N5350 Roles Final Study Guide

1. What are the 4 settings for prescriptive authority? Describe the requirements in each setting for physician supervision, # of NPs, chart review, and any other special requirements in that site. correct answer- 1. Medi ...

1. What are the 4 settings for prescriptive authority? Describe the requirements in each setting for physician supervision, # of NPs, chart review, and any other special requirements in that site. correct answer- 1. Medically Underserved 2. Physician Primary Site 3. Physician Alternate Site 4. Facility Based Practice Site. * General requirements per TBON rule 222.5: regular visits, chart review as determined by APRN & physician, periodic face to face meeting of APRN & physician to discuss pt care & improvement. 1a) Medically Underserved correct answer- *site must be official, physician must be reachable by phone & must be provided with daily status report of any major problems outside of the protocol. *must have protocols. 1b) Physician Primary Practice Site correct answer- * Must have protocols. *Sign drug orders only for pts whom the MD has/will establish a relationship. *alternate MD may delegate. *MD may delegate to no more than 7 APNS or PAs. *Physician on-site visits should be 50% of the time according to BME. 1c) Facility Based Practice correct answer- *Must be physically present in facility (hospital or long term facility). *Physician must give prior consent. *Delegation only at > one hospital or > 2 long term care facilities - now it is 7 FTEs. *Long term care-only 4 APNs (APRNs) or 4 PAs or their FTE equivalent - now it is 7 FTE & approved by Chief Physician of Facility. *Protocol signed by the Chief Physician. 1d) Physician Alternate Site correct answer- *No longer in effect. 2. The FOUR Approved Categories of APN in TX? correct answer- *CRNA, NP, CNS, and CNM 3. NP requirements by BON for approval of license/ AP recognition each biennium. correct answer- *Current valid RN licensure. *400 hours of current clinical practice. *20 hours of CEs. *8 hours of continuing education in pharmacotherapeutics. *Current board certification. *Separate application for dual roles. 4. New NP graduate requirements when applying for the board? correct answer- *Must take and pass national certification exam. 5. What is the NP's scope of practice based on? correct answer- *Nurse practice acts define legal scope of practice for licensed practitioners. *Includes privileges for diagnosis, treatment, prescriptive authority and reimbursement. 11. What are clinical privileges and how are they obtained? correct answer- *autonomy to perform expanded role functions based on the individuals licensure, educational preparation, clinical experience, and credentials. *Via contractual agreement with hospitals or long term care facilities. 12. Define Malpractice correct answer- *Any professional misconduct, unreasonable lack of skill, or infidelity in professional or fiduciary duties, or illegal or immoral conduct. *Negligence is the failure of an individual to do something that a reasonable person would do, that results in injury to another. *The alleged failure on the part of a professional to render services with the degree of care, diligence, and precaution that another member of the same profession in similar circumstances would render to prevent injury to some one else. 13. FOUR Elements of Malpractice correct answer- 1. Duty: provide some level of care, had some contact. 2. Dereliction: reasonable, ordinary care, skill and diligence as NP's in good standing in similar practice. 3. Damage: Must have an injury or no malpractice even if violated standard of care; cap "pain and suffering" $250,000 to $500, 000. 4. Causation of Injury: For malpractice to have occurred, a breach of the standard of care must have caused an injury to the patient. 15. National Practitioner Data Bank correct answer- *Receives and discloses the reports on medical malpractice. Who is credited to be the first advanced practice nurse role? correct answer- Nurse Anesthesia in 1800's- perhaps the oldest advanced nursing specialty, Sister Mary Bernard at St. Vincent's Hospital was the first anesthetist Who is credited to be the founder of the first nurse practitioner role? correct answer- Loretta Ford-1965- Colorado Who is (are) the oldest primary care providers in the history of advanced practice nurses? correct answer- Midwifes in 1700's- perhaps the oldest primary health care provider Martha Bullard, 1785 is the oldest noted in publication What are the roles of APRNs? How are they different from each other? correct answer- To provide health care to individuals, family, groups in a variety of health care settings (homes, hospitals, institutions, offices, clinics, etc) APRN includes NP, nurse midwife, nurse anesthetist, and clinical nurse specialist What states are responsible for being the first to have advanced practice language in their nurse practice act? correct answer- Idaho (language read- "assess, diagnose, treat") What is NONPF? What is their influence for APRNs? correct answer- National Organization of Nurse Practitioner Faculty They have developed domains and competencies Organized role competencies (policy, ethics, quality, leadership, etc) How is the NP role different from PA role? correct answer- •PA's work directly under a MD, NP's can function independently •NP's focus on multiple practice and nursing models •PA's focus on medical tasks utilizing a medical framework What are the key elements of OTA, Brown, Safriet and Mundinger correct answer- • OTA NP's provide equivalent care to MD's. Patients who receive care form an NP show decreased patient symptoms. • Brown Patient satisfaction and resolution of pathological conditions were greater for NP's over MD's NM's use less technology/ analgesia NM's achieved equivalent neonatal outcomes • Safreit There is abundant data on the NP role in providing high quality, cost effective care/ There are major restrictions on the practice of NP's and these barriers should be removed. • Mundinger Compared outcomes in patients who were randomly assigned to either NP's or MD's. Results showed that patient outcomes were comparable. How does the Texas Board of Nursing define the NP role? correct answer- A RN approved by the board to practice as an APN based on completing an advanced education practice program acceptable by the board. The term includes an NP, nurse midwife, nurse anesthetist, and a CNS. The APN is prepared to practice in an expanded role to provide health care to individuals, families, and/or groups in a variety of settings including but not limited to homes, hospitals, institutions, offices, industry, schools, community agencies, public/private clinics and private practice. The APN acts independently and/or in collaboration with other health care professionals in the delivery of health care services. Where and when did the role first begin? correct answer- 1965- University of Colorado-PNP What factors have supported initiation of the role and its development over time? correct answer- 1.Changes socially/culturally •WW2, Vietnam war- needed anesthetist •Communities needed midwives, lack of prepared OB's 2.Changes in the Health care system •No physicians to administer anesthesia •Decrease in medical interns and MDs, and was therefore an increased need for the NP What are 3-5 major research outcomes (process or outcomes findings) about NP impact that you can document? correct answer- 1.NP's provide equivalent care to MD's •Process measures: Adequacy of pedi exams, medication prescribed, short and long term compliance •Outcome measures: improved patient functioning, resolution of acute problems, decreased pain or discomfort in children 2.NP's provide superior care to MD's •Process measures: # of diagnostic tests, effectiveness of interpersonal management skills •Outcome measures: reduced patient symptoms, better HTN control, increased weight reduction, pain decreased in adult patients, improved activity and decreased anxiety in chronic patients 3.Patients are generally satisfied with the quality of care provided by them, particularly with the interpersonal aspects of care. 4.NP's are a solution to healthcare system issues such as Access to Care, Quality of care and Cost of Care What are 3 major questions about the NP role and its impact that research should address? correct answer- 1.Does eligibility reimbursement for nurses cause loss of quality of care or incentive to help more people? 