Description
Discussion 1:
Interprofessional collaborations, also known as clinical teamwork, ensure the best possible care. This level of cooperation is required to deliver high-quality, patient-centered care while reducing errors and improving patient outcomes (Morgan et al., 2020). When professionals fail to collaborate, the patient and their families suffer the consequences. As an illustration, a cardiologist saw a patient for a routine checkup for mild congestive heart failure. The patient had shortness of breath due to fluid overload, as evidenced by generalized edema. The patient is also on hemodialysis, which cardiology clinicians are aware of but refuse to communicate with that department due to personal reasons from previous patient issues and disagreements on patient treatment plans. The cardiology clinicians increase or change medications prescribed by the nephrology clinicians without consultation or communication. The patient follows the orders of the new medication prescription. Still, because of the lack of interprofessional communication regarding the other medications the patient is on, the patient gets sick, and potassium, sodium, and calcium levels are out of sorts. As a result, the patient gets admitted to the hospital with hyperkalemia and cardiac irregularities. According to Didier et al. (2020), approximately 70% of errors in the healthcare system that result in unfavorable events are brought on by ineffective communication or deficient conduct between nurses, doctors, and departments. In a professional setting, advanced practice nurses must maintain boundaries and keep personal issues separate from patient care. In addition to advocating for patients during decision-making processes and upholding autonomy, patient advocacy in advanced practice nursing entails working together successfully and professionally for the patient’s health and well-being (Abbasinia et al., 2019). The profession of nursing as a whole is crucial to providing excellent, patient-centered care.
Peer questions: What are some common personal issues that advanced practice nurses or clinicians, in general, may face, and how do they affect patient safety and advocacy in their practice? How would you, as an APN, handle the role of “middleman” and advocate for the patient?
The roles and responsibilities of each healthcare provider in providing patient care are outlined in a collaborative standard care agreement between physicians and advanced practice nurses (Joel, 2022). The Collaborative/Standard Care Agreement can be both beneficial and a burden. According to a national survey by Martin & Alexander (2019), the restriction of a collaborative care agreement can create professional and psychological disadvantages for both advanced practice nurses (APN) and physicians. Consider the scenario where an APN must speak with a doctor before treating a patient. In that case, this may restrict the APN’s autonomy and ability to make decisions, which may have a negative effect on their job satisfaction. When a doctor is required to oversee the care given by an APN, the doctor may face an increase in workload and responsibilities, which could be detrimental to their psychological and mental health and stress capacity. On the other hand, the standard care agreement between the APN and the doctor can be helpful, especially for nurses who are new to advanced practice. Originally the agreement was put in place to act as a barrier to increased patient safety and to provide a wealth of knowledge when working together. The agreement, however, continues to prevent APNs from using their knowledge and skills to their fullest potential, compromising patient care and adding to the workload for physician supervisors (Moore et al., 2020).
Peer questions: In your experience, what are some common barriers between APNs and doctors regarding the collaborative standard care agreement? Can you provide examples of how using the standard care agreement by the providers you currently work with has improved patient care or outcomes?
The 2021 American Association of Colleges Nursing Essentials that this assignment meets focus on the APN role and relationship with the physician. In this nurse’s opinion, those include the domains of knowledge for nursing practice, scholarship for nursing discipline, interprofessional partnerships, quality and safety, professionalism, and personal, professional, and leadership development. Patient-centered care is also met in this assignment in relation to patient advocacy.
References:
Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2019). Patient advocacy in nursing: A concept analysis. Nursing Ethics, 27(1), 141–151. https://doi.org/10.1177/0969733019832950
Didier, A., Dzemaili, S., Perrenoud, B., Campbell, J., Gachoud, D., Serex, M., Staffoni-Donadini, L., Franco, L., Benaroyo, L., & Maya, Z.-S. (2020). Patients’ perspectives on interprofessional collaboration between health care professionals during hospitalization: A qualitative systematic review. JBI Evidence Synthesis, 18(6), 1208–1270. https://doi.org/10.11124/jbisrir-d-19-00121
Joel, L. A. (2022). Advanced practice nursing: Essentials for role development (5th ed.). F.A. Davis Company.
Martin, B., & Alexander, M. (2019). The economic burden and practice restrictions associated with collaborative practice agreements: A National Survey of Advanced Practice Registered Nurses. Journal of Nursing Regulation, 9(4), 22–30. https://doi.org/10.1016/s2155-8256(19)30012-2
Moore, C., Kabbe, A., Gibson, T. S., & Letvak, S. (2020). The pursuit of nurse practitioner practice legislation: A case study. Policy, Politics, & Nursing Practice, 21(4), 222–232. https://doi.org/10.1177/1527154420957259
Morgan, K. H., Barroso, C. S., Bateman, S., Dixson, M., & Brown, K. C. (2020). Patients’ experiences of interprofessional collaborative practice in primary care: A scoping review of the literature. Journal of Patient Experience, 7(6), 1466–1475. https://doi.org/10.1177/2374373520925725
The American Association of Colleges of Nursing (AACN). (2021). Retrieved January 26, 2023, from https://www.aacnnursing.org/Portals/42/AcademicNur…
Discussion 2:
Identify a time in which collaboration was not used and that led to negative consequences for the patient. Discuss the responsibility of the APRN as a patient advocate.
