Narrative Analysis NR667 MSN-FNP Program

Narrative Analysis NR667 MSN-FNP Program

Narrative Analysis: MSN-FNP Program

Before the completion of the program, a narrative analysis is to be completed by summarizing and demonstrating how Chamberlain University’s Master of Science in Nursing (MSN) program Family Nurse Practitioner (FNP) track has prepared its graduates. In this analysis, an evaluation is completed to assess how each program outcome correlated with the assignments from each class. In this review, I will summarize the evaluation of my own professional growth and development as a graduate student in the cognitive, psycho motor, and affective domains as it pertains to this program.

I will also summarize the evaluation of my own professional growth and development as it pertains to the American Association of Colleges of Nursing (AACN) MSN Essentials for Graduate Education and the National Organization of Nurse Practitioner Faculties (NONPF) Competencies. Lastly, I will reflect how my own cultural competencies have been transformed.

How Each Artifact Meets MSN-FNP Program Outcomes

There are five program outcomes in the Chamberlain College of Nursing Family Nurse Practitioner program. These program outcomes are expected to be met by all students and they include:

1. Provide high quality, safe patient centered care grounded in holistic health principles,

2. Create a caring environment for achieving quality health outcomes,

3. Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity,

4. Integrate professional values through scholarship and service in health care, and 5. Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Chamberlain University, 2021).

AACNS MSN Essentials

The American Association of Colleges of Nursing developed nine Essentials of master’s Education as a guide for the graduate nurse to work in various health care settings (AACN, 2021). The nine essentials are 1. background for practice from science and humanities, 2. organizational and systems leadership, 3. quality improvement and safety, 4. translating and integrating scholarship into practice, 5. informatics and healthcare technologies, 6. health policy and advocacy, 7. interprofessional collaboration for improving patient and population outcomes, 8. clinical prevention and population health for improving health, and 9. masters level nursing practice (AACN, 2011).

Throughout this program, I have grown into a more confident leader and disseminator of patient education. I am ready to portray myself as a more confident nurse and nurse practitioner. As an inpatient nurse over the last 18 years, the AACN’s essentials ought to be the framework for how hospitals should operate. By using science and humanities to make the best clinical decisions, it would allow for better patient outcomes and improve quality and safety. Through great organizational and systems leadership, staff satisfaction would be high all while caring for our patients in a more compassionate way.

NONPF Core Competencies

The National Organization for Nurse Practitioner Faculties (NONPF) developed core competencies that reflect the goals for each nurse practitioner program. The NONPF competencies include 1. Scientific Foundations, 2. Leadership, 3. Quality, 4. Practice inquiry, 5.

Technology and information literacy, 6. Policy, 7. Health delivery system, 8. Ethics, 9. Independent practice (Nurse Practitioner Core Competencies, 2017). These competencies explain the steps involved to become confident and educated nurse practitioners. In my own growth and development, I began this career with a scientific foundation by attending graduate school, becoming a leader and charge nurse on a busy cardiac unit, giving ethical and quality care to each patient, and being a disseminator of patient education.

Course Artifacts Correlated to Program Outcomes NR 500NP: Foundational Concepts & Advanced Practice Roles

NR 500 introduced the graduate student to the conceptual foundations and skills essential for a masters prepared nurse. This course explored the scholarly communication of ideas, the use of critical inquiry, and information dissemination (NR 500 Syllabus, n.d).

Artifact #1: Area of Interest PowerPoint assignment. This assignment allowed the student to choose an area of interest, identify a practice problem, and offer positive change solutions. The topic I chose was the early assessment of depression in adolescence. The outcome achieved in this assignment was number 2 and 3. This assignment allowed the student to create a caring environment for achieving quality health outcomes by engaging in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (NR 500 Syllabus, n.d).

Artifact #2: Roles in advanced practice paper. The purpose of this assignment was to provide the student an opportunity to explore the roles and competencies of the advanced practice nurse (NR 500 Syllabus, n.d). This assignment examined roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care which is program outcome #5.

Artifact #3: Systems theory and practice issues. The purpose of this discussion was to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice (NR 500 Syllabus, n.d.). The program outcome met during this assignment was program outcome number 3.

NR 501NP: Theoretical Basis for Advanced Nursing Practice

Artifact #1: Application of theory paper. The purpose of this discussion was to use the application of information in professional experiences to promote the analysis and use of principles, knowledge, and information learned and related to real life professional situations (NR 501 Syllabus, n.d). This assignment demonstrated logical and creative thinking in the analysis and application to a theory of nursing practice which correlate with program outcome #2 and #5.