2.Would requiring a DNP for APN cause less nurses to become APN and therefore cause a greater shortage for the growing population. 3.Does have limitations on prescriptive authority cause a delay in care and pain management? What are 3 major healthcare system issues that can be impacted by the NP role? Describe how these can be impacted. correct answer- 1.Assess to care 2.Quality of care 3.Cost of care *According to Safreit, in order for NP's to be part of the solution, barriers to practice that exist must be removed. •Scope of Practice: no protocols, full authority to practice with no supervision •Unlimited prescriptive authority •Full reimbursement •Autonomy as a provider: hospital privileges What are 3 issues that can impact the NP role either positively or negatively? Describe how the issues can impact the role and what you think needs to be done to promote a positive outcome. correct answer- 1.DNP: positive side is lengths of programs are lengthy anyways with no change in credentialing awarded. You would not have to do or much extra, and you would have a DNP. Negative side is this might push nurses from continuing their education and the need for care providers should take precedent over professionalized agenda. 2.Prescriptive authority: increasing prescriptive authority could impact the role positively in that patients will not have a delay of care. Pain could be better managed. 3.Eligibility for reimbursement: offers larger groups of people in communities primary care but can also cause competition as NP's and MD's attempt to serve the same population. Also, umbrella corporations tend to give the NP a min number of patients to see and then offer incentive pay to see more. Loss of quality of care? Identify and be able to discuss the 3 phases of transition by Barton, 2007. correct answer- 1.The Identity Loss Phase •Early in the APN program. Come in as expert and now you are a novice nurse again. Try to separate from prior career. 2.Transitional Role Evolution •Uncertainty of the APN role continues. Feel a sense of role limbo and may feel invisible. Peers are important. Resocialization occurs acquiring individuality and new role identity. 3.Incorporation Phase •Occurs at the end of the program usually in the final practicum course. Change in relationship between RN peers. End of phase is passing of the APN certification exam What are the considerations towards transition from the RN to the APN role? correct answer- •Develop a Theoretical Nurse Practice Framework: emphasizes EBP, research, to stay on top of APN profession •Know the APN scope of practice •Choose appropriate preceptors that will encourage feelings of self worth •Get a mentor •Reflect each day •Maintain a clinical Elog (values, attitudes, practice) •Maintain a clinical portfolio •Network with peers and experienced NP's •Have a Positive Attitude •Maximize clinical experiences •Treat failures as learning experiences •Keep up with legal issues What are 5 major responsibilities of the RN role that you will bring to the NP role? correct answer- •Document •Educate •Observe and assess patients •Review treatment/care plan •Consult with MD's and other professionals Be able to identify/discuss top issues for the APN. correct answer- •You can become so specialized that you lose broad knowledge that is needed. •Some specialty roles are recognized in some places but not others. Ex: forensic NP in California but not in TX •There are so many credentials that it is confusing •Being recognized as a PCP as an NNP •Putting the MD name on a prescription bottle, pharmacies accepting NP scripts •Hospital privileges •Medicare and Medicaid reimbursements •Third parties can deny reimbursements to NP for care •Have to get an NPI number (everyone has to have it, don't really get why its an issue) •Autonomous APN Practice- no supervision by MD. Would have prescriptive authority •Has to be in protocols to delegate to anyone other than MA, NA •Needed md signature to order supplies •Social problem of discounting Discuss the evolution of the APN. correct answer- i.Includes Specialization: a concentration in a selected area of clinical nursing. •Includes specialties (pedi, women's health) and subspecialties (diabetes) ii.Involves expansion •Stage 1: Specialty begins- in a practice setting •Stage 2: Specialty organizes- institution training develops, specialty organization forms (NANN) •Stage 3: demands mount, knowledge base grows, scope of practice grows, regulations established to make sure public is safe, articles appear Is there a difference between the APRN, APN, and the Nurse Practitioner? If yes, elaborate? If no, elaborate. correct answer- •The NP is a type of APN. •APRN and APN are similar terms for the same thing. What are the 4 APRN Roles? correct answer- •Clinical nurse specialist (CNS), nurse anesthetist (CRNA), nurse midwife (CNM), and nurse practitioner (CNP) What are the recognized NP roles by the Consensus Model? correct answer- •Family, Adult-gerontology, neonatal, pediatrics, women's health/gender, and psychiatric-mental health Medicare and Medicaid reimburse the NP at what percentage of the physician's reimbursement? correct answer- •Medicare: 85% of the 80% the MD gets for reimbursement •Medicaid: 92% of the 80% of the MD unless its Texas healthy steps and then its 100% of what the MD gets Organizations and Resources: What is CNAP/ NONPF? NAPNAP" NANN? AANP? ANCC? Tri Council? AACN? TNP? correct answer- •CNAP: Coalition for Nurses in Advanced Practice •NONPF: The National Organization of Nurse Practitioner Faculties- promotes quality nurse practitioner education at the national level •NAPNAP: National Association of Pediatric Nurse Practitioners: organization for PNP's •NANN: National Association of Neonatal Nurses • AANP: American Association of Nurse Practitioners •ANCC: American Nurses Credentialing Center •Tri Council: organized to advance policy at national level •AACN: American Association of Critical-Care Nurses •TNP: Texas Nurse Practitioner Which of these organizations in question 7 is responsible for certification of APRNs? What are the renewal requirements of the certification by the recognized organization(s) in questions 7? correct answer- •ANCC- American Nurses Credentialing Center, renewed every 5 years. 150 Contact hours. Min of 1000 practice hours. Testing if you do not have practice hours. Can a Blog be accessed by the public? True or False? Explain. correct answer- •Yes, it can be disseminated to others Are confidentiality and privacy the same? Explain. correct answer- •NO they are different. •Confidentiality has to do with sharing only the information with the patients informed consent or that is required if not disclosing the information could result in patient harm. Or sharing with other health care members for the purpose of providing care. •Privacy: has to do with the patient's expectation and right to be treated with dignity and respect. "need to know" What are the steps to avoid for inappropriate us of social media by the NP? correct answer- •Ethical and legal obligation to maintain privacy and confidentiality at all times. •Prohibited from transmitting electronic media any patient-related image •Do not identify patients by name or give info that can identify them •Do not refer to patients in a disparaging manner •Take photos or videos on personal devices •Maintain professional boundaries with patients in the online environment •Consult employer policies and comply with them •Promptly report any identified breach •Do not make disparaging remarks about employers or co-workers •Do not post content or speak on behalf of the employer unless authorized to do so What are the 6 tips to avoid as listed by ANA? correct answer- 1.Standards of professionalism are the same online as in any other circumstance 2.Do not share of post info or photos gained through the nurse-patient relationship 3.Maintain professional boundaries in the use of electronic media. Online contact blurs the boundaries 4.Do not make disparaging remarks about patients, employers, or coworkers 5.Do not take photos or videos of patients