Introduction
Since the beginning of 20th century, nursing profession has continued to evolve with development of technical machines and appropriate medicine. Nursing practice is no longer considered an occupation but a fully developed profession. The evolution has seen change of training mechanism and for APNs, a master’s degree is now the minimum academic level. Intrinsic to nursing is the concept of collaboration between physicians and nurses.
Collaborative nursing that call for meaningful collaborative agreement for APNs and physicians a cross the globe. Towards this, Arkansas State has not been left out in this kind of paradigm shift in nursing profession. This paper takes a critical analysis of collaborative agreement between APNs and physicians and the laws and regulation governing the nursing practice in Arkansas.
Collaboration in medical and health care provision is important since it provides a great opportunity for nurses and brings health care services close to the people; more so, for advanced practice nurse is a general nursing term used to refer to CRNA, CNMs practices, CNS and PCNP. Nurse practitioners, NP fall in the group amid difference with the other groups in that its field of application is wide and its patient base is also immense. “There are accepted regulations that guide the nursing practices and depending on which state applies APN, the rules and formulated in line with state laws,” (Hamric et al., 2009).
Certified Registered Nurse Anesthetist (CRNA)
For an individual to be considered as Nurse Anesthetist, one ought to be an Advanced Nursing Practice (ANP) beside completion of training for anesthesia administration. To ensure that professionalism is held, there are recommended bodies that obligated with education and training of nurses and an accreditation body. Upon successful education and an accreditation, one becomes CRNA.
The highest academic requirement for a CRNA holder was bachelor’s degree in the US but Council of Accreditation embarked on development of a masters program. As a result, institutions that offered CRNA started developing advanced curriculum to reflect course requirement as set by COA and in 1990, all institutions that offered CRNA were to transition their program to masters by 1998; and this level of education became the doorway for CNRA certification.
Today in the United States, baccalaureate degree or any nursing course completed after four year in the basic step to becoming a CNRA. Upon completion, one has to register as a nurse followed by a whole year real time experience as required by American Association of Nurse Anesthetic, AANA. AANA recommend that the real training be experience must be on full time basis. In addition, job experience should be in an acute care set up. Highest attainable level of education in US for a CRNA is either Doctor of Nurse Anesthesia Practice, DNAP.
The capacity of nurse anesthesia is to administer all anesthetics patients in the US and the practice in done in 50 states, Arkansas and North Carolina among them. All states are in charge of setting their on boards to formulate practicable regulations with AANA headquarters in Park Ridge, Illinois. CRNAs offer their services to a whole range of institutions like: public and private organizations, hospitals, and as individual practices.
Their greatest responsibility; however, lies in service provision for American servicemen and senior citizens. In the public health sector, CRNAs corroborate with other medical practitioners like dentists, surgeons or any other medical health practitioner requiring their intervention. In anesthetic medical conditions, CRNAs are allowed by law to administer any case reported for a patient, (Hamric et al 2009).
Certified Nursing Midwife (CNM)
According to American Pregnancy Association, (2010), “Certified Nurse-Midwife (CNM): an individual trained and licensed in both nursing and midwifery. Nurse-midwives possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives.” CNMs practice involves offering emotional and physical aid to pregnant women at the prenatal and post natal stages. For an individual to become a midwife, one has to obtain certification as a registered nurse with an added specialty in midwifery. Midwifery does not only involve taking care of women but their newborns too.
A certified CNM holds hands on skill in gynecology; for instance, reproductive health. Besides, it is the responsibility of CNMs to help train women on how too handle newborns in regard to family issues, proper child nutrition, and general infantry care among other related health issues. CNMs do not work on their own in all medical matters. At times they have to seek help from other medical health professional or they can offer advice to the said medical health practitioners. American Pregnancy Association, (2010) notes that, “Midwives routinely consult with obstetricians, perinatologists, and other healthcare professionals and will refer women to the necessary medical professionals if complications arise.
At high school level, a student seeking to land a career in CNM must take Biology, Psychology, English and Hone Economics among other key subjects. At college, initial requirement at college level for a CNM is to first of all be a registered nurse prior to enrolling to any midwifery program. Upon completion, one has to undergo accreditation academic program for either master’s degree or certificate. The final step is then to pass certified exam set by the American College of Nurse Midwives, ACNM. Interpersonal skills are vital for midwifes at the workplace. CNMs following academic and certification programs can discharge their duties at health organizations, public and private hospitals, and birth centers among others.