This nurse has experienced a multitude of instances in which members of the healthcare team did not collaborate with each other, leading to poor patient outcomes. In the ICU, there can be multiple different specialties on each case, and there is usually always an intensivist. ICU nurses depend on the intensivist for most of their orders because that physician is the most easily accessible to them. Often times, there is conflict when it comes to the intensivist managing patients with other specialties on board, due to their orders being contradictory of each other. However, if the intensivist would discuss the care plan with other specialist and make sure everyone was on the same page, this would be a less common issue. This nurse had a patient recently with worsening respiratory failure. After calling the intensivist and explaining that the patient was worsening on the bipap, with a poor breathing pattern, and worsening respiratory acidosis on ABG, the intensivist still did not order a pulmonology consult and did not come see the patient. Later, the patient continues worsening despite many efforts by respiratory therapy in changing bipap settings, as well as calling the intensivist themselves. Many hours later, the intensivist finally orders a pulmonology consult after assessing the patient, in which at that time was not available. The pulmonologist sends a resident to see the patient. The resident calls the pulmonologist due to need for intubation. The pulmonologist and the fellow were unavailable. Anesthesia was called for intubation. This patient ultimately went into cardiac arrest after intubation by anesthesia due to lack of initiative and collaboration physician to physician. Following multiple rounds of CPR, this patient lost their life. The intensivist should have evaluated this patient shortly after this ICU nurse called with concerns, or they should have sent their resident or colleagues to do so if busy. Poor collaboration from the ER doctor requesting to admit the patient to the accepting intensivist occurred, as well as poor collaboration from the intensivist in contacting pulmonology in a timely manner.
The role of an APRN in patient advocacy is similar to that of an RN in the essence of promoting positive health decisions and searching for the right plan to fit their care needs. However, the APRN advocates for patients a little differently. APRNs have advanced education and a higher level of experience caring for patients and their families (Hanks et al. 2018). APRN’s exhibit more responsibility than that of an RN. These responsibilities include protecting patients from harm; communicating patient preferences; fostering collaboration; providing essential information to inform decision-making; and supporting the voice of the patient regarding choices and care (hanks et al, 2018). With the ability to diagnose and prescribe medications, APRNs demonstrate a greater power in advocating for their patients through treatment of health conditions (Hanks et al. 2018).
Review the posted Collaborative/Standard Care Agreement. Discuss the positive and negative aspects of it in the discussion board.
Upon review of the Collaboration/ Standard Care Agreement, there are so many positive aspects presented. The main agreement condition that stood out is that the physician must have substitute physicians overseeing the APRN in case the primary physician within the agreement is unavailable. This provides the APRN with a backup resource for consultation in case of an emergency or inability for the usual physician to oversee. Throughout the agreement, there seemed to be one negative aspect that stands out. With a shortage of physicians in the country and an increased need for APRNs, this nurse finds it hard to understand why 1 physician can only collaborate with up to 5 APRNs. The US is overcome with an increase in the aging population, as well as a continuously growing population (Zhang et al. 2020). With an increase in the insured population following the Affordable Care Act, healthcare demand is growing fast (Zhang et al. 2020). Improvement in quality of care, access to care, and control of healthcare expenses depends on the availability of healthcare providers (Zhang et al. 2020). In rural areas where there may be limited health services, 5 APRNs may not be enough to serve the area under 1 physician.
3. Identify which of the MSN essentials this assignment meets.
This assignment encompasses many of the MSN essentials discussed throughout this course. Domain 2, the need for person centered care, is incorporated when discussing the APRNs role in patient advocacy. To advocate for patients properly and effectively, the APRN must tailor their clinical reasoning behind the patient and their preferences (AACN, 2023). Domain 3 discusses population health and the need for improvement across all age groups. Patient advocacy by the APRN will be provided amongst all age groups being seen in any area of practice (AACN, 2023). As discussed in response to question number 2, with a growing population in the US, there is need for more healthcare providers, including APRNs. Domain 6 assesses the need for interpersonal partnerships (AACN, 2023). This assignment is centered upon collaboration and partnership agreements with the physician and APRN. The need for interpersonal partnerships is exclusively important in the APRN role, due to the collaboration agreement one must follow with the physician.
References:
The American Association of Colleges of Nursing (AACN) homepage. AACN Essentials. (n.d.). Retrieved January 27, 2023, from https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf.
Hanks, R. G., Starnes-Ott, K., & Stafford, L. (2018). Patient advocacy at the APRN level: A direction for the future. Nursing Forum, 53(1), 5–11.
Zhang, X., Pforsich, H., & Lin, V. W. (2020). Physician workforce in the United States of America: Forecasting nationwide shortages. Human Resources for Health, 18(1).