Artifact #2: Course reflection paper. The purpose of this assignment was to provide the student an opportunity to reflect on the weekly concepts learned in the course. This assignment demonstrated logical and creative thinking in the analysis and application of a theory to nursing practice which correlates with program outcome #2 and #5.

Artifact #3: Concept analysis paper. The purpose of this assignment was to provide the opportunity for the students to complete an analysis of a concept found and a nurse practitioner role supported by a nursing theory using an identified process (NR 501 Syllabus, n.d). The program outcome number 4 was met for this assignment.

NR 599: Nursing Informatics for Advanced Practice

Artifact #1: Medical Appraisal GoodRx paper. The purpose of this assignment was to research available discount programs for medication assistance and be able to disseminate those results to our patients. This correlate with program outcome # 2.

Artifact #2: Patient engagement in partnerships in health care discussion. The reason for this assignment was to demonstrate nursing informatics skills to critique commonly used mobile applications in synthesizing nursing and non-nursing knowledge using a guided appraisal process (NR 599 Syllabus, n.d). This assignment correlate with program outcome #1 by exemplifying professional values in scholarship to support professional and personal development. pier

Artifact #3: Clinical decision support systems paper. The goal of this assignment was to bring ideas and beliefs to the discussions guide for students to engage in dialogues as they achieve the desired learning outcomes/competencies associated with their course (NR 599 Syllabus, n.d.). This assignment actively engaged the student in written ideas of themselves and others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty which correlates with program outcome number 4.

NR 506NP: Healthcare Policy & Leadership

Artifact #1: Health care policy analysis PowerPoint. The reason for this assignment was to develop a health policy analysis presentation that included a problem statement, background, landscape, options, and recommendations from the week’s readings (NR 506 Syllabus, n.d). This assignment correlates with program outcome #4 to analyze social, historical, ethical, and political contexts of health care policies in advanced practice leadership.

Artifact #2: Quality health care: measuring NP performance paper. The purpose of this assignment was to have students research the measurement tools of NP performance. This assignment correlates with program outcome #1 to employ strategies to impact the development, implementation, and consequences of holistic health care policy’s using evidence-based practice principles (NR 506 Syllabus, n.d).

Artifact #3: Legal and ethical decision discussion. This week five assignment was given to students to assist with exploring potential effects on patient outcomes an implication for members of the health care team because of conflict among the health care team (NR 506 Syllabus, n.d). This assignment pairs with program outcome #2 which critically analyzes how healthcare systems and advanced practice registered nurses practice are organized and influenced by ethical, legal, economic, and political factors.

NR 505NP: Advanced Research Methods Evidence-Based Practice

Artifact #1: State of the Science PICO paper. The purpose of this assignment was to provide the opportunity for the graduate nurse practitioner student to become familiar with research processes which are specific to quality improvement (NR 505 Syllabus, n.d). This correlated with program outcome numbers two and five which integrate knowledge related to evidence-based practice and person-centered care to improve healthcare outcomes.

Artifact #2: State of the Science PICO paper part 2. The purpose of this additional information to the first paper was to add additional elements including an abstract, review of the literature, strengths and limitations of current evidence, and development of a quality enhancement improvement plan (NR 505 Syllabus, n.d). This assignment follows the program outcomes for #1, 2, 5, and 6.

Artifact #3: Qualitative Article appraisal. The purpose of this discussion was to explore the meanings and application of various methods used to improve the delivery of health care. This assignment correlates with program outcome #3 where students can engage in a lifelong personal and professional growth through reflective practice.

NR 503: Population Health, Epidemiology, & Statistical Principles

Artifact #1: Chronic health problem paper. The purpose of this paper was to identify a common chronic health issue and provide a detailed background and significance of the disease. The topic I chose was alcohol addiction and I provided current surveillance and reporting, epidemiological analysis, screening and guidelines, and a thorough treatment plan. This assignment correlated with program outcome #5 by displaying compassionate care through evidence-based research for positive health outcomes.

Artifact #2: Healthy people 2020 impact paper. The purpose of this assignment was to provide the framework for the study of infectious and chronic health issues/diseases, which provides a rich source of data for the analysis of trends in disease and health (NR 503 Syllabus, n.d.). This assignment correlates with program outcome #2 which allows the student to obtain population health information from surveillance, observation, community, and control trial-based research.

