Description
NURS 682 Responses
Maria Bates Response 1
APRN’s must follow their state and national level policies/rules. Legislation must pass laws that are discussed with other professionals, which makes it important for APRNs to attend these meetings. The presence of APRNs can provide knowledge, experience, and concerns regarding laws and regulations that are in place or new laws and regulations that are being discussed. “Regulation is used to describe scope of practice, the level of education, prescriptive authority, and the level of physician involvement” (Blair, 2018, p. 188). Scope of practice refers to who can prescribe, who can practice as an APRN, and who can receive reimbursement. Licensure refers to authority to practice and “credentialing is the process of assessing and confirming the license or certification, education, training, and other qualifications of the licensed or certified healthcare practitioner” (Blair, 2018, p. 188). Various states have different laws and regulations.
One of the issues for APRNs is having full prescriptive authority. There are 14 states that allow APRNs to practice without physician supervision and have full prescriptive authority. “The states that allow APRNs to have full prescriptive authority include AK, AZ, DC, HI, IA, ID, MT, ND, NH, NM, OR, RI, WA, and WY” (Blair, 2018, p. 188). There are 11 states in which APRNs have independent practice with full prescriptive authority after a period of being under supervision. And there are 26 states in which APRNs have limited practice and prescriptive authority under supervision by a physician (Blair, 2018, p. 188). Having limited prescriptive authority can delay care for the patient as the APRN would need to consult with the physician. “The United States still faces a growing and aging population, and NPs can provide a cost effective and quality source of care” (Brom et al, 2018). APRN can provide care to those who are unable to receive services in a cost-effective manner. This can result in quality care for their patients.
Yeslie Ruiz Gomez Response 2
Important Issue
The most significant issue concerning credentialing and licensing APRNs is the country’s lack of a universal credentialing and licensing system. APRNs must seek state services to get credited and receive their license, which limits their ability to practice in other states. As a result, this factor limits the potential of APRNs to offer healthcare services in other regions that may be underserved. While various measures have been suggested to help solve the issue, a licensing system granting qualified candidates a universal license would help solve this problem. Secondly, the lack of such a system subjects APRNs to extra processes of seeking licensure every time they move to a different state. The nurses must wait for their licenses to be approved before practicing in their new location. A licensing system allowing nurses to practice anywhere in the country would solve these delays, provided they meet the required specifications.
Barriers and Challenges
The most significant barrier that has derailed the progress of APRNs is the presence of differing state laws concerning the scope of practice. Various states differ in the type of autonomy nurses have when providing their services. APRNs face three types of practice environments, including full, reduced, and restricted authority (Kleinpell et al., 2023). States with full authority allow APRNs to offer complete care, including conducting patient evaluations, diagnosing patients, and prescribing medications (Kleinpell et al., 2023). It is different from those with reduced and restricted practice. As a result, this factor becomes a significant challenge for APRNs since most are qualified to offer full practice. Restricting their ability to use their skills slows the progress of APRNs. Most APRNs undergo similar programs and practice hours, and limiting their ability to practice based on state laws derails progress.
Current Legislative Policy
The APRN Compact is a legislative policy proposed in 2020 to allow APRNs to practice in multiple states without applying for additional licensure (Burger, 2023). While this policy is still under discussion in various states, the APRN Compact will help advance their practice since they can offer services in multiple states. However, the differing state laws concerning practice authority continue to delay this revolution. Seven states must pass the law to implement it, and only Utah, Delaware, and North Dakota have passed the policy as of August 2023 (Burger, 2023).
References
Burger, C. (2023, August 14). Catherine Burger, MSOL, RN, Nea-BC. RN Programs – Start Your Journey as a Registered Nurse. https://www.registerednursing.org/articles/aprn-compact/Links to an external site.
Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to aprn practice: Policy and regulatory implications during COVID-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9Links to an external site.
NURS 683 Responses
Rocio Reyes Echemendia Response 1
Fluoxetine is a selective serotonin reuptake inhibitor FDA-approved for major depressive disorder, obsessive-compulsive disorder, panic disorder, bulimia, binge eating disorder, and premenstrual dysphoric disorder (Sohel et al., 2022). Generally, 20 mg to 40 mg daily dosing is required to be effective for most individuals (Sohel et al., 2022). Given Linda’s symptoms and history of depression, it would be advisable to adjust the dosage due to the severity of the symptoms. In this case, the medication can be increased to 40 mg to achieve the optimal therapeutic effect.
In addition to medication, therapy or counseling could be incorporated into Linda’s plan of care. Psychotherapy for patients with depression strengthens the therapeutic alliance and enables the patient to monitor their mood, improve their functioning, understand their symptoms better, and master the practical tools they need to cope with stressful events (Karrouri et al., 2021).
References
Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges. World journal of clinical cases. https://doi.org/10.12998/wjcc.v9.i31.9350
Sohel, J., Shutter, M., & Molla, M. (2022). Fluoxetine. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459223/
Monica Sanchez Response 2
Linda has been taking Fluoxetine 20 mg daily for the past six months and is now experiencing symptoms of fatigue, tearfulness, and difficulty sleeping. I would start by doing a physical assessment to rule out any acute medical conditions causing these symptoms. If everything came back normal, I would ask if there were any life changes or new stressors in Linda’s life that may be causing her symptoms. Once Linda has explained her personal life, I may prescribe a different type of antidepressant to see if that may help Linda’s symptoms. According to Keks et al. (2016), switching antidepressants is warranted when there is an unexpected response in treatment, but any change must be done with caution and must be monitored. Fluoxetine must be tapered off, and there might be a period of having no type of medication in their system, which might cause potential life-threatening exacerbation of illness, which is why close monitoring must be performed (Keks et al., 2016).
According to Antidepressants: Can They Stop Working? (n.d.) there is a condition named tachyphylaxis where the body might adjust to the antidepressant, and the medication might stop working, which is why I would try to switch the prescription and try a new antidepressant. I would also incorporate therapy due to little evidence that having psychotherapy in combination with antidepressants shows a better outcome Cuijpers et al. (2014).
References
Antidepressants: Can they stop working? (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dep…
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry, 13(1), 56–67. https://doi.org/10.1002/wps.20089
Keks, N., Hope, J., & Keogh, S. (2016). Switching and stopping antidepressants. Australian Prescriber, 39(3). https://doi.org/10.18773/austprescr.2016.039
