Implementing Routine Outcome Monitoring In Answers

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Subject Name : Nursing

Nurse Practitioner

Introduction to Implementing Routine Outcome Monitoring in Clinical Practice

A Nurse Practitioner (NP) is a Registered Nurse (RN) qualified at master’s level in their nursing specialty and approved by the Australian Nurses and Midwives Board (NMBA) aim of providing healthcare delivery in a specialized and established nursing position. Since the 1960s, NP has delivered healthcare services worldwide (NMBA, 2016). An NP is a licensed nurse with specialized clinical and academic expertise for a specific population (Scanlon et al., 2016). NPs can diagnose and manage the most prevalent and several chronic conditions, interacting closely with patients. They are allowed to conduct physical exams, request and analyze medical tests, deliver therapy and training, and prescribe medication. NPs are fast becoming the healthcare preferred partner for thousands of Australians. NPs bring a broad perspective and personalized service to healthcare services as physicians who combine clinical experience in managing and treating health problems with an additional focus on patient safety and quality care (MacLellan et al., 2015). In this essay, the role and responsibilities of the NP have been critically analyzed with a theoretical understanding of the role.

The creation of the NP position is sensitive to the rising needs on healthcare and a need to enhance access to healthcare, especially in rural and remote areas. The NP position encapsulates specialized nursing experience and enhanced skills to meet the customer needs while seeking to solve gaps in current healthcare organizations sometimes delivering services where nothing exists today. The position also helps clinicians advance their careers while retaining valuable clinical knowledge (McTiernan & McDonald, 2015). Although autonomy helps NPs to provide versatile and comprehensive care, it is a vital part of NP practice to work along with other healthcare providers. The NMBA and Australian Health Practitioner Regulation Agency (AHPRA) work in a co-regulatory model in certain jurisdictions which may not be the only agencies responsible for completing evaluation relevant to a confirmation. Registration for NP is the duty of Australia's Board of Nursing and Midwifery (Forrester, 2017).

Currently, the larger number of NP is funded by local and state governments in intensive care settings. The protocol for hiring a public sector nurse practitioner varies across states and territories in Australia. Nurses have to approach the appropriate state or territorial department of health to obtain jobs in the public sector. Inside a private place, whether as being a worker or in their very own practice, NP may also be hired. With the creation of access to the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Plan (PBS) for nurse practitioners, nursing practitioners are expected to play a larger role in the future healthcare delivery system. NP does have a chance to create new models of practice that can be customized to suit personal and local needs (Sellers et al., 2015).

The government of Australia recognizes the important role of NP within the health care system of the country. Under the health reform agenda of the government, this position has been recognized. NP would have had a much larger role in providing clinical outcomes underneath the policy reforms. The government has invested in national programs which will expand the amount of NP and ensure that they get the support and training which they require (Parker & Hill, 2017).

As part of the health policies, NP will be employed in hospitals with performance requirements to help and respond to:

A National Access Goal of four hours for hospital emergency rooms;
An improved number of beds for sub-acute care; and
Lower waiting periods for elective surgery.

The health care budget has included funds to allow qualifying nurse practitioners' accessibility to the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Plan (PBS). The goal of this program is to encourage increased access to general health care services and to facilitate team-based and multidisciplinary healthcare strategies. The financing also promotes a significant role for NP in non-acute environments, such as the areas of patient healthcare, elderly care, and in rural and remote Australia (Knott et al., 2015).

Education and training

The Nursing and Allied Health Scholarship and Support Scheme is indeed an effort of the Australian government to manage students beginning or preparing to start an approved nursing program at an Australian university or registered training institution that gives them the right to enroll with Australia's NMBA. This provides grants for registered nurses to pursue a university degree in NP research (NMBA, 2016).

Qualifications

NPs receive rigorous professional qualification, annual peer assessment, clinical outcome reviews, and comply with a code of professional standards to be accepted as qualified health care professionals to maintain the highest standard of care. To retain professional competence, self-directed continuing learning and leadership training is also important (APHRA, 2019). Besides, NPs can also lead and engage in both the technical and health care networks, undertake experience and publish results in the clinical practice to enhance quality medical care and optimize health outcomes (Buppert, 2017).