on personal devices 6.Promptly report a breach of confidentiality or privacy What are 3 key elements of any healthcare system and how do these interact with each other? correct answer- -Cost -Access -Quality -change in any one of the parameters above changes the remaining two Describe primary care and discuss how your specialty role relates to the primary care system. correct answer- -Primary Care: (Buppert pg 7-8) •the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs •when a consumer makes contact with a healthcare provider who assumes responsibility and accountability for the continuity of healthcare regardless of the presence or absence of a disease •the healthcare which the clients receive at the first point of contact with the healthcare system that is continuous and comprehensive, included health promotion, prevention of the disease and disability, health maintenance, rehabilitation, identification of health problems, management of health problems, and referral •The NNP provides very specialized care to a specific group of patients in the NICU in collaboration with the neonatologist. How can (and how has) the NP role been affecting healthcare in the US? correct answer- (Buppert pg 7) The NP can address a need for more primary providers in underserved areas of the nation, as well as address changes in health care from the Affordable Care Act. As more health plans designate certain generalist physicians as PCPs for groups of patients, it is important for NPs to be included in the definition of PCP. It is also important for NPs to be included as providers who can be a "medical home" for a patient. What identified issues drive health care changes? correct answer- Employers wanting lower premium costs, improved QOC, and enhanced employee benefit packages. Increases in cost of health care services (cost rising twice as fast as wages). Not enough primary care physicians. Fear about government intervention/control. Lack of universal access to care. Growing complexity of health care system. Growing number of uninsured (12.4 million women and 8 million children). Health Care Triangle (Costs, Access, Quality) Health Care System Basics (Cost, Access, Quality) - a change in one parameter changes the remaining two What are the various organizational designs of managed care delivery systems? correct answer- A.HMO (Health Maintenance Organizations) - Primary feature is the sharing of financial risk between insurer and care provider. Comprehensive care for fixed costs. Cost control is limitations of patient seeking services and services being referred. 3 types 1st - Staff Model: health care providers are salaried employees of health plan, more control over services allowed 2nd - IPAs (Independent Practice Associations): contracts are made with health care providers in private practice settings to offer health care services to HMO members, less control over how services are used 3rd - Network: a combination of staff and IPA B.PPO (Preferred Provider Organization) - discounted fee agreements, seeking outside of list will result in higher costs C.POS (Point of Service) - patients can select their choice of provider at the time the service is needed rather than upon entry into plan D.UR (Utilization Review Companies) - assist in monitoring how and what health care services are being used, authorize services requested, validates claims submitted, monitoring of and reporting on the medical necessity of services provided E.EPO (Exclusive Provider Organizations) - contracts with 1 hospital to service the HMO members with a specific set of health care providers, if don't use contracted group pay total cost out of pocket F.Managed Insurance - traditional insurance companies that implement some sort of the managed care principles ex BCBS, Aetna, Cigna, Kaiser, Humana What are the attributes of the PCP according to Joel? correct answer- Primary Clinical Practitioner: -comprehensive assessment -diagnosis of health and disease -treatment and management -referral to other professionals -counseling -leadership and management -health promotion and disease prevention What does Joel identify as the principles guiding the Medical Home Model? correct answer- MHM is an ongoing relationship with the health care provider to provide first contact, continuous, and comprehensive care. Should include: active patient participation, enhanced access, open scheduling and expanded hours, new patient communication and potentials via email/phone, emphasis on preventive services for all age groups. Identify seven external forces affecting health care delivery? correct answer- A. Social Values - ethnic diversity, cultural diversity, social cohesion B. Global Influences - immigration, trade and travel, terrorism, epidemics C. Economic conditions - general economy, competition D. Technology development - biotechnology, information systems E. Population characteristics - demographic trends and issues, health needs, social morbidity (AIDS, drugs, homicides, auto accidents) F. Physical environment - toxic waste, air pollutants, chemicals, sanitation, ecological balance, global warming G. Political climate - president and congress, interest groups, laws and regulations Social Media What are the 4 settings for prescriptive authority? correct answer- 1. Medically Underserved (site must be official-federal or state) 2. Physician Primary Site 3. Physician Alternate Site 4. Facility Based Practice Site (licensed hospital/LTC) Describe the requirements in each setting for physician supervision, # of NPs, chart review, and any other special requirements in that site. correct answer- *Medically Underserved- Physician Supervision>Reachable by phone> provided daily status report of major problems,> onsite 10% of hours of operation>Chart Review>10%-Special Requirements>Must have protocols *Physician Primary Site-Physician Supervision-Must have protocols, physician on site 50% of the time--# of NPs-7 APNs/PAs per MD *Physician Alternate Site-Physician Supervision-Physician reachable, on site 10% of the time, within 75 miles of primary practice *Facility Based Practice Site-Physician Supervision-MD present at facility, MD gives prior consent--# of NPs-7 FTEs-Special Requirements-Protocol signed by MD What are the 4 approved categories of advanced practice nurses in Texas? correct answer- CRNA, NP, CNS, and CNM What things does the Board of Nursing require the NP to have before approving for RN license/advanced practice recognition each biennium? correct answer- -Current valid RN licensure. -400 hours of current clinical practice. -20 hours of CEs. -8 hours of continuing education in pharmacotherapeutics. -Current board certification. -Separate application for dual roles. What are the requirements for the new NP graduate when applying to the Board? What does initial approval look like? correct answer- -Texas BON grants authorization, APRN licensure (not advanced practice titles) -Must take and pass national certification exam. What is the NP's scope of practice based on? correct answer- -Educational preparation, continued advance practice experience, Accepted scope of professional practice of specialty organizations -Nurse practice acts define legal scope of practice for licensed practitioners. -Includes privileges for diagnosis, treatment, prescriptive authority and reimbursement. How would an NP change his/her scope of practice? What would be required? correct answer- -Proof of graduation from APN program and/or national certification. Need post-master's certificate and MSN How is the term "protocol" defined in Texas? correct answer- -Texas: protocols as written authorization to initiate medical aspects of care (allow APN to exercise professional judgment and are not required to outline specific steps APN must take) What are the key elements of a protocol or practice agreement? correct answer- -Broad enough to allow APN to exercise judgment ("but not limited to...") -Accessible to verify authority to provide medical aspects of care -Maintained, review and re-sign annually Are NPs in Texas allowed to prescribe controlled substances? If so, what is required to be able to do this? What are limitations, if present, on this kind of prescribing? correct answer- -Must obtain valid Rx authority number (must practice in