08/02/2011. What is a Nurse Practitioner? Brief History of the Profession. Brief History of the Profession. Brief History of the Profession

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1 Interacting with the Pediatric Neurology s What is a? Definition A registered nurse who has advanced his or her career through formal education or formal training. Other definitions vary by state AANP Advanced practice nurses who provide high-quality health care services similar to those of a physician. s diagnose and treat a wide range of health problems. They have a unique approach and stress both care and cure. Besides clinical care, Nurse Practitioners focus on health promotion, disease prevention, health education, and counseling ( DEFCA /4710/2011FAQswhatisanNPupdated.pdf) The (NP) role was created in 1965 in response to a physician shortage It was first developed as a Master s Degree program at the University of Colorado The focus of the program was on pediatrics and well child treatment Specialties began to imerge Family Adult Acute Care Gerontological Neonatal Psych American Nurses Association (ANA) and the American Academy of Pediatrics issued guidelines on educational programs in 1971 Master of Science (MSN) in Family specialty developed in 1972 at the University of Washington Intent of the program was to create NPs who could practice independently and collaborate with physicians as necessary 1979 Push for all education of NPs to be at a Masters level NP programs 86 certificate programs 45 Master s Degree Programs ANCC (American Nurses Credentialing Center) developed first NP certification exam Now other specialty societies have certification exams 1984 Master s Degree was required 1996 Master s Degree requirements established by American Association of Colleges of Nursing (AACN) Advanced health and physical assessment Advanced physiology and pathophysiology Advanced pharmacology 1997 Medicare allowed NPs to independently bill 1

2 States Scope of Practice Currently s perform in accordance with their state s Scope of Practice Autonomy Prescriptive authority Push for doctoral degree programs (DNP) States Scope of Practice Demographics Chart Overview from UCSF Center for the Health Professions, Fall 2007 More information regarding Individual State s Scope of Practice Guidelines Twentieth Annual Legislative Update in The Journal vol33, No. 1, ,712 s ,532 s 94% female % practicing in offices 11.6% practicing in hospital based out-patient services 9.8% in hospitals Education and Certification Most NPs have Master s Degrees 2003 survey showed 90.5% of all NPs had a Master s Degree In 2006, there were 342 accredited Masters and Post-Masters Degree Programs 2 Accrediting bodies CCNE: Commission on Collegiate Nursing Education NLNAC: National League for Nursing Accreditation Commission Master s Degree Programs must address: Research Healthcare policy, organization, and financing Ethics Professional Role Development Theoretical foundations of nursing practice Human diversity/ social issues Health promotion and disease prevention Education and Certification Advanced Practice Care Core Courses Advanced health and or physical assessment Advanced physiology and pathophysiology Advanced pharmacology Clinical Practice Minimum of 500 hours in direct clinical practice during the educational program Current programs range from 500 to 720 clinical hours Current Programs 87.9% offer Family Tracts 48.3% offer Adult NP 63.1% required GPA of >3.1 for admission 46.3% offered distance learning Didactic Component Typically credits 2

3 Doctorate in Nursing Practice (DNP) Required by 2015 Schools began to admit to DNP programs in schools 140 schools with DNP programs in planning process 1000 hours of clinical practice required Focus on practice (PhD focuses on research) 36 mos of full-time study 12 mos for post-masters candidates final DNP project Practice portfolio Practice change initiative *must use evidence to improve outcomes The Essentials of Doctoral Education for Advanced Practice Nursing AACN, The Neurology Neurology Neurology No current NP programs providing a dedicated Neurology focus on the job training We use PNPs and FNPs Primary and supportive roles Role requirements Health history and exam Ordering appropriate diagnostic studies Diagnosing and treating various Neurological conditions Promoting wellness and disease/injury prevention Patient and family education/ counseling Performing minor procedures Participating in research Patient advocacy Administrative duties Collaborating with other members of the health care team Providing service in a cost-effective manner Our s The University Child Neurology In Patient Vanessa Ruppe, APRN (Epilepsy Surgery Program) Britt Schloemer, APRN Out Patient Angela Bishop, APRN Paula Hartman, APRN