Clinical Nurse Specialist (CNS)
CNS also form part of the APN group whose responsibility targets a specific group of patients. A CNS can specialize to handle diabetic patients or a particular cardiovascular condition. Though specialty is on a given medical condition, a CNS can work in a number of section; for instance, theater rooms, or crisis room. In addition CNSs can work in a number of organizations and due to work load; it is a very challenging responsibility to handle.
Zuzelo, (2009) notes that, “These activities are rewarding but time consuming. The needs can be accustomed to taking obligations very seriously and as a result, CNSs may experience personal burnout as they juggle family, clinical work, scholarship and organizational activities.” Prioritization is therefore key for any practicing CNS to enable the professionals organize there duties according to urgency and find time to recollect on personal life spectrum.
Academic requirements for a CNS are baccalaureate degree or any nursing course completed within a time span of four year. In order for one to be a certified CNS, a master’s degree is inevitable as set by accreditation bodies that set CNS programs. To finally qualify as a CNS, one must pass examination set by CNS or other accredited entities. After academic pursuit, job experience is of essence in all the areas of specialization. The highest level of a CNS practitioner is getting a doctorate through recertification. The standards of doctorate certifications are set by state mechanisms and boards set for CNS. The doctoral level does not focus on treatment but on further studies of issues in CNS.
Primary Care Nursing Practitioner (PCNP)
As already mentioned NPs duties are broadly based and for NPs to effectively discharge their responsibility, the duties must be articulately spelt out. One of NP duties involves analysis of medical history of a patient to ease the performance of medical examination for a patient in a subsequent visit. After successful examination, NPs carry out diagnosis of medical conditions. Also, interpretation of lab tests and scans and general services carried out by CNMs.
NPs are not only involved in medical care of patient but also “in seeking correspondence with insurers, employers, government agencies and other health care providers about established clients as necessary. They also manage care of clients based on social issues that affect them,” (Buppert, 2007). Nursing practitioners practice in mainstream health organizations, private and public hospitals, and hospices among other health related institutions.
Collaborative Agreement Process for APNs in Arkansas
History of Collaboration
Collaboration has been a crucial way in which APNs provide nursing service to US citizens. The medical practices in Arkansas were designed in a unique way. Under the process, physicians were the first category of health care providers to be licensed. In order to carry out medication to patients they had to APN professionals even though APNs services were not highly recognized at that moment.
However, modernity coupled with legislative changes has brought forward significant changes in the medical practice. A legislative change that allows a collaborative agreement for APNs in health care presents APNs with enormous opportunity to advance their careers. Advanced practice nurses (APNs) in Arkansas are often presented with employment practice agreements when they seek for employment. “A collaborative practice agreement is a written statement that defines the joint practice of physician and an APN in a collaborative and complementary working relationship” (Pearson, 2008)
This agreement provides an outline and a clear mechanism for the legal protection of the APN. It further sets out the rights and responsibilities of physician and APNs. It is advisable that all APNs, regardless of practice setting, should be well acquainted about aspects of a collaborative practice agreement before appending their signatures. The collaboration between physicians and APNs is critical and therefore requires a precise agreement process.
In Arkansas, unlike in other states, there exist different levels of collaboration for APNs who prescribe. In this regards, APNs in Arkansas can practice independently for those who don’t prescribe to the collaborative ideals. “Arkansas requires physician direction/protocol for NPs who were originally authorized by the state and the statute provides second licensure for APNs who are nationally certified” (Pearson, 2008).
In Arkansas, “APNs must complete pharmacology course, including three graduate credit hours from accredited college or university,45 contact hours in pharmacology course , and 3 graduate hours in pharmacology including advanced practice nursing education program” (Pearson, 2008). In addition, “they must also have had at least 300 hours of pre-ceptorial experience in prescription of drugs, medicine and therapeutic devices with a qualified preceptor” (Pearson, 2008).
Arkansas law (17-87-310) requires APNs to have a collaborative practice agreement with physician who has a practice comparable in scope, specialty, or expertise to that of APNs and must be registered and certified by the Arkansas state board of Nursing.
The collaborative process in Arkansas is a three course procedure that must be carried out by APN bodies that are registered by the Arkansas state board of Nursing. Secondly, APN must certify all the legislative requirement state in the state law and Arkansas state board of nursing regulations. In addition, APN must present a written agreement between him/her and licensed physician to the Arkansas state board of Nursing.
