As the demand for higher quality health care grows, so does the responsibility of advanced practice nurses. The issues that the nursing community has to address are numerous, which stipulates the need for resourcefulness and readiness to lead and manage change. The present paper synthesizes the knowledge obtained throughout the course and uses it to identify and analyze an issue in American health care that a nurse practitioner can handle: specifically, it deals with the problem of childhood obesity and applies it to the context of North Carolina, which is known to be facing such problems at the moment. It outlines the setting in which this change can be implemented and the main stakeholders that can be interested in the issue.
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Advanced practice roles in nursing
Advanced practice nurses (APN) are specialists that have received their post-grad education in nursing and are, therefore, capable of providing higher quality care along with medical doctors of assorted fields of practice. APN is a category to which family practitioners, anesthetists, informaticists, administrators, and nurse educators belong; consequently, APN is an occupation encompassing every area of nursing practice. The roles of advanced practice nurses differ depending on their qualifications and the settings they function in. Still, every role they assume relies on the postulates of the nursing profession, which is patient-centered care and excellence achieved through evidence-based practices and critical analysis.
The role of nurse practitioners (NPs) is most noted by textbook authors and those writing on primary care. The role of nurse practitioners shifted over time, and primary care was the area where this shift had the most impact. NPS’s role has changed over time from being an assistant to a physician to a specialist entitled to independent practice, which is what makes nurse practitioners stand out among other advanced practice nurse roles. The healthcare community’s acceptance of the change proved beneficial to both the quality and cost of primary care. Unsupervised practitioners are not merely capable of providing quality care along with physicians; their services are also more cost-effective (Naylor & Kurtzman, 2010).
Nurse educators are valued both in clinical and educational settings. At the baseline, they are responsible for the formation and training of professionals who later save people’s lives, which is why their responsibility is enormous. Following the mission of their respective institutions, nurse educators stand out by their commitment to academic excellence and sharing this commitment with their students. In clinical settings, educators also have a crucial impact: they provide peer mentorship, participate in program design to meet the community’s and individual learning needs, and optimize the existing guidelines for a more efficient workflow.
The nurse informaticists have developed their field well past the point where they simply collaborate with the IT department to optimize the EMR software. Similar to the NPS’, their role has ceased to be that of assistants. Rather, the nurse informaticists have an in-depth understanding of the clinical practitioners’ workflow and more innovative and effective ideas on how to optimize it. To apply them to practice, they use the knowledge of information technology and its wisdom when working in clinical, medical/surgical, emergency, and all other settings. The informaticists can perform multiple roles, but their main aim is to use their knowledge for practice enhancement in all those areas. As separate instances, these areas of practice reduce the chances of clinical errors, which explains the criticality of this role (Naylor & Kurtzman, 2010).
Workflow smoothness is the task of nurse administrators, along with supervising the staff, planning, directing, and coordinating the delivery of health care. These tasks are summed up under the concept of leadership – the primary obligation that nurse administrators perform. Their leadership capabilities are the key characteristic making them stand out among other practitioners – they communicate the vision and mission uniting the nursing community under a common goal of professionalism and excellence (Naylor & Kurtzman, 2010).
Nurse Practitioner occupation
As said, the role of nursing practitioners is prime in reforming the very processual paradigm of primary care. In North Carolina, the conduct and scope of NP practice are determined by the NC Nursing Practice Act, specifically, the issues about physician supervision and legal requirements.
North Carolina requirements and regulations
To practice as an NP within North Carolina, a practitioner should have completed a board-approved education program. This information should be submitted to the board for subsequent evaluation (State Regulation of Nurse Practitioner Practice, n.d.). The educational requirements duplicate those outlined by other such documents all over the country in that a practitioner should have a Master’s (or higher) in their respective field of practice and have a post-master’s certificate in the corresponding area – which is optional.
North Carolina is among the states where an NP is liable to a physician’s supervision when performing certain medical actions such as diagnosing. Such administration occurs via written notes of authorization issued by physicians. The state also obliges its nurse practitioners to report to both the Board of Nursing and the Medical Board while practicing. On the other hand, unlike most board-regulated states, North Carolina’s nurses’ prescriptive powers are broader.
Nurse practitioner competencies
Having received their Master’s or Ph.D., a nurse practitioner should have their certificates on hand. By the means of certification, it is ensured that the practitioner continues their practice voluntarily and do their best to upscale the range of their professional skills beyond the formal education scope. The urge to continuing education is one of the core competencies a nurse practitioner must possess. Other competencies include the scientific inquiry (the ability and desire to analyze facts), leadership (initiate and manage change), quality (base the practice on the highest-quality evidence), IT literacy (understand and utilize technology in practice and decision-making), policy (participate in policies promoting equitable access and cost-efficiency), ethics (comply with the principles of ethicality and accountability), and population-focused competencies (patient-centered health management). A nurse practitioner should be prepared to perform counseling and personalize their practice to account for the patient’s needs.