Artifact #3: Infectious disease paper. The purpose of this assignment was to provide the student an opportunity to explore a communicable disease, to apply the epidemiological triad, and to discern the demographic and at-risk background data for a specific infectious disease agent (NR 503 Syllabus, n.d). This correlate with program outcome #5 by advocating for positive health outcomes through compassionate, evidence based, collaborative advanced nursing practice.

NR 507: Advanced Pathophysiology

Artifact #1: Disease process presentation assignment. the purpose of this assignment was to begin the exploration of the disease process. The topic I chose for this assignment was polycystic ovarian syndrome and I introduce the disease with a brief definition and description with risk factors and the connection to the etiology (NR 507 Syllabus, n.d). This assignment correlates with program outcome #1 by analyzing pathophysiologic mechanisms associated with selected disease states across the lifespan.

Artifact #2: Reflection discussion over weeks one through eight. The purpose of this assignment was to reflect over the past eight weeks and describe how the achievements of the course outcomes in this course have prepared the graduate nurse to meet the MSN program outcome, MSN essentials, and NONPF Core competencies (NR 507 Syllabus, n.d). This assignment correlates with program outcome #1 which relates to research findings in the management of patients with complex pathophysiologic dysfunction.

Artifact #3: PCOS PowerPoint part 2. The purpose of this assignment was to build on the presentation developed in Week 2 by submitting a PowerPoint presentation that contains thorough speaker notes, detailed information on the chosen topic, and the entire disease process presentation. This assignment correlates with program outcome #1 by integrating advanced pathophysiological concepts in the diagnosis and treatment of health problems in selected populations.

NR 565: Advanced Pharmacology Fundamentals

Artifact #1: The autonomic nervous system study discussion. The purpose of this assignment was to provide a problem-based learning methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems (NR 565 Syllabus, n.d). This assignment correlates with program outcome #2 by assisting to make appropriate evidence based therapeutic treatment decisions for individual patients utilizing drugs from the major drug classes.

Artifact #2: State specific guidelines when prescribing controlled substances for the nurse practitioner. The purpose of this paper was to provide the student an opportunity to explore the most recent guidelines and recommendations in the student state of practice for pain management therapies and education (NR 565 Syllabus, n.d.). This assignment connects with program outcome #1 and 2 by identifying client indicators of therapeutic, ineffective, adverse responses and side effects to drug therapy.

Artifact #3: Reflection of the past eight weeks discussion. The reasoning for this assignment was for the student to be able to reflect on personal and professional growth toward achieving competence as a family nurse practitioner. This assignment correlates with program outcome #4 by integrating professional values through scholarship and service in healthcare.

NR 566: Advanced Pharmacology for Primary Care Family

Artifact #1: Hypertension guidelines discussion. The reasoning for this assignment was to provide students with the opportunity to compare two common but different hypertension clinical practice guidelines. The two clinical practice guidelines discussed was the JNC8 and ACC/AHA guidelines for hypertension. this assignment allowed for program outcome #5 by writing appropriate prescriptions according to evidence-based practice guidelines.

Artifact #2: Respiratory guidelines discussion. The purpose of this paper was to discuss how to address the several types of respiratory issues encountered in the primary care setting. Included in this paper was information regarding how to select appropriate medications, analyze factors pertinent to making the most effective drug selection, and analyze client indicators of therapeutic and adverse responses to drug therapy. This assignment correlated with program outcome #5 bye learning how to write appropriate prescriptions according to evidence-based practice guidelines.

Artifact #3: Week five immunization paper. The purpose of this assignment was to familiarize the student with the most recent guidelines and recommendations for vaccine preventable illnesses in the United States. I chose the topic of the pneumococcal vaccine and how it can prevent bacterial pneumonia. This assignment correlated with program outcome #5 by teaching the student to analyze whether pharmacological therapy like vaccines is appropriate for individual patients.

Artifact #1: Introduction of the soap note. The purpose of this assignment was to gather subjective and objective data by completing a focused, detailed health history and physical examination for each physical assessment assignment. In this assignment I created a personalized soap note for a patient in the clinical setting and submitted for review to my professor. This correlates with program outcome #1 and 2 by completing a focused health history an examination for various patient populations.

Artifact #2: Week three soap note template. The purpose of this assignment was to provide the opportunity to conduct a focused exam on the shadow health patient who presented with recent episodes of chest pain in a non-emergency setting. After seeing the patient in the shadow health setting, the student was to create a soap note and compile a list of differential diagnoses. This correlates with program outcome #1 and 2 by in the graduate student how to document findings of the history and physical examination in a logical and organized sequence.