Law and Regulations Governing APNs Practice in Arkansas
Arkansas law spells out that, “APNs are only allowed to prescribe controlled substances in schedule III – V. Physicians must write any schedule II medications and sign the prescription personally,” (Pearson, 2008). Arkansas law, (A.C.A. §§ 17-87-310 & 17-92-110) “allows advanced practice nurses who have met all the relevant requirements to exercise prescriptive authority. However, this authority is not dispensing authority” (Pearson, 2008).
In Arkansas the law and regulations requires that, “APNs must complete pharmacology course, including three graduate credit hours from accredited college or university,45 contact hours in pharmacology course , and 3 graduate hours in pharmacology including advanced practice nursing education program” (Pearson, 2008). In addition, “they must also have had at least 300 hours of preceptorial experience in prescription of drugs, medicine and therapeutic devices with a qualified preceptor,” (Pearson, 2008). These regulations are important since they provide the bench mark qualification necessary to practice as APNs. Towards this, the state government is able to regulate the number of APNs and drive out quacks from health care programs.
Type of Services APNs Provided in Arkansas
APNs in Arkansas collaborate with physicians and other health care professionals in their day to day provision of health care services to the people in the society. APNs are health care professionals and are widely qualified to offer the several medical services to the people. APNs practice embraces the nursing concept of therapy, prevention, diagnosis, etiology, and harm analysis. In this case there work involves services listed below:
- APNs Provide diagnosis and treatment of health Problems
- APNs Focus on the effects health problems have on the patient and the family
- APNs take the opportunity to explain health problems and the impact of Medications to patients in the community.
- They emphasize wellness and self-care and through this awareness they help people in the society to prevent diseases
- APNs are responsible in manage their own caseload
Just like in other medical practices, APNs work in almost all the medical settings and these include; hospitals, ambulatory, long term care, clinics, communities with social worker. This is because the nature of their service is needed in both primary care setting as well as critical medical care setting. It is therefore prudent to note that APNs can work in any medical and health care setting in their provision of health care services.
The Process of Certification and Recertification in Arkansas for Mental Health Nurses in Arkansas
In Arkansas, nursing certification which is generally the process of training an individual to do nursing is carried out by University of Arkansas for Medical Science, UAMS. The process in based on the sensitivity of nursing as a career and whoever wants certification from Arkansas state must have attained academic qualification in at least a nursing course. There are medical standards that are set to guide nursing practices; therefore, after verification of academic achievement, one has to adhere to standards set by UAMS.
As already been mentioned, prioritization is key for any practicing CNS to enable the professionals organize there work schedule in accordance with state law and to uphold credentials earned. Certification does not aim at only giving gate pass to land a job; but, it has to represent equilibrium between commitment and professionalism. In Arkansas, certification does not only mean getting certificate to work as a practicing nurse but it also mean that once one becomes a professional, he/she will still continue pursuing education, uphold nursing standards, and carry out research that would be of benefit to the entire nursing fraternity.
Similarities and Differences of Nursing Requirements in Arkansas and Chicago
Conclusion
Comprehensive medical care is achieved when all the stakeholders in medical and health care work as a team. This team work calls for a mutual collaboration which not only enhance effective health care but also improve career and living standard of both physician and APNs in the society. Collaboration is also important in medical practices since diagnosis of diseases may require expertise of another professional. Working with other physician in general medication; thus, will benefit patients and encourage research for a number of medical conditions. Modern technology in the medical sector has been underutilized and if collaboration can be enhanced usage of these techniques and equipment.
Effective collaborative and interpersonal relationship among health care providers goes aims at redefining medical practices to curb medical challenges that continue to engrave our society. Therefore, relevant policies, regulation as well as legislation should be put in place to ensure that effective collaboration is enhanced among the health care providers. In addition, Arkansas health care policy makers should further enact legislation with improves the already existing collaboration and working agreement between physicians and APNs in the society.
References
American Pregnancy Association, (2010). Midwives. Web.
Buppert, C. (2007). Nurse practitioner: business practice and legal guide. New York, NY: Jones & Barlett Learning.
Hamric, A., Spross, J., & Hanson, C. (2009). Advanced practice nursing: An integrative approach. 4th edn. St. Louis: Saunders.
Pearson, L. (2008). “Annual -Update of How Each State Stands on Legislative Issues Affecting Advanced Nursing Practice.” Nurse Practitioner. 23(1): 14-66.
Zuzelo, P. R. (2009). The clinical nurse specialist handbook. 2nd edn. New York, NY: Jones & Barlett Learning.