Assignment Paper: APN Interviews

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The work for this paper entails interviewing TWO different categories of advanced practice nurses (APNs). One APN has to be a primary care nurse practitioner (e.g., family NP, adult NP, pediatric NP); that is, the NP cannot be one who is an acute care NP. Furthermore, the NP must work in a primary care setting such as a “doctor’s office” or community health center—that is, in a setting the buzz-word for which is now medical home. An NP who works in a retail clinic or free-standing urgent care center would also be acceptable (but NOT an emergency department). Yes, there are many APNs who are prepared as FNPs or adult NPs who take jobs in non-primary care settings (e.g., as hospitalists and as providers in nursing homes). But a common premise with health care reform and the Affordable Care Act is that there already is and will be a huge need for primary care providers, thus paving the way for even greater opportunities for NPs in this area. It is important that you get a firm grasp of how NPs are prepared for primary care, and thus why NP organizations assert an important solution to the primary care provider shortage is educating more NPs which is why every state should allow full independent practice authority for APNs, especially NPs.

The other APN may be your choice of one of the following: a certified nurse midwife (CNM) or a certified nurse anesthetist (CRNA) or a clinical nurse specialist (CNS). There is no limitation regarding the types of settings these APNs might work. Be sure to indicate the state(s) where the APNs practice.

Although the information gathered from these APNs will be acquired via an interview, the paper should be written in summary format (i.e., it should not look like a dialogue between you and the APN). Information on both interviews should be in a single document. It is not necessary to provide the APNs’ full names. Most elements of APA format should be used, including a title page and abstract. Most students’ papers that address all of these questions for both APN are about five double-spaced pages, without counting the title page or abstract (be sure to read your APA manual regarding what an abstract should look like!). An exception to the APA format requirement is that a reference list is not required, since all of the information will be derived from two sources (the APNs whom you interviewed). Although you have free range to discuss other topics about advanced practice nursing, you must address the following issues with each APN (please follow the order of list below):

1. Reason for their choosing their specific APN specialty.

2. Descriptions of: (a) the type of setting where they work (e.g., community hospital, major medical center, private primary care practice, clinic for the underserved, etc.), and (b) a “typical” day as they render care.

3. Level of satisfaction with their role in general, and specifically within the system where they are currently employed.

4. The type of APN certification that they hold, including identifying the accurate name of the certifying body with which they are certified (Note: Review your textbooks for the correct names of these certifying bodies. Also note there are several different certifying bodies for NPs).

5. Whether they have prescriptive authority and whether they prescribe controlled substances. If they do prescribe controlled substances, you must indicate from which schedules of controlled substances they are allowed prescribe.

6. Whether they must practice according to an agreement with a physician. If so, is the relationship supervisory or collaborative?

7. Are they credentialed and privileged by a hospital or health system? If the answer is “yes,” ask them to explain what the credentialing and privileging process entails at their organization (e.g., are the documents reviewed by only the human resources department, the nursing department, or the medical staff office, a combination of all three, etc.).

8. Whether they belong to a professional organization(s) that specifically addresses APN issues. If so, which one (s)? If not, why not?

9. Their understanding about the DNP degree (i.e., have them actually explain what they know about the degree) and whether they have this degree already or intend to pursue it. Be sure to probe to see if they have positive or negative feelings about the DNP—and why.

10. Final grading criterion: Paper’s adherence to APA format (with the exception that references are not required for this particular paper), including grammar, spelling, punctuation, sentence structure, etc.

Total points for this assignment is 100; each question above is worth 10 points.

CRNAINTERVIEW.docx

Interview questions for Advanced Practice Nursing.

First of all, I would like to express my thanks for being willing to participate in this process as I work towards becoming a Nurse Practitioner. Your feedback is a valuable part of my education, and I would like to thank you for your assistance on this part of my journey. Assignment Paper: APN Interviews

Please feel free to add additional comments, discuss other topics in addition to your responses to the required elements below.

Thank you again!

Zelda

What is the reason that you chose your specific APN specialty?

I chose to become a CRNA because I saw it as the most advanced nursing practice that I could see myself doing. I wanted to do clinical work and not management. I enjoy the bedside aspect of ICU nursing and anesthesia encompasses that as well as more independence.

Please provide a description of: a) the type of setting where you work (i.e. community hospital, major medical center, private primary care practice, clinic for the underserved, etc.), and (b) a “typical” day as you render care.