Artifact #3: Week four soap note discussion. The purpose of this assignment was to complete a shadow health physical assessment on a female patient named Tina Jones who was two days prior in a low-speed car accident. The physical assessment of this patient allowed me to increase my own understanding of advanced practice physical assessment skills and techniques and to conduct focused and comprehensive histories and physical assessments for various patient situations. This correlates with program outcome #1 and 2 by teaching the student how to differentiate normal from abnormal physical examination findings and how to document these findings in a subjective and objective format.

NR 511: Differential Diagnosis & Primary Care Practicum

Artifact #1: Allergic rhinitis PowerPoint. The purpose of this assignment was to create a problem-based learning methodology designed to help students develop the reasoning process used in clinical practice. In this assignment I created a treatment plan for allergic rhinitis based on the most current clinical practice guidelines. This assignment correlates with program outcome #5 by formulating an evidence-based management plan for acute and common health problems based on the needs of the patient and family.

Artifact #2: History and physical discussion. The purpose of this assignment was to teach the student how to summarize the history and physical findings briefly and concisely as if you were presenting it to another health care team member using the pertinent facts from the patient. This assignment connects with program outcome #5 by developing comprehensive differential diagnosis through analysis of histories, physical findings, and diagnostic studies.

Artifact #3: Week 2 SNAPPS assignment. The purpose of this assignment is to create a learner centered approach to case presentation in the clinical setting. The SNAPPS model allows the student to take an active role in their educational encounter by discussing the patient encounter beyond the facts. In this assignment I was able to summarize patient findings into an organized oral presentation. This assignment correlated with program outcome #5 by making appropriate use of diagnostic tools (SNAPPS) with consideration to costs, risks, and benefits to individuals.

NR 601: Primary Care of the Maturing & Aged Family Practicum

Artifact #1: Psychiatric disorders in primary care. The purpose of this assignment was to provide the student an opportunity for application of depression and anxiety screening tools for a selected case patient. This assignment correlates with program outcome #1 by employing appropriate health promotion guidelines and disease prevention strategies in the management of mature and aging individuals and families (NR 601 Syllabus, n.d).

Artifact #2: Week 2 COPD case study part one. The purpose of this assignment was to demonstrate competence in the evaluation and management of common respiratory problems by distinguishing between obstructive and restrictive lung diseases (NR 601 Syllabus, n.d). This assignment correlates with program outcome #5 by formulating appropriate diagnosis and evidence-based management plans for mature and aging individuals and families.

Artifact #3: Endocrine case study. The purpose of this assignment was for the student to analyze provided subjective an object if information to diagnose and develop a management plan for a selected case study patient and apply national diabetes guidelines to create an appropriate treatment plan (NR 601 Syllabus, n.d.). This assignment correlate with program outcome #4 by integrating theory and evidence-based practice in the care of mature and aging individuals and their families.

NR 602: Primary Care of the Childbearing & Childrearing Family Practicum

Artifact #1: The discussion of marginalized women. The purpose of this assignment was to provide the student with an opportunity to explore the concept of marginalization and how it impacts the health care of women in childbearing families. This assignment reminded me to provide the most compassionate care to all my patients because you never know what someone is going through. This assignment correlate with program outcome #5 by identifying and addressing health care needs of the marginalized childbearing and child rearing families.

Artifact #2: Week three immunization case study. The purpose of this assignment was to familiarize the student with the most recent guidelines and recommendations for vaccine preventable illnesses in the United States. This assignment correlates with program outcome #5 by integrating current evidence based clinical practice guidelines in the care of childbearing and child rearing families.

Artifact #3: Week four Pediatric Clinical Pearl discussion. The purpose of this assignment is to guide students in identifying behaviors and interactions that commonly occur during the health history portion of a well child exam. This assignment correlates with program outcome #5 by appropriately applying anticipatory guidance and health promotion in the care of childbearing and child rearing families.

NR 603: Advanced Clinical Diagnosis & Practice Across the Lifespan Practicum

Artifact #1: Cardiovascular and hematological conditions in primary care case study. The purpose of this assignment was for the students to be able to improve their ability to formulate diagnosis based on clinical presentation of patients and their ability to understand and apply national guidelines for that diagnosis. This assignment correlates with program outcome #5 by teaching how to interpret subjective and object if data to develop appropriate diagnosis and evidence-based management plans for patients and families with complex or multiple diagnosis across the lifespan.