qualifying site, MD/DO must delegate authority per delegation protocols, MD/DO must register name and license of APN with BME, APN registration of Prescriptive authority form) -Must apply for DEA number: -Forms provided by board -Limitations: -Prescribe per protocols and scope -controlled substances: schedules III, IV, and V -Issued for only 90 day period -Must consult with MD/DO for refills -Not authorized for child less than 2 y/o without consulting MD/DO -Document consult -DEA # of MD/DO must be on the prescriptive authority -APN's DEA and DPS must be on prescription Can you delegate medication administration to an unlicensed person? If not, how would you manage this in a primary care setting? correct answer- -Cannot delegate to MA, LVN, CNA, but MD can delegate to NP to delegate to MA, LVN, or CNA What are clinical privileges and how are they obtained? correct answer- -Clinical privileges the autonomy to perform expanded role functions based on the -individual's licensure, educational preparation, clinical experience, and credentials. -Via contractual agreement with hospitals or long term care facilities. Obtaining: -acceptance of APN by medical and hospital staff -clear definition and approval of the scope of practice of APNs -development of entry & credentialing process -revision of hospital and nursing policies to reflect expanded nurse roles How is malpractice defined? correct answer- -Any professional misconduct, unreasonable lack of skill, or infidelity in professional or fiduciary duties, or illegal or immoral conduct. What are the 4 key elements of malpractice that must be proven for malpractice to have occurred? Give a clinical example of each one. correct answer- 1. Duty: provide some level of care, had some contact. (even bad advice on the phone/neighbor). If you give professional advice or treatment in ANY setting, a duty may be established. 2. Dereliction: reasonable, ordinary care, skill and diligence as NP's in good standing in similar practice. Evidence-based practice 3. Damage: Must have an injury or no malpractice even if violated standard of care; cap "pain and suffering" $250,000 to $500,000. 4. Causation of Injury: For malpractice to have occurred, a breach of the standard of care must have caused an injury to the patient. What is the difference between a claims-made and an occurrence based malpractice policy? correct answer- Claims-made coverage: only those claims filed during the policy coverage period, regardless of when they occurred (buy tail insurance as needed- coverage extension- large lump sum) Occurrence-based coverage: covers events of alleged malpractice which occurred during the policy period, regardless of the date of discovery or when the claim was filed (all NPs should obtain their own occurrence insurance per Dr. Adams- keep your policy letter showing you were covered back then) What is the National Practitioner Data Bank? correct answer- Tracks actions against health care practitioenrs, all hospitals query data bank q2years, not available to public thought. Receives and discloses the reports on medical malpractice. What are at least 5 things you can do to prevent malpractice claims? correct answer- -Care in establishing pt-provider relationship -Know the standard of care & practice within it -Follow practice guidelines &/or protocols -If in doubt, take conservative approach -Rule out worst diagnosis early on -Know your limits (training & experience) -Follow-up with pt & document the plan to do so -Effective interpersonal relationships -Careful, complete documentation in chart What are 3 things you should do and/or not do if you are notified of a malpractice claim? correct answer- Call your liability insurance company Do not talk about the suit with anyone Retain your attorney (provided by insurance company) Never change a record (your insurance company can drop coverage) A deposition can be as important as trial (and can prevent a trial) Think carefully before agreeing to settlement (goes on record with NPDB) What are key characteristics of an effective collaborative relationship? correct answer- Trust- ensures a high-quality working relationship, develops over time Knowledge- knowledge and trust remove the need for supervision Shared responsibility - joint decision making for quality patient care and outcomes, as well as accountable practice Mutual respect- for the expertise of all members of the team should be the norm Communication- not heirarchial but rather two way to ensure the sharing of patient information and knowledge, questioning the approach to care of either partner cannot be delivered in a manner that is construed as criticism, but as method to enhance knowledge and improved patient care Cooperation/Coordination- promote the use of the skills of all team members, prevent duplication, and enhance the productivity of the practice Optimism- promotes success when the involved parties believe that collaboration is the more effective means of promoting high quality of care What specific things can you do to promote effective collaboration? correct answer- Create a collegial team, accept growth and development as a joint responsibility, use protocols and guidelines wisely, watch your language, socialize students to communication skills needed for collaborative interactions.Agreement on common purpose, effective communication, must have frequent and direct communication for a positive collaborative practice, value and acknowledge each providers contribution, implement role negotiation and conflict resolution on a daily basis to preserve relationship. What are three key characteristics from Joel of the definition or essentials of collaboration? correct answer- Essential Components: Separate and unique practice spheres - autonomous, trusting relationship; confidence in partner's skill Common goals - bidirectional referrals and consultation Shared power control Mutual concerns - consensus-driven decision making; equitable reporting lines and evaluators; mutually defined goals of the practice; open, informal communication; parity between providers (physical space, caseload, and support staff); positive support by collegues, support staff, and consumers What are three key competencies identified by Joel for to achieve collaborative practice? correct answer- Assertiveness, communication skills, conflict management, cooperation, coordination, clinical skills, mutual respect, decision making skills, positive attitude, trust, willingness to dialogue How do decision-making and communication interact with each other to affect collaboration? correct answer- Poor communication patterns also affect working relationships and seriously hinder any attempts at collaboration, often resulting in separate professional decision-making that can create confusion and safety issues. Physician abuse - result of poor communication and lack of trust, creating a defensive, noncollaborative practice environment in which the number of errors rises and patient safety and positive outcomes are threatened. Line of reporting accountability What are major steps having to do with communication that are helpful to achieve and/or improve Collaboration? correct answer- Create a collegial team, accept growth and development as a joint responsibility, use protocols and guidelines wisely, watch your language, socialize students to communication skills needed for collaborative interactions. Agreement on common purpose, effective communication, must have frequent and direct communication for a positive collaborative practice, value and acknowledge each providers contribution, implement role negotiation and conflict resolution on a daily basis to preserve relationship. What is a specific strategy you will use in your first NP position to overcome barriers to collaboration identified by Clarin (2007)? (First list the barriers she identified.) correct answer- Joel states: educational isolation, professional elitism, organizational hierarchy, unrecognized diversity, role and language confusion, inadequate communication patterns, professional dissonance. Clarin states: lack of knowledge on NP scope of practice, lack of knowledge about NP role, poor physician attitude, lack of respect, poor communication, patient and family reluctance to NP care. Participate in