There are several nursing associations for affiliation in North Carolina. For instance, the North Carolina Nurses Association (NCNA) is an organization that inspires professional growth in its members. It promotes continuing education for nurse practitioners and invites everyone concerned to use the educational resources it provides. The Association possesses several diverse programs to assist its associates in their professional growth, hosts conferences, and webinars for free or at large discounts.
North Carolina Board of Nursing (NCBON) is an organization big enough to authorize nurse practitioners to practice within the state. Catering for the best quality health care, the Board also offers a variety of programs for aspiring and practicing professionals performing various roles, including educatory, and assists them in preparing their instructions. Affiliating with any of these organizations would be an honor and an extremely useful experience for any practitioner (http://www.ncbon.com/).
Clinics in North Carolina are constantly improving their policies to leverage access to health care and increase cost-efficiency, which means that practically any institution would provide sufficient work experience for an ethically-minded practitioner. Among the highest-rank hospitals are Duke University is known for its variety of adult and pediatrics-related specialties, Wake Forest Baptist Medical Center (the one renowned for its education facilities), Carolinas Medical Center (the largest one), and other facilities with high patient flow and good staffing. Some of them are known for their research and innovation advancements, others are doing their best to close the diversity gaps and providing the best professional education opportunities on the state’s scope but, as it were, all these institutions ensure their patients are treated with the latest advances in clinical technology and pursue a noble mission in line with the universal values of the health care community worldwide.
Health policy issue: Childhood obesity
Among the issues most emphasized at Robert, Wood Johnson Foundation is obesity, which seems to have the most drastic effects on children. Today, schools are encouraged to control the children’s calorie intake and the daily exercise they get within the educational facilities, and these policies seem to bring their results. Still, the issue of obesity is of great concern, especially in the context of North Carolina.
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The fact sheet provided by Robert Wood Johnson Foundation indicates a significant increase in the number of schools watching their students’ diets and exercise. Across the nation, the overwhelming majority of educational institutions (98%) are focusing on healthy eating standards; the assorted programs they take part in resulted in an overall increase in the food quality (A Healthy New Era for School Meals, 2016). Schools are switching to whole foods less rich in saturated fats and calories; as the healthy eating habits are cultivated in children, they are known to opt for healthier food choices, fruit, and vegetables (Robert Wood Johnson Foundation, 2016).
In North Carolina, the Alliance for a Healthier Generation supported by Robert John Woods Foundation is adopting a variety of programs to tackle the obesity issues (Alliance for a Healthier Generation, 2016). Still, the 2015 childhood obesity figures are alarming: with the overall obese children (10-17 years) percentage of 16.4, the state ranks the 7th nationwide (Childhood Obesity in North Carolina, 2016). The state is currently taking part in the Healthy Schools Program catering for a healthy diet and physical activity education among school students. However, the fact that the majority of schools are located near the state’s center leaves out the rural communities, who might be more vulnerable to obesity and related issues.
There is no significant evidence that rural children are less likely to be active. On the other hand, the relations between the children’s rural surroundings, their level of education, marginalization status, and obesity are generally reported to be positive. The exclusion of rural communities from health care programs under the mission of quality of life and well-being enhancement across America regardless of the citizens’ status, therefore, poses a significant problem to the integrity of the health care community.
Change process and management
A sustainable change can only be achieved when all shareholders are involved, especially within a rural community. As the current status suggests, this community is largely excluded from the obesity decrease programs – an indicator of low awareness and little interest. On that scale, the change program should start with awareness increase, in which concerned nurse practitioners can be involved.
The steps to awareness increase among the shareholders (the legislators, health providers, and disease prevention institutions) would include, primarily, assessing the problem. A concise report of the scope of childhood obesity would attract attention to the issue. Secondly, the existing policies should be overviewed, and the data on the best practices (and their outcomes) near the geographical center of the state can be also presented to the concerned parties. Furthermore, effective policy cannot be developed and implemented unless the barriers to its implementation are identified. In a rural community, these would potentially include lower access to health care, despite the state’s best efforts, marginalization, and poverty. Specifically, about obesity, poorer infrastructure, and lack of exercise facilities can be considered a critical barrier; although it is outside the scope of a nurse practitioner, infrastructure improvements can be advocated for. More tangibly, the shareholders should face the necessity to seek the involvement in the successful programs statewide – a task a nurse practitioner can perform.
The result of the advocacy would be that the legislators and health providers are in the know of the issues of childhood obesity taking place within their jurisdiction. Obesity and related issues are crucial both short-term and in the long run, but no change can be implemented unless the stakeholders are aware the issue is present. The task of a nurse practitioner, at that, is to raise their voice and start the change to the better of the community.
A Healthy New Era for School Meals. (2016). Web.
Alliance for a Healthier Generation. (2016). Web.
Childhood Obesity in North Carolina. (2016). Web.
Naylor, M. D. & Kurtzman, E. T. (2010). The Role Of Nurse Practitioners In Reinventing Primary Care. Health Affairs, 29(5), 893-899.
Robert Wood Johnson Foundation. (2016). Web.
State Regulation of Nurse Practitioner Practice. (n.d.). Web.