Artifact #2: Mental health clinical presentation part one. The purpose of this assignment was for the student to have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses in to develop management plans based on current scientific evidence and national guidelines. This assignment correlate with program outcome #5 by incorporating cultural preferences, values, health beliefs, and behaviors into the care of patients and families with complex or multiple diagnoses across the lifespan.

Artifact #3: Mental health final treatment plan/analysis Part 2. The purpose of this assignment was to compile a final treatment plan that included the primary diagnosis, diagnostic testing recommended by national guidelines. This assignment correlates with program outcome #5 by involving the patient and family in the formulation of management plans that align with their goals and perspectives of health and wellness.

NR 667: FNP Capstone Practicum & Intensive

Artifact #1: Narrative Analysis. The purpose of this assignment was for the student to submit a scholarly reflective narrative that demonstrates how all the artifacts submitted, and the course in which the artifacts were produced, meet each MSN program outcome. This assignment correlates with program outcome #5 by appraising my own personal in professional growth toward achieving understanding of the NONPF competencies, MSN Essentials, and Chamberlains Program outcomes.

Artifact #2: Certification review plan. The purpose of this assignment was for the student to develop a plan to study and prepare for the certification exam. This assignment correlate with program outcome #3 by having a plan to engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity.

Artifact #3: Reflection. The purpose of this assignment was for students to Learn the phases a new nurse practitioner could experience in the first few years of practice. This assignment correlates with program outcome #1 by providing high quality, safe, patient centered care grounded in holistic health principles.

PO 1-5 met by discussing how the assigned program outcomes per course were met by discussing three artifacts for each class taken in the FNP MSN Program.

My Professional Growth and Development as a Graduate Student

The three domains of learning are categorized as cognitive, psychomotor, and affective.

In 1956, a group of researchers led by Benjamin bloom formulated these domains into a classification best explained as a taxonomy of learning domains (Muzyk et al., 2018).

The cognitive domain is broken up into six categories, they are as follows; 1.

Remembering, 2. Understanding, 3. Applying, 4. Analyzing, 5. Evaluating, and 6. Creating. These categories are the basic objectives to learning and involve recognizing and remembering facts, comprehending facts, and using them in application, analyzing the new knowledge while building a structure or pattern from diverse elements to form a whole, and evaluating oneself by making judgments about information in presenting defending opinions. In this program, I felt like the education I had received was all being put together once I started clinical. I was remembering facts and skills that I did not think had sunk in.

The affective domain is broken down into five categories, they are as follows; 1. Receiving phenomena, 2. Responding to phenomena, 3. Valuing, 4. Organization, and 5. Internalizing values. This domain describes the way people react emotionally and their ability to feel other living things pain or joy (Muzyk et al., 2018). This was an important domain regarding the clinical setting and collaborating with patients. Once I started really working with each patient and learning about their needs and requests, the patient end provider relationship formed, and I genuinely wanted the best for each patient.

Bloom and his team did not add to the psychomotor domain however, other educators have created their own psychomotor taxonomies. This domain relates to the learner’s response to cues, both verbal and nonverbal, as well as performance, imitation, and trial and error (Muzyk et al., 2018). The psychomotor domains now are categorized into 7 categories, they are as follows; 1. Perception, 2. Set, 3. Guided response, 4. Mechanism, 5. Complex overt response,

6. Adaptation, and 7. Origination. To me, this means through trial and error, we learn what to do and what not to do. In clinical, I am learning to produce differentials along with treatment plans and present them to my preceptor who guides me in the correct direction.

Transformation of My Cultural Competence

There are many factors outside the traditional healthcare setting when it comes to health. These social determinants of health (SDH) include, but are not limited to, education, housing quality, and access to healthy foods (Nair, & Adetayo, 2019). These social determinants often cause many of our patients to have negative health outcomes, often at no fault of their own. Over the last 9 months, I am happy to say the clinic I have done my clinical hours in have been eye opening and have evolved my own cultural competence as well as my emotional intelligence.

I was able to meet many Afghanistan refugees and their families as well as learn more about their culture and ways of thinking. It is extremely important nowadays to fully embrace each patient as a unique entity and care for them while considering their own cultural aspects, even if it is not our own way of thinking.