interdisciplinary rounds to visibly show the pt/family the NP's involvement with the medical management of care. What approximate percentage of revenue generated is used for office overhead? correct answer- Rule of Thumb is 50%. Larger practices with lower overhead (cost to open practices doors, salaries, rent, utilities, phones, etc), due to economies of scale might be 25-35% What key data do you need to be able to track your revenue generation? Use specific terms to answer. correct answer- Revenue - income generated Volume - the number of services provided Price - income received for each service provided Ex: -20pts/day, 100pts/week, 4800pts/year over 48 weeks -Average $85 reimbursement per patient (each practice will be different, includes labs, and only collected billings, and based on federal payers (Medicare), state payers (Medicaid), third party payers (insurance companies), or self pay -4800 x $85.00 = $408,000 revenue generation What kind of financial data will you ask the office manager to receive? correct answer- Buppert pg 350-351) - Name - Address - Telephone Number - Social Security Number - DOB - Method of payment: insurance, cash, credit card - Insurance company name, address, and telephone number - Copy of insurance card - Emergency contact name, address, and telephone number What are all the sources of revenue that you will need to track in your practice? correct answer- (Joel pg 204) In addition to patient services, organizations may generate other operating revenue such as: parking garage or cafeteria, or indirect research revenue, the overhead received from research sponsors for providing facilities and administrative support for research projects. What kind of billing can an NP submit for hospitalized patients on which she/he is rounding? What is required for billing? How is the physician involved in this billing? correct answer- Medicare: In-hospital care, the NPs services can not be billed separately to Medicare id the NPs salary is reported as part of the annual cost report (NP employed by hospital); if the hospital is not receiving reimbursement for the NPs salary as a component of the annual cost report or the NP is part of a physician group or is a subcontractor to the hospital, the NP services can be billed as a component of Medicare Part B physician services; an NP can not take over care of the patient on his/her own because federal law requires that a patient is under the care of a physician Name 3 factors used to calculate the RVUs score. correct answer- Practice Expense: the practice's overhead expenses Work: physician's time, intensity, and technical skill required for the service, mental effort and judgment Malpractice Expense What is the intended purpose of RVUs? correct answer- To determine the physician fee schedule based on variety of factors including geographic location. Services are reimbursed on the basis of resources related to the procedure rather than historical trends. Physician services are paid on a fixed fee schedule. What data are needed to calculate an NP's productivity? correct answer- Level of visit code. Number of patients seen. Other revenue from labs, etc. Patient age and ICD-9 code profiles. Patient satisfaction. Number of patients seen daily, weekly, monthly, annually. Level and type of service provided. Accurate tracking of patients and receipts. What is the percentage of overhead expenses in a medical practice range from the lowest to the highest? correct answer- 25-50% of the productivity income What is considered a typical payment rate to a physician collaborator by an NP with an Independent practice? correct answer- The NP pays the physician 10% of net revenue for consultation fee. What is the difference between the resume and the curriculum vitae (CV correct answer- The CV is an overview of your professional life, everything you have done professionally. A resume is a general and concise introduction of your experiences and skills as they relate to a particular career or position that you are aiming to acquire. When should the resume be used? correct answer- A resume is used to apply to most non-academic jobs When should the CV be used? correct answer- CVs are mostly used when applying for faculty positions, for grants or fellowships or for research positions in industry, academia or government. Whenever your research productivity and teaching experience would be valued. How often should both be revised/updated? correct answer- Every 6 months When and how could each be required to submit in the course of the career of the APN? correct answer- Resume- for each time you apply for a job or advancement within current position. CV- Any time you apply for a faculty positions, grants or fellowships or for research positions, academia or government. What are the steps of the marketing process? correct answer- •Assessment of personal and professional goals, Planning, Implementation (updated resumes, prepared for interviews), Evaluation What are the 4 "Ps" of marketing? Discuss the characteristics of each of the "Ps". Discuss the characteristics of the 5th "P". correct answer- 1.Product - The service the APN offers. "YOU!" Consider the benefit of the product (Convenience, uniqueness, quality, economy, scope of service.) 2.Place - The location and environment for the APN practice 3.Price - The monetary value exchanged for the services of the APN--Profit - sum of money left over after revenue is generated and bills are paid. Fixed Costs. Variable costs. Total Costs 4.Promotion - The marketing of the services offered and available by the APN to the target population/group/community 5.Public relations-The "5th P"-Establish a plan for public relations. Consider hiring a public relations agent Discuss marketing and the 10 key questions to be considered related to marketing. correct answer- •What are we in and what is the purpose for the organization's existence? •Who is the client? •What is the client's need? •Which markets should the organization be addressing? •What are the strengths of the organization? •What are the weaknesses of the organization that need to be attended to? •Who are the competitors? •Which groups (sections/targets do we want to serve in the community? •What are our marketing strategies to communicate to these groups? •What strategies should we develop related to pricing, promotion, access, and the types of services offered? Identify and describe the current marketable skills as related to traditional roles of the NP. correct answer- A.Clinician B.Consultant C.Educator D.Researcher E.Administrator Describe/discuss ownership or structure of a business. Sole Proprietorship - correct answer- a.Owned and operated by one person b.Simple organization c.Easy to form / inexpensive d.Owner resumes all responsibility and risk e.Advantages i.Owner makes all decisions ii.Losses can be deducted from person income iii.No potential liability for purchases, mistakes or bad judgments from partners iv.No double taxation f.Disadvantages i.Owner responsible for all expenses ii.Ups and down are managed alone Describe/discuss ownership or structure of a business. Partnership- correct answer- a.The association of two or more people to carry on a business and make a profit b.Are relatively easy to form c.Liabilities for debts and expenses are shared d.Capital is easier to obtain e.Decisions to be made: i.If a partner dies, is sued, wants out; how losses and profits are divided, how are decisions made, ii.Who is the administrator -shared? f.Advantages: i.Risk is shared ii.Success and failure are shared iii.Losses can be deducted from individual partner's taxable income iv.There is back-up for individual partners in a practice g.Disadvantages i.Debts incurred by one partner is shared in the partnership ii.Partners share liability for the others mistakes iii.Higher risk for disputes among partners iv.Less productive partner affects the business Describe/discuss ownership or structure of a business. Limited Liability Company (LLC)- correct answer- a.Combines elements of partnerships and corporations b.Individuals are liable for debts of company with limitations c.Income is to the individuals as in a partnership d.Losses pass through the individual as in a partnership e.Professionals may form a LLC f.Advantages i.Combines