I work in a 500 bed pediatric and adult level 1 trauma center. I care for patients in both the adult hospital as well as the children’s hospital. I care for patients getting all types of surgery except cardiac and liver transplant. I do both inpatient and outpatient OR settings. My typical day begins the day before doing chart reviews of my cases for the next day and writing preop notes. I also develop my anesthesia plan for the patient based on the case and the patient.

The next day I come in and set up my anesthesia work area, discuss the anesthesia plan with my staff anesthesiologist and do a preop assessment for my patient. In these few moments before going to the OR with the patient my job is to put them at ease and get them to trust me with their life in the OR. The OR RN and I take the patient back to the OR, I determine if any pre medication for anxiety or pain is needed and administer it if so. After the OR timeout typically the MD anesthesiologist pushes induction drugs. I mask ventilate the patient, place any airway device needed for the case, assess its positioning and secure the device. From this point generally I administer medications as needed for pain, nausea, muscle relaxation and reversal. I am responsible for monitoring and maintaining the patients vital signs. At the end of the case, the MD is required (for billing) to be present for emergence from anesthesia and extubation. Typically I am responsible for actually stopping the anesthesia, removing the airway device and assessing airway patency after removal. The surgery resident and I then transport the patient to the PACU and give bedside report to the PACU RN.

What is your level of satisfaction with your role in general, and specifically within the system where you are currently employed?

As a CRNA, when we graduate most of us must decide whether we want to practice independently, do our own regional anesthesia but not care for very sick patients on a regular basis or practice at a large center where we likely will not do our own regional anesthesia and be medically directed but then care for sicker patients. The smaller facilities generally come with higher pay, but more call. The larger centers, especially those with residents come with a more restrictive practice, usually less pay but a much more favorable schedule and far less call. Assignment Paper: APN Interviews

When I finished school I was older than most new CRNA’s, I have children and my choice was to have a better schedule. I would love to practice independently but at this point in my life the schedule is more important. I also have a love for pediatric anesthesia and while you may care for some healthy kids getting basic procedures in smaller places, you will not care for the types of patients that I do at a large children’s hospital. The children’s hospital keeps my satisfied with my current position. The perfect CRNA position currently does not exist where I could do my current job with independent practice.

What type of APN certification do you hold? Identify the accurate name of the certifying body with which you are certified.

I am a CRNA. We are certified by the NBCRNA (National Board of Certification and Recertification of Nurse Anesthetists)

Do you have prescriptive authority and do you prescribe controlled substances? If you do prescribe controlled substances, from which schedules of controlled substances are you allowed to prescribe?

I do have prescriptive authority. In my current position I do not prescribe outside the OR. Legally I can prescribe controlled substances schedule 2 and all other legal schedules.

Must you practice according to an agreement with a physician? If so, is the relationship supervisory or collaborative?(Please share as much information re: this as you are able.)

In my current position I am required to practice with an agreement with an MD. This is a supervisory relationship as our OR cases are billed as medically directed. This is the most restrictive type of anesthesia billing and practice for a CRNA. It is typical of all large medical centers throughout the country.

In the state of WI however, APRN’s are not required by the practice acts to have practice agreements. APRN’s can practice indecently and because we are a medicare opt out state we can also bill independently.

Are you credentialed and privileged by a hospital or health system? If your answer is “Yes”, please explain what the credentialing and privileging process entails in your organization (i.e., are the documents reviewed by only the human resources department, the nursing department, or the medical staff office, or perhaps all of these, etc.). Assignment Paper: APN Interviews

I am credentialed by a hospital. The credentialing process is actually fairly easy and efficient. We have to be credentialed every 3 years. I am sent a packet of forms to fill out about 2 months ahead of time and just have to fill it out and turn in to our HR contact. The finalized credentials are reviewed by the hospital credentialing committee and the hospital medical staff affairs office.

Do you specifically belong to a professional organization (s) that specifically addresses APN issues? If so, which one (s)? If not, why not?