Narrative Analysis NR667 MSN-FNP Program References

American Association of Colleges of Nursing. The Essentials: Core Competencies for Professional Nursing Education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf

Chamberlain University. (2021). Academic catalog/Syllabus 2021, Vol.13: Graduate program outcomes. https://www.chamberlain.edu/media/3371/catalog.pdf

Muzyk, A.J., Tew, C., Thomas-Fannin, A., Dayal, S., Maeda, R., Schramm-Saptya, N., Andolsek, K., & Holmer, S. (2018). Utilizing Bloom’s taxonomy to design a substance use disorders course for health professions students. Substance Abuse, 39(3), 348-353. doi: 10.1080/08897077.2018.1436634.

Nair, L., & Adetayo, O. A. (2019). Cultural Competence and Ethnic Diversity in Healthcare. Plastic and reconstructive surgery. Global open, 7(5), e2219. https://doi.org/10.1097/GOX.0000000000002219

National Organization of Nurse Practitioner Faculties (NONPF). Nurse Practitioner Core Competencies. https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/npcorecompetenciesfinal2012.pdf

NR 667 Week 1 Discussion

The purpose of this assignment is to provide an analysis and synthesis-level evaluation of the factors that influence both contemporary advanced practice nursing and the time-period of transition that occurs within the first year of clinical practice.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Reflect on the elements of successful transition from Registered Nurse to Advanced Practice Registered Nurse. (CO 5)
2. Evaluate the patient-centered medical home, value-based payment, and interdisciplinary care models espoused by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its’ impact on the quality of healthcare. (CO 2, 5)

Due Date: Wednesday 11:59pm MT of Week 1

The student must provide an initial response to the discussion topic by Wednesday, 11:59pm MT. Subsequent posts, including substantive responses to peer(s) and faculty questions must occur by Sunday, 11:59pm MT. A total of 3 substantive posts are required on 3 different days.

A 10% late penalty will be imposed for initial discussions posted after the deadline on Wednesday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).

A 10% penalty will be imposed for not entering the minimum number of interactive dialogue posts (3) OR not posting on the minimum required number of days (3). NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).

Total Points Possible: 50

**To view the grading criteria/rubric, please click on the 3 dots in the upper in the box at the end of the solid gray bar, above the discussion board title, and then Show Rubric.

Requirements:

Part 1: Using Brown and Olshansky’s (1997) model, describe what interventions you plan to do during your first year of practice to help you navigate the changes described during in each phase.

Part 2: We are seeing rapid change in primary care as stakeholders are demanding higher quality healthcare at reduced costs. After reading the Cuenca (2017) and Shi, et al. (2017) articles, provide a synthesis-level evaluation of how you believe the patient-centered medical home and value-based payment models will: (1) impact your personal practice as a nurse practitioner, and (2) transform the way primary care is delivered in the United States.

Part 3: After reading the AANP (2015) and White, et al. (2017) articles, what are your thoughts on the economic benefits of using nurse practitioners in healthcare practices? How would you respond to this question if asked in a job interview? Support your response in Part 3 with evidence from the literature.

NR667 Week 1 Discussion: Transition to Advanced Practice Registered Nurse Sample Approach

Nurses may consider advancing their careers in the pursuit of personal growth and development, as well as the quest for better care delivery approaches. The advanced practice registered nurse (APRN) role is an important nursing role development that was created as a solution to the shortage of primary care physicians, as well as to meet the primary care needs of the rural and underserved population (Kerr & Macaskill, 2020). The number of APRNs in the job field has been growing at an exponential rate, which can be attributed to the emerging and anticipated future service needs created by the growing and aging populations.

While there is a clear opportunity for personal development and improved care, it requires a greater level of commitment, dedication, hard work, and compassion-fueled efforts. As a result, as I prepare to embark on the journey, I am ready to face the challenges while also using them to shape me into a better future APRN.

The purpose of this paper is to (1) describe the interventions I intend to use in navigating my first year of experience using Brown and Olshanky’s 1997 model and (2) provide a synthesis-level evaluation of how patient-centered medical homes (PCMH) and value-based payment models (VBPM) will impact my practice and transform primary care delivery, and (3) provide my thoughts on the economic benefits of using nurse practitioners in healthcare practices.

Part 1: Theoretical Model of the Transition to the Primary Care Nurse Practitioner Role

The first year of practice presents numerous challenges to new nurse professionals, but it also serves as a crucial foundation upon which they can build professional expertise. Brown and Olshansky (1997) described the “from limbo to legitimacy” model, which nurses can use as they advance in their careers from amateurs to cognoscenti. The model is divided into four stages: laying the foundation, launching, meeting the challenge, and broadening the perspective. The stages highlight the distress and accomplishments of the initial year of advanced practice.

