, 2009, p. 3). Building credibility and defining practice of APN roles did not firmly establish until in late 1970s (Hamric, Spross, and Hanson, 2009, p. 17).
In 1992, the American Nurse Association (ANA) established Healthcare Reform which focused on restructuring the United States healthcare system to reduce costs and improve access to care (Hamric, Spross, and Hanson, 2009, p. 23). Today APNs face many challenges as they strive to be recognized by members of the society. The current issues faced by APNs are discussed below and this information is based on Advanced Practice Nursing: An Integrative Approach (4th ed.).
The Key Issues
The identified key issues are education, scope of practice, specialty practice, reimbursement, titling, prescriptive authority, legal status, regulation, and credentialing issues. The similarities among these issues are all embedded in regulatory languages which make it difficult for APNs to benefit from development of nursing role. The differences occur when one failed to collaborate and to address these above issues as a whole and to promote collaborative relationships with other regulated health disciplines both at the national and state level. And, indeed these issues are still importance to the practice of advanced practice nurses.
Three Chosen Issues
The three chosen issues are scope of practice/specialty practice, reimbursement, and prescriptive authority. Like never before, the profession for APNs has emerged into different era which presents many different opportunities and challenges for newcomers. Today APNs can be found working anywhere from the family practice, cardiology office, urgent care always to emergency medicine. As a new graduate APN, the role can present many challenges and obstacles especially when she or he tries to adjust to the new role while attempting to comply with several clinical practice guidelines.
Even though the title of APN is recognized as a valuable asset to the community and other healthcare team member, many of them are still struggled to get reimbursed properly. The holistic caring approach provided by APNs is not inferior to the medical model provided by physicians. The education requirement for both professions will be soon about the same especially with the new requirement of a doctoral degree for APNs. This is the reason APNs still debate for equal pay for equal service when care is compared between both health providers.
After reading Advanced Practice Nursing: An Integrative Approach (4th ed.) page 606 and 607, the reality becomes clear that APNs have to prove so much in order to gain sole authority in scope of practice. The Board of Medicine continues to find ways to limit the scope of practice for APNs. According to Lugo, O'Grady, Hodnicki, & Hanson (2007), 23 states possess sole authority from the board of nursing; whereas other states possess joint authority with the board of medicine, the board of pharmacy, or both (Hamric, Spross, and Hanson, 2009, p. 606). The outcome of this disagreement affects the role and practice of APNs greatly especially when they attempt to provide the best care possible in a timely manner.
Top Two Issues
The chosen top two issues are reimbursement and prescriptive authority. As a new graduate APN, she or he must get educated well about different payment options such Medicare and Medicaid, third party payers, and more to ensure proper reimbursement. The second strategy is to encourage schools throughout the country to incorporate this valuable lesson as part of the standard curriculum. The nursing profession as a whole should continue to flight aggressively for equal service for equal pay because nursing profession should not be assumed as inferior to other independent health providers despite different styles of caring approach. As an individual APN, one must continue the education to doctorial level in order to try to resolve the unfair disadvantage of prescriptive authority across the nation. The second strategy is APNs should continue to promote the recognition of APN as safe and cost-effective alternative provider throughout the healthcare systems.
Regulatory Barriers
The current regulatory barriers for APNs are prescriptive authority, reimbursement schemes, nursing education, and scope of practice and titling. The variance in board regulations from state to state is a problem facing APNs who highly mobile (Hamric, Spross, and Hanson, 2009, p. 610). Even though prescriptive authority exists over the years and becomes fairly standard for APN prescribers, but the requirements still vary from state to state (Hamric, Spross, and Hanson, 2009, p. 607). For those APNs who love to travel and work at another state to make sure to check the scope of practice for that state as it varies significantly (Hamric, Spross, and Hanson, 2009, p. 607). The professional nursing organizations and the National Council of State Boards of Nursing (NCSBN) have been working on a new regulatory model for APNs in order to promote some uniformity on credentialing and licensure (Hamric, Spross, and Hanson, 2009, p. 610). A system of mutual regulatory recognition between states is needed and remains to be done.
Conclusion
Even though most of the hard work was done to promote the path to independency and uniformity for advanced practice nursing, but several issues remain to be solved especially in the areas of credentialing and regulation. Many nursing organization is working aggressively to put a new regulatory model in place to promote a system of mutual regulatory recognition. The field in advanced practice nursing is evolving and changing rapidly, especially in the areas of advanced practice nursing specialties. As a result of this complex change, policymakers and regulators face many challenges and obstacles to ensure development of broad-based practice standards. At the same time this challenge also presents many new opportunities for advancing practice nursing; thus APNs continue to prove themselves as safe and cost-effective providers to the members of society and to move forward to a better professional future.