I am a member of the AANA (American Association of Nurse Anesthetists). This is our voice for legislative actions. Currently they are addressing a few things, first the AANA recently approved “nurse anesthesiologist” as a descriptor for us. The American Society of Anesthesiologists (ASA) is currently fighting this with bills in several states to stop this. They also are constantly lobbying for our ability to practice independently in all states. Another large practice issue for us to try to prevent licensure of anesthesiologist’s assistants (AA) from getting practice authority in any more states. The ASA is consistently fighting to try to make our CRNA practice level the same as the AA level of practice. AA’s can not practice independently ever and this is what the ASA would like for us as well. Many of our issues are the same as any other APN, sadly the AANA and other APN organizations do not work together very well. If they would all work together we may have more success.

What is your understanding about the DNP degree (Please explain what you know about the degree itself), and whether you have this degree already or intend to pursue it? Can you please also tell me your feelings ( Positive or negative) about the DNP and why you feel this way.

The DNP is a clinical doctorate degree. It is 1 of 2 end degrees for an APN (PHD being the other). The DNP is more focused on clinical practice than research. I plan to get my DNP (or DNAP) at some point. I think that requiring a more advanced degree to practice is not a bad thing. If we are going to make the case that we are as good as an MD, adding more education can not hurt that argument. Assignment Paper: APN Interviews

Please feel free to add any additional information re: your specific field that you may feel may be beneficial for my learning process.

CRNA’s as a group had a falling out with other APN’s and RN’s in the past. This is why many CRNA programs are not housed in schools of nursing. Consequently many CRNA’s do not have a traditional MSN or DNP. Many of us have Masters or doctorate of nurse anesthesia practice, some even have a masters in biology or just anesthesia. Some nursing schools do house CRNA programs but most do not.

If at all possible, please return the responses to me by sometime Saturday, Feb,8,2020.

Sorry, I know its a little late, I was on call this weekend 🙁

Many thanks!

Zelda Skaife MSN/RN
CNPinterview.docx

1.)    What is the reason that you chose your specific APN specialty?

The love of this side of medicine and the lack of empathy from others. These patients support and understanding.

2.)    Please provide a description of: a) the type of setting where you work (i.e. community hospital, major medical center, private primary care practice, clinic for the underserved, etc.), and (b) a “typical” day as you render care.

I currently work in a hospital clinic in 2 different locations. A typical day for me is seen patients starting at 8:00 in the morning and 8 AM at 5 PM. I see anywhere between 10 and 22 patients per day

3.)    What is your level of satisfaction with your role in general, and specifically within the system where you are currently employed?

I love what I do. I attempt to stay out of the weeds and politics.

4.)    What type of APN certification do you hold? Identify the accurate name of the certifying body with which you are certified.

I am an adult psychiatric nurse practitioner board-certified and gain this certification through the ANCC.

5.)    Do you have prescriptive authority and do you prescribe controlled substances? If you do prescribe controlled substances, from which schedules of controlled substances are you allowed to prescribe?

I do have prescriptive authority and prescribed controlled substances. I do not prescribe class I.

6.)    Must you practice according to an agreement with a physician? If so, is the relationship supervisory or collaborative?(Please share as much information re: this as you are able.)

In the state of New Mexico I do not have to work under a physician. However, due to regulations as well as hospital bylaws I do work under a physician. I do not have to report to this physician each and every patient. Assignment Paper: APN Interviews

7.)    Are you credentialed and privileged by a hospital or health system? If your answer is “Yes”, please explain what the credentialing and privileging process entails in your organization (i.e., are the documents reviewed by only the human resources department, the nursing department, or the medical staff office, or perhaps all of these, etc.).

I am credentialed and have privileges at my local hospital. However, the hospital has not begun allowing nurse practitioners to admit under their own names. We still have to admit under an MD.

8.)    Do you specifically belong to a professional organization (s) that specifically addresses APN issues? If so, which one (s)? If not, why not?

I belong to ANCC and APNA

9.)    What is your understanding about the DNP degree (Please explain what you know about the degree itself), and whether you have this degree already or intend to pursue it? Can you please also tell me your feelings ( Positive or negative) about the DNP and why you feel this way.

DNP programs are meant for people who are wanting more knowledge and the research area as well as a social area. I am not sure if this is something I want to obtain/pursue at this time. This is mainly due to no increase in pay or standing within the medical community. I believe that a DNP is worth while, but not at this time due to financial gains.

Please feel free to add any additional information re: your specific field that you may feel may be beneficial for my learning process.

When you are completed with your program it is important that you work with others who are willing to continue your learning in a collaborative manner. Do not feel you have to take the first job or decrease in pay since you’re a new provider. Assignment Paper: APN Interviews