The first phase, laying the foundation, is the time between graduating from school and beginning the initial nurse practitioner position. This stage has been divided into four subcategories: recuperating from school, negotiating the bureaucracy, looking for a job, and worrying (Brown & Olshansky, 1997). During this phase, I intend to take a two-week vacation away from home with my friends. The years I spent in nursing school were filled with difficulties, and I intend to ease and relax my mind by taking a break from the shackles of nursing school.

In addition, after my vacation, I intend to spend more time with my family members—siblings and parents—to bolster my bonds with them. After one month, I anticipate having pressing financial needs, which will prompt me to apply for jobs at various hospitals. However, due to the uncertainty of finding work, I anticipate that worry will pretzel the situation, which I intend to duck by volunteering at hospitals of my choosing while I wait for a job.

The second phase is launching, which is described as the most painful and difficult period. This is the time it takes to transition from the safe shores of school to the turbulent and tumultuous waters of the first year of practice (Brown & Olshansky, 1997). This stage is distinguished by heightened anxiety, a sense of being an imposter, getting through the day, and battling time. According to Brown and Olshansky (1997), the lack of experience among novice professionals contributes to feelings of imposter syndrome.

I intend to avoid this by identifying and utilizing a mentor, consulting on things I don’t know, and reading to alleviate any anxiety that may arise from not knowing. Brown and Olshansky (1997) also emphasize that there is no harm in saying, “I don’t know what this is, but I’ll look it up before the procedure.” While I understand that novice nurse professionals are slower than their experienced counterparts and that the pressure to complete tasks may be doubled or tripled, especially at 4:30 p.m. on Fridays, I will make sure that I schedule appropriately, seek help when necessary, and consult in areas that are unclear to me.

In the third phase, meeting the challenge, nurses have made significant progress and are less anxious, more settled, and more legitimate. At this point, they reflect on environmental issues and concerns that may have contributed to their success. Following an interview with 35 nurses at 1, 6, and 12 months after graduation and entry into the practice field, the majority reported feeling more like a nurse practitioner at 6 months, and even better at 12 months than at 1 month, indicating they have accumulated sufficient knowledge and skills in the practice (Brown & Olshansky, 1997). I intend to boost my confidence and competence by seeing multiple patients and performing a variety of procedures.

Finally, the last stage of the model is broadening the perspective. Nurses become more system savvy at this point, learning how clinics operate, connect with other institutions, and become more involved in politics and advocacy roles (Brown & Olshansky, 1997). The patients’ positive feedback, praises, gratitude, and numerous thank-you notes for the services they receive are credited for the competency attained at this stage. Such words of affirmation encourage nurses to take more risks in learning more complex systems to improve their competency. At this point, in addition to developing system knowledge and reassuring myself, I will up the ante.

Part 2: Patient-Centered Medical Homes (PCMH) and Value-based Payment Models (VBPM)

Various healthcare delivery systems, including patient PCMH and VBPM, have been developed to achieve the triple objectives: improve patient care delivery, reduce healthcare costs, and improve the patient care experience. The PCMH models ensure the delivery of a comprehensive, accessible, high-quality, cost-effective, patient-centered, culturally appropriate, and team-based approach (Shi et al., 2017). In contrast, the VBPM advocates for reimbursement methods that are based on the value a care provider adds to the patient (Cuenca, 2017).

The emergence of VBHM is attributed to the efforts of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which created new incentives for physicians to transition to value-based, alternative payment models, the US Department of Health and Human Services (HHS), which announced in 2015 a goal of moving 50% of Medicare payments into alternative payment models linked to value by 2018, and the Health Care Transformation Task Force, an alliance of major health systems, insurers, and other industry players, which announced a goal of placing 75% of its business into value-based payment arrangements by 2020 (Cuenca, 2017). The PCMH and the VBPOM have implications for a nurse’s practice and primary patient care in general.

Impact on my Practice as a Nursing Practitioner

To implement the PCMH, a nurse must demonstrate a high level of planning, which will allow for the appropriate scheduling of patient visits. This will help me improve my planning skills as a nurse practitioner and my ability to solve problems by seeing patients and addressing their concerns in the allotted time. Regarding VBHM, due to patient attribution, nurses are individually accountable to specific patients, striving to solve their problems as effectively as possible (Cuenca, 2017). Furthermore, this approach will allow me to surround myself with a team of dedicated professionals who will check whether quality metric data has been correctly assigned, update any missing metrics, and review patient satisfaction surveys, thereby increasing my productivity.