Education Law - An Overview

Education Law takes care of any legal issues around education. There are many areas of education where law dictates how things work. Here we take a brief look at some areas that are covered by education law.
EMPLOYMENT
Just like any other business anyone who works for an educational institution, such as a school, college or university, must act and be treated according to the normal employment laws.
EUROPEAN LAW
There are European laws that dictate certain areas of education law. This is likely to increase in the near future, with the Lisbon Treaty going through. This means that many of the education laws are likely to be uniform across Europe.
INSTITUTION RESPONSIBILITIES
There are certain responsibilities set out by law that educational institutions must abide by. They have a duty to teach certain things (depending on the type of institution) and sometimes they have certain procedures which they must follow. For example secondary schools must teach certain subject, such as English, Maths and Science.
TRAINING
Anyone working in education must be trained sufficiently to fulfil their specific role. School teachers have to have formal training, both to make sure they have the skills to teach children and to make sure they know their subject areas sufficiently.
CHILD CARE
Educational institutions have a duty of care. Those looking after children must be deemed fit to take on such a role. This can include background checks so everything possible is done to make sure children are safe in their care.
SPECIAL NEEDS
Institutions have a legal obligation to meet the needs of those with special needs to make sure that they are given the same opportunities as others.
HEALTH & SAFETY
There are health and safety guidelines that must be followed. Premises must be deemed safe for purpose. Compensation might be payable if an institution is found to be liable for an injury that has occurred while the victim was at the premises.
DISCRIMINATION
Students (and teachers) cannot be discriminated against for any reason. Everyone must be treated equally irrespective of gender, age, race, sexuality or religion.
FINANCE & FUNDING
Certain rules apply as to how different institutions can acquire funding. For example, states schools have to be free for all. Different regulations apply to state and private institutions, as they do depending on what type of institution they are (e.g. schools and universities are treated differently).
STUDENT ADMISSION
This is an area that has been much debated recently. Rules that decide who has the right to attend a specific school are set out by law, something that is based on the geographical areas in which they live. Many parents have been known to dispute these decisions.
STUDENTS TAKING ACTION AGAINST EACH OTHER
Although rare, there are some occasions where students have taken legal action against each other using education law solicitors, with the most common reason being that they have been bullied by the student in question.
DISCIPLINE
There are laws stating forms of discipline that can be carried out. In the past physical punishment was legal but this is no longer the case. There can also be disputes where children have been excluded from school.
POSSESSION OF SUBSTANCES
Certain substances are banned by law from premises. Illegal drugs are obviously not allowed, but cigarettes and alcohol are also not deemed acceptable at certain premises. This mostly applies to schools.
SEARCHING
Students are allowed to be searched on occasions but only when there is sufficient suspicion that they have broken rules. This can include searching pocket, bags and lockers.

Driving Under the Influence of Legal Drugs

Many driving schools teach the dangers of drinking and driving with some also mentioning the effects and dangers of driving while under the influence of marijuana. But how many drivers realize that driving under legally prescribed drugs and some herbal medications can be just as dangerous?

Diving is a skill, actually it is a very complex skill determined by changes in our physical, emotional and mental conditions all of which can be impaired by the use of drugs.

Over-the-counter medications such as Antihistamines cause the brain to slow down and could impair reaction time, coordination and cause drowsiness. Decongestants can also cause drowsiness, anxiety and dizziness. The National Highway and Traffic Safety Administrations estimates 100,000 traffic crashes and approximately 1,500 deaths are caused annually by people becoming drowsy while driving with many of these people using over-the -counter medications.

Some drivers say they feel more alert and confident when driving under certain medications.

The reality is drugs can fool you into believing you are in control of your driving when in fact, you are driving impaired.

This is also true with prescribed medications such as Xanax, Valium, Klonopin, OxyContin and Roxicodone. Although these drugs have their benefits when prescribed by a doctor and taken as prescribed, patients prescribed these medications should always read the label and information that usually comes with these medications. All of these medications recommend that a person does not operate a motor vehicle or machinery when taking the drug.

Today, some of the drugs dangerous to driving a motor vehicle are called Herbal Medications, or Supplements. These herbal or naturopathic remedies are not registered with the Food and Drug Administration and will often, in fine print, disclose the FDA does not certify the product. These products are produced to inform you of the desired affects, not the actual effects the medication could have on the human body.

Currently with the expansion of the Internet, people can order herbal medications that are legal in the majority of states however, closely related to illegal drugs. Herbal medications such as K2, Salvia, and Kava-Kava cause hallucinations something a driver does not want to experience when behind the wheel. Other legal supplements sold under a variety of names mimic the effects of dangerous drugs such as Ecstasy and Cocaine. The use of any of these drugs will impair the skills necessary to drive a vehicle.

It is important to avoid harming yourself and others when driving, talk with your physician and pharmacist and learn all you can about the medication you are taking especially the side effects, what drugs are considered safe to combine and how any drugs affect your driving skills.

Never doctor yourself by taking over-the-counter medications or herbal drugs. It is always best to seek professional help from your physician. Remember, a safe driver is a smart driver and a smart driver knows better than to drive under the influence of any drug.

The National Safety Commission works to increase awareness of important safety issues, particularly those that deal with highway and traffic safety information. Our mission is to make consumers more vigilant and understand that "safety is no accident," through education and outreach programs. We promote driver education and training through our Driver Safety Blogs.