Cheryl H. DeVore, RDH, MS, JD The Ohio State University College of Dentistry

Transcription

1 Cheryl H. DeVore, RDH, MS, JD The Ohio State University College of Dentistry

2 Professional Boundaries and Managing Scope of Practice Issues that May Arise 2

3 Looking at the possible issues that may arise Three (3) main themes seem to emerge: 3

4 Emerging Themes Scope of Practice/Professional Boundaries Role Conflict Accountability (all probably considered part of the hidden curriculum and not often discussed) 4

5 Scope of Practice Those lawful activities the professional can perform Between professional groups Within professional groups State to state variability in laws defining practice responsibilities 5

6 Between Professional Groups Lack of Understanding/knowledge of the others scope of practice or clinical competence/lack of referral (Csikar et. al. 2009) Not valuing, understanding the clinical experience of other professionals (Csikar et. al. 2009) Legislative changes in scope of practice/lead to disequilibrium; new paradigms result professionally(kaplan & Brown 2007) 6

7 Within Professional Groups Bullying Vertical (M.D. s & Nurses) Horizontal (between colleagues and based on years of experience and different credentials) Harassment No clear role boundaries 7

8 Confounding factors (State to state variability in legal scope of practice) Overlapping scopes of practice between team members Scope of practice variations inside and outside institutions 8

9 State of Ohio Physician Assistant (PA) (Medical Board) Registered Nurse (RN) (Nursing Board) Certified Registered Nurse Anesthetist (CRNA) (Nursing Board) 9

10 Nursing Practice Ohio Florida Registered Nurse Registered Nurse *Licensed Practical Nurse * Certified Registered Nurse Anesthetist (APN) * Clinical Nurse Specialist (APN) Certified Nurse Midwife (APN) Certified Nurse Practitioner (APN) Advanced Registered Nurse Practitioner (ARNP) Clinical Nurse Specialist RN/ARNP RN/CNS ARNP- works under a protocol with a Florida licensed physician, osteopathic physician or dentist Advanced Practice Nurse (APN) *under direction of a physician, podiatrist or dentist 10

11 Standard Care Arrangement Under Ohio law (ORC Sec (N)) a standard care arrangement means a written formal guide for planning and evaluating a patient s health care that is developed by one or more collaborating physicians or podiatrists and a clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner 11

12 Role Conflict Not understanding ones role limitations Inappropriate empowerment on the team 12

13 Accountability Professional accountability may be blurred Negative impact on patient care Liability for the team/institution 13

14 Resulting Consequences unhappy workers result in professionals leaving the field negatively impacts patient care inefficient team 14

15 Emerging Themes for Success Share a common approach to care Establish clear roles/boundaries to ensure the best contribution from each professional Better understand each other s roles Work together to best leverage each other s strengths, competencies Have pluralistic world views that are client focused Have a team manager across disciplines Establish tracking for ownership and accountability; use of rounds, communication and care coordinators 15

16 IPP Teams Psychiatric Care is probably one of the first areas to focus on Interprofessional Team Care as a result of the nature of the illness 16

17 The Palliative Care Team Example Physician Pharmacist Nurse Patient Clergy Social Work Dentist 17

18 The Palliative Care Team Example Physician prolong life Nurse Social Work quality of life engage family and community 18

19 The Palliative Care Team Example Dentist oral health and quality of life Clergy spiritual influence Pharmacist medication management 19

20 Selected References Rogers, T. (2004) Managing in the Interprofessional Environment: A Theory of Action Perspective. Journal of Interprofessional Care, 15 (3) Glick, M. (2005) Scope of Practice, A Matter of Skills, Knowledge and Erudition JADA, 136, Kaplan, L., Brown, M. (2007) The Transition of Nurse Practitioners to Changes in Prescriptive Authority. Journal of Nursing Scholarship, 39 (2), Csikar, J.I. et.al., (2009) Dental Therapy in the United Kingdom: part 4. Teamwork-Is it Working for Dental Therapists?, 207 (11), Eagar, S.C. et.al., (2010) Scope of Practice Conflict in Nursing: A New War of Just the Same Battle? Contemporary Nurse, 36(1-2), McCallin, A. (2001) Interdisciplinary Practice, A Matter of Teamwork: An integrated Literature Review. Journal of Clinical Nursing, 10 (4)