Impact on Primary Care Delivery in the United States

Both the PCMH and the VBPM are low-cost interventions that aim to improve quality of life. As a result, such models have increased access to healthcare because people are no longer concerned about the exorbitant costs that must be paid, and they are also guaranteed quality care.

According to the Centers for Disease Control and Prevention (2021), the PCMH model is associated with effective chronic disease management, increased patient and provider satisfaction, cost savings, improved quality of care, and increased preventive care. VBHM has been linked to higher patient quality metrics. Cuenca (2017), however, expresses concern that the ease of access to high-quality, cost-effective interventions may lengthen patient wait times. This is ethereal in comparison to the benefits accrued from the care model.

Part 3: Economic Benefits of Using Nurse Practitioners in Healthcare Practices

The expansion of the supply of nurse practitioners has been proposed as one method of addressing the shortage of primary care physicians as well as other issues such as access to care. Poghosyan et al. (2019) conducted a study to determine the economic impact of expanding the scope of practice (SOP) of nurse practitioners for Medicaid. The findings were as follows: compared to states with reduced SOP, states with full OP had 17% lower outpatient costs (i.e., $160.45 per beneficiary per year) and 10.9% lower prescription drug costs (i.e., $145.44 per beneficiary per year).

States with restricted SOP had 11.6% higher outpatient costs (i.e., $107.31 per beneficiary per year) and 5.1% higher prescription drug costs (i.e., $67.89 per beneficiary per year). These findings not only support nurses’ roles in the profession but also the need to broaden their scope of practice. According to the American Association of Nurse Practitioners (AANP) (2015), the cost-effectiveness of nurse practitioners begins with their academic preparation, which costs 20% to 25% less than that of physicians.

Furthermore, nurses are far more cost-effective than physicians in terms of compensation, with statistics demonstrating that while the median total compensation for primary care physicians ranges from $208,658 (family) to $219,500 (internal medicine), the mean full-time nurse practitioner’s total salary was $97,345, across all types of practice (AANP, 2015). As a result, my thoughts, as supported by the literature cited, are that the role of nurse practitioners in lowering healthcare costs is indisputable.

In a job interview, I would cite the median earnings of physicians and compare them to those of nurses, as stated clearly on the AANP’s websites. Furthermore, I will compare the costs of academic preparation for nurses and physicians to demonstrate that nurses are more cost-effective in healthcare delivery. Moreover, unlike physicians, who may leave the hospital to attend to their private clinics, nurses stay in hospitals for longer hours to care for patients. This increases their importance in providing patients with high-quality, cost-effective care.

Narrative Analysis NR667 MSN-FNP Program References

American Association of Nurse Practitioners. (2015). Nurse practitioner cost-effectiveness. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-cost-effectiveness

Brown, M.-A., & Olshansky, E. F. (1997). From limbo to legitimacy: A theoretical model of the transition to the primary care nurse practitioner role. MCN. The American Journal of Maternal Child Nursing, 22(5), 274. https://doi.org/10.1097/00005721-199709000-00016

CDC. (2021, May 14). Patient-centered medical home (PCMH) model. Centers for Disease Control and Prevention. https://www.cdc.gov/dhdsp/policy_resources/pcmh.htm

Cuenca, A. E. (2017). Preparing for value-based payment: Five essential skills for success. Family Practice Management, 24(3), 25–33. https://www.aafp.org/fpm/2017/0500/p25.html

Kerr, L., & Macaskill, A. (2020). The journey from nurse to advanced nurse practitioner: applying concepts of role transitioning. British Journal of Nursing (Mark Allen Publishing), 29(10), 561–565. https://doi.org/10.12968/bjon.2020.29.10.561

Poghosyan, L., Timmons, E. J., Abraham, C. M., & Martsolf, G. R. (2019). The economic impact of the expansion of nurse practitioner scope of practice for medicaid. Journal of Nursing Regulation, 10(1), 15–20. https://doi.org/10.1016/s2155-8256(19)30078-x

Shi, L., Lee, D.-C., Chung, M., Liang, H., Lock, D., & Sripipatana, A. (2017). Patient-centered medical home recognition and clinical performance in U.s. community health centers. Health Services Research, 52(3), 984–1004. https://doi.org/10.1111/1475-6773.12523

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