4 In-patient Manages the plan of care for all patients admitted to the Neurology Service as well as those patients requiring consultations within Kosair Children s Hospital Provides care to Neurology patients within the scope and practice of the State of Kentucky and under the supervision of the attending Neurologist Provides recommendations to other members of the medical team, including ER physicians Answers pages and calls regarding Neurology questions at Kosair Children s Hospital or KCMC Provides patient and family education Facilitates discharge with the help of the discharge planners In-patient (cont.) Provides vital communication to all members of the health care team including other physicians, nurses, and out-patient personnel Adjusts VNS settings Updates and establishes policies, procedures, and protocols Provides education to hospital staff through in-services, lectures, and handouts Is an active member of the Kosair Children s Hospital Medical Team, participating in activities to establish Kosair Children s Hospital as a top children s hospital in the United States Provides accurate documentation Participates in lectures for all members of the Child Neurology Team Epilepsy Surgery NP Manages all patients who may be potential surgical candidates Ensures all testing has been performed or ordered Coordinates all members of the surgical program Neurologists Neuropsychiatrists Neurosurgeons Neurovascular Surgeons Nurses Nuclear Medicine Radiology PICU Attendings and staff Anesthesia Provides care for the surgical patient while in Kosair Children s Hospital Out-Patient Provides complete care to out-patient Neurology patients with a variety of diseases and disorders Estimated Child Neurology Patients Works closely with the Child Neurology Attendings, requesting input and advice as needed Admits patients to Kosair Children s Hospital when appropriate Answers questions and provides recommendations to patient families Provides Neurological recommendations to Primary Care Physicians and other sub-specialty personnel regarding children who are not admitted to Kosair Children s Hospital. Advises physicians outside of Kosair Children s Hospital as to what procedures, diagnostic tests, and treatment options are available for their patients Video EEG patients Out-Patient Makes medication adjustments Adjusts VNS settings Ensures patients have adequate medication and provides refills as necessary Provides accurate documentation and dictations Ensures accurate billing of services Participates in lectures for all members of the Child Neurology Team Provides excellent care to Child Neurology patients in a cost-effective manner Seizure/Event Clarification Used to clarify events Typically follow a normal routine EEG with a history consistent with seizures. Can also be used when events continue or change despite interventions Can also be helpful when a patient has an abnormal EEG but has different event characteristics Call a nurse practitioner at the office for advice on when and how to order prior to ordering this test ( ) Please FAX the pt s HPI and PMH to Vanessa at Surgical Candidates Seizure clarification and focality identification First of many steps Patients may be taken off of their medications prior to or on admission Usually done after a routine EEG Contact person is Vanessa Ruppe, APRN

5 Summary Questions concerning general neurology patients admitted to Kosair Children s Hospital Britt Schloemer, APRN Questions concerning patients admitted to the Epilepsy Monitoring Unit Vanessa Ruppe, APRN Questions concerning patients who are not currently in Kosair Children s Hospital Paula Hartman, APRN or Angela Bishop, APRN Questions concerning how to order diagnostic tests or needing to have a patient seen ASAP Paula Hartman, APRN or Angela Bishop, APRN References AACN. (2006). The Essentials of Doctoral Education for Advanced Practice Nursing. Retrieved June 15, 2011, from AACN Web site: American Association of Neuroscience Nurses (2009, February 27). American Association of Neuroscience Nurses Scope of Practice for Neuroscience Advanced Practice Nurses. Paper presented at the meeting of the. unknown. American Medical Association (2009, October). AMA Scope of Practice Data Series: s. Christian, S., Dower, C., & O'Neil, E. (2007). Overview of Scopes of Practice in the United States -Discussion. San Francisco: UCSF Center for Health Professions, University of California. Questions? 5