Services

Independently and in partnership with health care providers as well as other stakeholders, NPs offer a large range of acute, primary, and specialized healthcare facilities like:

Requesting, conducting, and evaluating medical tests including such x-rays and laboratory work.
Finding out and addressing chronic and acute disorders like high blood pressure, injuries, diabetes, and infections.
Prescriptions drugs as well as other therapies.
Maintaining the general treatment of patients.
Counseling services.
Increasing awareness on preventing disease and good nutrition and wellness decisions (Madler & Helland, 2017).

Unique approach

This sets NPs apart from the other health care providers is their special focus on the well-being and health of the entire person. NPs direct patients to make smarter nutrition and wellness decisions with an emphasis on disease prevention, health promotion, and therapy and health education, which in turn will minimize the out-of-pocket costs of patients (Kilpatrick et al., 2015).

NP Credibility: NPs are much more than healthcare service providers; who are advisors, instructors, scientists, and administrators. The involvement in professional associations and involvement in local, state, national, and international health care policy programs positively influence the function of the NP and ensuring that clinical standards are upheld.
Reduced healthcare Costs: NPs will minimize healthcare costs for patients by delivering high-quality care and therapy. For example, patients who just see NPs as their healthcare providers also have fewer hospitalizations, reduced hospital, and lower prescription costs.
Patient satisfaction: patients show incredibly greater satisfaction with the service they received, with visits made to NPs per year.
Primary care crisis solution: NPs have more than 290,000 solutions to the primary care crisis facing today's society, by providing cost-effective, high-quality, patient-centered health care (Madler & Helland, 2017).

Skills & Personality Traits of Successful Nurse Practitioners

There is absolute proof that it can be a great profession to become an NP, and having unique abilities or personal characteristics can position an individual up for future success. NPs must be caring, self-confident, logical, approachable, and calm, and collected. Since NPs may be faced with time-sensitive healthcare problems, in unpredictable circumstances, they should be able to make better choices under duress and demonstrate accountability. General knowledge of mathematics and science adds to the everyday problem-solving, research, and therapeutic strategies of NPs. Active NPs often spend a great deal of time communicating with patients, their families, and healthcare staff, so outstanding communication skills are needed to be available. Many desirable qualities such as being detail-oriented, empathic, and healthy mentally (Kerr et al., 2020).

Literature Review of Implementing Routine Outcome Monitoring in Clinical Practice

The increase of 'endorsed' NP and those preparing to become NPs has risen in Australia since the very first trained one in 2000. The development has, nevertheless, been sluggish because there were only around 500 NPs in practice in 2012. The sluggish growth in numbers of them is amid the evidence promoting the positions as a way of enhancing patient outcomes and the effectiveness in the workplace. There is a great deal of literature on the roles of NPs, but the little consensus among NPs, nurse managers, and nurse policymakers mostly on effects on the growth and development of the positions (Boswell et al., 2015). And although the literature suggests support for themselves, especially at the level of government, challenges persist in their adoption in Australia including some in conventional health care. Challenges involve a lack of resources, healthcare, position consistency, and organizational engagement. So many Australian state and local healthcare facilities have advocated the implementation of the positions, and numerous healthcare systems have attempted to incorporate them, with several doing so effectively (Trezona et al., 2018).

Besides, several nurses took up the learning task and welcomed the additional obligation needed to obtain certification, or accreditation, to work in NP positions, as it is called in the UK. In the Australian sense, certification is the lawful acknowledgment of the necessary skills and knowledge of an individual in a field of practice. However, in these positions, about 30 percent of nurses certified as NPs are not working (Barnes et al., 2018). A study is being conducted to gauge the growth in various settings of the nursing contribution NPs make to healthcare services. It sought information from various nursing perspectives that of NPs, nurse managers, and nurse policymakers. It pursued input from different nursing perspectives those of NPs, nurse administrators, and nurse lawmakers. While its study findings reflect Australian viewpoints, the findings have international significance, as demonstrated by interventions at the global nurse practitioner and advanced nursing practice system conference. In settings where NP functions are in the preparation or implementation process, the results are especially important.

Nurse practitioner positions had already been implemented in many countries even though they were adopted in the US in the 1960s. A combination of approval and opposition has also been encountered with both the positions and the description, assessment and risk evaluation have also been investigated. In several fields, it is a well-recorded worker deficit in healthcare services, so the need to alter the way tasks are structured. NP is very well positioned to navigate care environments and effectively reshape the delivery of care to address the needs and organizational objectives of clients. The positions have also been recognized as a means of solving multiple medical problems, especially ones related to oppressed groups' accessibility and equity (McMurray, 2016).