the best of partnerships and corporations ii.The business entity affords protections against individual liability as in corporations in lawsuits. g.Disadvantages i.States may not recognize this type of business ii.There may be major or minor restrictions with this form of business Describe/discuss ownership or structure of a business. Corporation- correct answer- a.A legal entity apart from the owners with all the legal rights and responsibilities of a person i.Except for those rights that only a natural person can exercise b.There is a larger group of persons to make decisions c.Liability is limited to the corporation's assets and tax advantages i.There are higher taxes and operating expenses d.Advantages i.Several individuals have ownership increasing the distribution of responsibilities for decision-making and dispute resolution ii.Expenses are taken from a central pool before distributions of profits to stockholders iii.There is legal limitations on the personal liability of individuals e.Disadvantages i.Large amount of documentation required by law ii.Corporate profits are taxed meaning the owner could pay taxes twice - one of corporate profits and the second on distributions of profits What are the components of a business plan? correct answer- 1.A business plan is a guide to operation and a source of management information to facilitate decision-making and performance measurement. 2.Specifically tailored to the intended business 3.Will vary in format, depth and length according to its purposes and uses 4.An important document towards the success of a new business in the marketplace 5.Should be concise and interesting 6.SEE THE 10 PRODUCT QUESTIONS (question #3) - a business plan answers the 10 questions 7.The major goal of the business plan is to get financing for the new business What is involved in a loan application? correct answer- 1.Educate the lending institutions about APN's roles and place in the market 2.All aspects of the business plan must be addressed 3.Be prepared to offer equity 4.Be prepared to present in-depth personal balance sheet 5.Loans have to be paid back within a time limit What are the marketing strategies for marketing the APN? What are at least 5 strategies you would use to negotiate for a desired outcome? Be specific about how you would use these. correct answer- •Market in low cost settings - Schools, neighborhood centers, clinics, the workplace •Educate on cost saving benefits to managed care organizations •Develop strong working relationships with physicians •Keep statistics and analyze the impact of the APN oCost savings, patient satisfaction, and outcomes •Develop a strong marketing plan and include critical elements oKnow the market oKnow the product oKnow your value •Overcome weaknesses oAreas with no or little knowledge, education, or experience. What are the 4 key elements of the marketing process? How would you apply these to your new practice when you graduate? correct answer- 1.Assessment 2.Planning 3.Implementation 4.Evaluation What are at least 5 evidence-based outcomes that NPs have provided based on research findings? How would you describe these to someone to promote the product that is a NP care? correct answer- 1.NP's provide comparable or better outcomes in primary care 2.NP's increase patient satisfaction 3.NP's increase retention 4.NP's increase revenue 5.NP's improve the efficiency of a practice 6.NP's improve the face "likability" of the practice. What are the difference between the models that exist in the healthcare system and the models of care provided by the NP? correct answer- Healthcare System Models (google...) 1) Beveridge Model: total government control of healthcare; healthcare is provided & financed by the government through taxes 2) Bismark Model: insurance system paid into by the employee & employer, covers everybody & is non-profit 3) National Health Insurance Model: private-sector providers paid by government run insurance program 4) Out of Pocket Model: pay cash or trade for services *NP models of care (google...) 1) Accountable Care Organizations (ACO): collaboration among primary care clinicians, a hospital, specialists & other health professionals who accept joint responsibility for the quality & cost of care provided 2) Medical Home: central primary care practice or provider who coordinates the pts care across settings & providers 3) Nurse Managed Health Clinics: led by APRNs, comprehensive primary care & wellness services to underserved or vulnerable populations Discuss the components of primary care and the components of tertiary care. correct answer- Primary Care: Health Promotion *broad & deep base of health care system by providing initial & continuing care and access to other types of care *accessible, prevention oriented, general wellness & illness care for individuals & families *woven through ambulatory sites, homes & residential settings Tertiary Care: *Disease management *emergent & critical care What is the role of the primary care provider? correct answer- *primary medical resource & counselor *continuing & comprehensive care Who are the providers of primary care? correct answer- *Physician, NP or PA *FNP, PNP, WHNP, GNP, CNM, select CNS's *RNs prepared in community/public health in baccalaureate programs What does the Institute of Medicine (IOM) define as primary care? correct answer- *an individual who uses a recognized scientific knowledge base & has the authority to direct the delivery of personal health services to pts What are the models often found in primary care and their structure. correct answer- 1) Community Oriented Primary Care (COPC) *blend of primary care & public health *systemically address needs of a community *Israel & South Africa 2) Community Partnership Primary Care (CPPC) *blend of COPC & community development *use Primary Care as strategy and resource to help community develop knowledge, skills & actions to help itself 3) Patient Centered Medical Home (PCMH) *patients are cared for by in a clinic by a multidisciplinary team with a physician led clinical team (collaborate team) *full services community medical center with specialists, lab, xray & pharmacy (no delivery or surgery) *advocating for co-management of physicians with NPs 4) Convenient Care Clinic Model (CCCM) *retail clinic (minute clinic) *extension of pharmacy *set with a formulary for diagnosis & treatment * not good for problem solving or gaining experience for new grad What is demand management vs disease management? correct answer- Demand Management: *healthcare model based on supply and demand *typical strategies: managing supply of healthcare resources Disease Management: *focuses on demand side, the patient side of the healthcare equation *seeks to cut costs & improve care by helping patients make better decisions *focus on improving health & behaviors & decisions *systems based, physicians directed, proactive care management of the total patient across the continuum of care with the goal of enhanced patient outcomes & reduced total cost of care Who implements Case Management? What are the components of Case Management? correct answer- Implemented by: baccalaureate nurses Components: systematic process of mobilizing, monitoring & controlling the resources that a pt uses over the course of an illness What are the leadership theories? Describe? correct answer- 1) Trait Theory of Leadership -early 1900's, great man theory -leaders were born not developed set of characteristics that inspire others 2) Style Theory of Leadership -1950's, leadership theory being highly relational -context driven, situational & adaptive -combine task, relationship & environment & utilize appropriate leader 3) Transformational Theory of Leadership -1990's & still popular today -highly interactive & highly motivational leaders -collaborative, consultative, consensus building 4) Authentic Leadership -ethics based, high values -imbedded in transformational -ethics & values guide decision making within the institutions What are the Leadership tasks? Describe? correct answer- * Envision goals * Affirm values * Motivate * Manage * Achieve unity * Develop trust * Explain * Serve as symbol * Represent the group * Renew Covey identifies effective characteristics of leadership to be what? correct answer- * Continuously engage in lifelong learning * Service oriented * Concerned with the common good * Radiate positive energy * Believe in other people * Lead balanced lives * Synergistic world view * Engage in self renewal What skills as a change agent are needed by the NP? correct answer- * Excellent communicator * Good observer * Knowledge of group dynamics * Perceptive re: political issues * Supportive attitude * Ability to establish trusting relationships * Ability to resolve/ deal with conflict * Credible Discuss the leadership expectations of masters prepared nurses functioning as NPs. correct answer- * demonstrate leadership potential as well as clinical competence * leader, role model for the professional development of peers, colleagues & others * ex: influence others toward a goal, to contribute to a positive outcome; reflected in clinical practice & professional associations How would you define the leadership role of the NP in a clinical setting? correct answer- (Facilitator, communicator, change agent) * facilitate the clinical development of others * coach others in interpreting, forecasting, responding to others * bridge the gaps in pt care * transform care delivery systems What leadership characteristics do you have and how would you implement these in a practice? correct answer- * know self * look forward * see the big picture * build self-directed work teams * take risks * recognize when time is right for action * see change as an opportunity * be proactive, not reactive * communicate effectively * mentor others * let go and take on * keep informed Define and discuss LACE in the Consensus Model. correct answer- •Licensure, Accreditation, Certification and Education (LACE). *Licensure is the granting of authority to practice. *Accreditation is the formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing-related programs. *Certification is the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession. *Education is the formal preparation of APRNs in graduate degree granting or post- graduate certificate programs. •The APRN Regulatory Model applies to all elements of LACE. Each of these elements plays an essential part in the implementation of the model. The Consensus Model has the following components - APRN roles-Population Foci- APRN specialties. True or False? Explain correct answer- True •APRN roles- there are four roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). These four roles are given the title of advanced practice registered nurse (APRN). •Population Foci- family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women's health/gender-related or psych/menta1 health. •APRN specialties: APRNs may specialize but they can not be licensed solely within a specialty area. Specialties can provide depth in one's practice within the established population foci. Examples include but are not limited to: Oncology, Older Adults. Orthopedics. Nephrology, Palliative Care What is the purpose of the Consensus Model? correct answer- •Strive for harmony and common understanding in the APRN regulatory community that would continue to promote quality APRN education and practice; •Develop a vision for APRN regulation, including education, accreditation, certification, and licensure; establish a set of standards that protect the public, improve mobility, and improve access to safe, quality APRN care; and •Produce a written statement that reflects consensus on APRN regulatory issues. Describe the components of an NP position description plan. correct answer- -Define the role of the nurse practitioner -Certification -Licensed - as RN, as NP -Certification - BCLS, ACLS, PALS or others as applicable to the job responsibilities -U.S. citizen, etc. -Description of Duties What are the duties most often found in a position description? correct answer- tasks/procedures as well as abilities Examples of Tasks: - Common diagnoses/conditions - Provide physical examination, care and treatment - Initiate and interpret x-rays, tests, laborator •Examples of Abilities - Managing specific disease processes for inpatients - Managing specific disease processes for outpatients - Providing patient education What are the differences in job duties and administrative duties for a positions plan? correct answer- Job duties have to do with patient care and administrative duties are duties having to do with the administrative side- attending CEU education, maintaining appropriate licensing, facilitating eval of records by physician etc... Discuss the components/elements of a contract by Buppert, found on the course reading list. correct answer- According to Buppert, the contract has four key elements 1. Capacity of all the parties - one party cannot withdraw without the agreement of the other 2. Mutual agreement or meeting of the minds - a valid offer and acceptance of the offer 3. Consideration - something of value that is given in exchange for some promise 4. Legality of the subject matter of the contract - the legal concept of the offer Define the legal terms found in a contract. Indemnification and subrogation- correct answer- •Indemnification - the promise between the parties to hold each party harmless for the wrongdoing of the other party •Subrogation - the health care facility recovers from the NP the monetary losses sustained after the agency is found liable for negligence of the NP or other individual to whom the NP delegated any aspect of care or treatment Define the legal terms found in a contract. Dispute resolution- correct answer- •Describes the process to be followed when there is a disagreement between the parties •Both parties will use their best efforts to solve the dispute •May have a binding resolution - the parties waive their rights to file a lawsuit in the event one of the parties is dissatisfied with the outcome of arbitration •May have a nonbinding resolution - the arbitration process must be concluded before a lawsuit is filed in court Define the legal terms found in a contract. Force Majeure correct answer- •Contract is not considered breeched in situations where the Act of God prohibits one party from performing in accordance to the terms of the agreement such as floods, hurricanes, or human disasters such as war, riots, etc. Define the legal terms found in a contract. Non-Compete Clause (Restrictive covenants)- correct answer- •Can't practice within a set number of miles from an employer's business for a set time or enter into ventures that would compete with the interests of the organization, plan or practice group •Covenant not to compete •Can't enter into ventures that would compete with the interests of the organization, plan or practice group What are the differences between an NP independent contractor and/or NP employed by an organization? correct answer- NP independent contractor -Are contracted by another to do something, but are not controlled by the other -Incurs liability for acts that are within the scope of practice •Do not have Respondeat Superior protection -Respondeat superior a legal doctrine which states that, in many circumstances, an employer is responsible for the actions of employees performed within the course of their employment. -Will not have benefits of sick time, annual leave, health insurance, life insurance, vacation unless this is part of the contract agreed between the two parties - Will need a collaborating Physician -The decision on how to run the business is independent -Practice quality is under the control of Independent contractor Employed by organization -have Respondeat Superior protection -benefits of sick time, annual leave, health insurance, life insurance, vacation -controlled by organization Practice management includes what elements according to Buppert/ the class notes. correct answer- setting up the exterior and interior structure is very important •Location, building, parking & parking lot, handicap entrance to building, handicap entrance to waiting room •Waiting room, reception desk, examination rooms, restrooms, sinks in all rooms, clean and dirty lab •System for admission and discharge, making return visit appointments immediately, have a follow-up remainder call system •Maintenance - inside and out •Office furniture - desk, chairs - at least three, telephone, bookcase - one or two, lighting - overhead, desk lamp, computer - dedicated table, chair, monitor, speakers, printer & ink, software, CD disc and storage case, wireless access - maintenance contract •Supplies - all office areas and examination rooms and labs; system for ordering supplies •Mailing supplies - envelopes, overnight delivery, stamps •Hiring Staff •Managing the flow of patients •Lunch time •PRN staff contacts for vacation coverage •Office policies - responsibilities of each member in the office - who makes the coffee •Policies and Procedure Manuals •Productivity - payment based on the numbers of patients seen per unit of time •Follow the elements of the Business Plan What is the difference between credentialing and privileging? correct answer- Credentialing is: •Is the process of obtaining, verifying, and analyzing the eligibility and qualifications of the practitioner to execute health care services. A process to assure providers working within the institution are practicing within their scope of practice and are competent. Privileging: *Process in which the institution grants specific authority to the practitioner to provide designated clinical activities. Delineates applicant's scope of practice, ensures competencies required by accrediting bodies; averts both institutional and professional liability issues, determines the impact the practitioner will have on the institutional's financial status, granted on an individual basis What data is required for each? credentialing and privileging? correct answer- Data Required Personal and demographic information Education and training Work history State(s) licensure history State-controlled substance licenses Certifications Drug Enforcement Agency (DEA) certificates Department of Public Safety (DPS) Peer references, usually 3 Continuing education Liability insurance and claims history History of sanctions/penalties imposed on practice as well as voluntary relinquishment of licenses/certifications Disclosures of physical, mental, substance or criminal problems Attestation of information completeness and accuracy Authorization statement to collect any information necessary to verify application Can you have one without the other? credentialing and privileging? correct answer- Yes, you can be credentialed without having privileges, but not the other way around. (If you work in a Dr office and will not be admitting patients to the hospital for example.) You must be credentialed before you receive privileges. What are the major elements of a contract that you expect to see in your practice? correct answer- - Scope Includes the activities governed by the agreement - Effective Date - Relationship and Responsibilities of the Parties Describes the working relationship between the parties Is Nurse Practitioner an employee or Independent Practitioner An Independent contractor should not have language that dictates when, where, and how service is performed An employee has language that dictates when, where, and how service is performed - Confidentiality - Conflict of Interest - Compensation - Indemnification and subrogation - Dispute resolution - Term, renewal, and termination - Termination - usually requires the terminating party to notify the other party within a 60 or 90 day period - Remedies for breach - Notices Identifies the persons who are to receive notice from the other party and includes contract information - Modifying and assigning the agreement - Severability Allows for noncontested and enforceable provisions of the contract stay in effect Conflict of Laws Identifies the jurisdiction where the contract was executed and what jurisdiction governs contractual disputes that may arise Legal Authority The parties in the agreement have the authority to enter into the agreement Force Majeure Contract is not considered breeched in situations where the Act of God prohibits one party from performing in accordance to the terms of the agreement such as floods, hurricanes, or human disasters such as war, riots, etc. Non-Compete Clause (Restrictive covenants) Can't practice within a set number of miles from an employer's business for a set time or enter into ventures that would compete with the interests of the organization, plan or practice group Covenant not to compete Can't enter into ventures that would compete with the interests of the organization, plan or practice group Signature Both parties sign and date the contract agreement and is considered executed What specifically do you want included in each element (e.g., vacation days, etc)? correct answer- Responsibility to maintain credentials Terms of on-call responsibilities Benefits Time off and expenses for continuing education vacation time Bonuses How would you specifically go about assessing the strengths and weaknesses of a clinical practice for which you are interviewing? correct answer- Interviewing the practice and speaking to employed NP's in the practice, looking at the past history of the practice and number of malpractice claims, Looking at financials of the practice and patient satisfaction scores. List several strengths and weaknesses and describe how you would collect data to get a sense of where the particular practice "measures". correct answer- Compensation and Benefits package- Employer human resources dept Amount of productivity of practice - Financial statements of practice Malpractice claims - public record/ practice financial dept Patient satisfaction - human resources dept Describe at least 10 business and clinical responsibilities/functions that are involved in daily clinical practice. correct answer- 1.Medical care and treatment of communicable diseases and/or injuries 2.Seek advice of consultants when appropriate 3.Perform stress testing 4.Provide post-procedural follow-up care 5.Prescribe medications, as appropriate, in accordance with the privileges and rules, regulations and policies of the respective institution - acute care focus 6.Maintains legible, accurate, and confidential medical records. 7.Responsible for the diagnosis and treatment of acute, chronic and long-term healthcare issues/needs 8.Facilitates evaluation of records by physician(s), peers, and Quality and Standards according to protocols, and receives and implements constructive directives 9.Attend continuing education/medical education, workshops, professional literature or "hands-on-training" 10.Utilizes the institution's information system for record keeping, etc. What ideas do you have about how to implement/oversee/evaluate each of these? correct answer- In the negotiation process for a job What is risk management in clinical practice? correct answer- Clinical risk management (CRM) is an approach to improving the quality and safe delivery of health care by: Placing special emphasis on identifying circumstances that put patients at risk of harm Acting to prevent or control those risks. What are 3 things you think should be in your practice to reduce risk? correct answer- 1.Preserve patients' rights of confidentiality- HIPAA 2.Properly document informed consent and medical discussions in the chart. 3.Maintaining competence through continuing medical education and documentation of NP's standard of care What is NCQA and what are the HEDIS measures? How could you use these in evaluating your clinical practice? correct answer- •NCQA: National Committee on Quality Assurance. They audit health plans •HEDIS measures: most commonly applied performance criterion among health plans. This data is gathered from patient surveys, patients charts, and billing forms What is Pay for Performance (P4P) and how will it affect your practice? correct answer- •P4P increases patient outcomes by: * Looking at days hospitalized, cost per episode, reductions in lipid levels *It is also based on Percent age-gender-risk appropriate screenings, and recognitions (BTE) What key data will you want to track to evaluate the impact of your NP practice? correct answer- •How much time you spend per patient. Documentation is important but too much time is costing money *Use checklist, flow sheet, blank paper, dictate, electronic medical record (EMR) *Develop smart documentation systems to be complete, accurate and time saving •In Primary Care, units of service, the level of the visit (new vs established patient) is a revenue source.