The implementation and longevity of the NP positions are complicated, but figures have risen globally. Based on the location or setting, even then, there has been a considerable disparity in the execution of the positions. Many scholars, for example, claim that the positions were implemented to meet the concerns of vulnerable populations, whereas others explain how the need for more providers to provide high quality and cost-effective health care motivated NP programs (Carter & Chochinov, 2007). Other reasons given for implementing the positions include more productive utilization of nursing staff resources, trying to relieve overpopulated emergency department visits (EDs), and seeking to simplify the delivery of public services. In the research, the reliable, secure, and open essence of care given by NPs is well supported. Continued and meaningful engagement through state assistance and resources from state governments is important for the further creation of the positions (Morris et al., 2012).

According to researchers, to facilitate worker growth and accessibility to a public health system that has historically supported the medical model, policymakers must impact changes in policy on a large scale. Another of the concerns described in the literature is that NP functions may not neatly fit into the existing health systems framework. Several of the confusion of NP roles that results in difficulties with the description can be clarified by discrepancies in the frameworks of responsibilities and conceptual rationales underlying the medical and nursing careers. The implication is that the capacity of patient care positions is not completely recognized (Yeo et al., 2020). The implementation of new nursing interventions to fill existing holes in the delivery of healthcare services implies the various positions must be recognized by the community, other healthcare professionals, and nurses themselves. Nurses support the expansion of advanced practice positions, such as those of NPs, as a professional community, but efficient development of the positions involves discussions to establish a systematic approach to the curriculum, skills, and practice scope of those within the positions.

There have been barriers to improvements to nursing positions in Australia, and to the recognition of NPs in conventional healthcare services (Fealy et al., 2018). The research is riddled with accounts of clinical resistance, especially those who have independent strategic decisions, to specialized nursing programs. Meanwhile, it was noted that a lack of information from fellow employees was perceived by most NPs participating in their study on the profile of NPs in Australia. For this, there could be many explanations. For instance, because of the change in their roles, NPs may feel alone, and also because of the previously stated absence of role clarification, their nurse coworkers might not always implement the new positions. Coworkers can even be personally insecure, which would be a less appealing probability (van der Biezen et al., 2017).

The obligation for healthcare legislation lies with all those who implement and administer it. The Australian Health Worker Study said that the other policy reforms and government money and regulations would promote effective workforce reform. Consequently, a need for standardized steps to keep growing NP positions must be acknowledged by professional organizations and recruiting agencies. Interventions might include support networks, advantages of the positions of NP will enable a substantial difference in the quality of acute and chronic health care in critical, public, and residential environments, and this study illustrates a widespread understanding of the advantages of employing NPs to institutions (Meyers et al., 2019). Even so, some respondents believe that they are not well received, despite encouragement for the positions. This may be due to varying views of the positions, their position in healthcare environments, and the healthcare team's scope of practice. It also indicates that confusion discredits specialized positions in nursing and adds to the view that they are invalid. For the introduction of NP positions, the support of senior executives is essential. The results published here illustrate a need for such management to take a more constructive role in the creation of approaches for incorporating NP positions in the workplace, instead of implementing them when identifying the performance gap (Wang & Brower, 2019).

Conclusion on Implementing Routine Outcome Monitoring in Clinical Practice

The findings of the study imply that it is complicated to accomplish, integrate, and maintain NP positions in hospital environments in Australia, which endorses the literature on the topic. Amid encouragement for, and optimistic views of, NP positions, participants defined obstacles that could hinder these roles' extension and sustainability. The obstacles found are comparable with those identified in many other studies, while complete examination of the issues was beyond the reach of this research. Consequently, it is proposed that more studies be conducted to gain a better understanding of these obstacles and also how NP functions are affected. It will help to define workable measures to meet that such a care model is implemented in an organized and implemented way into health professionals.

References for Implementing Routine Outcome Monitoring in Clinical Practice

APHRA. (2019). Register for practitioner. Retrieved fromhttps://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx

Barnes, H., Richards, M. R., McHugh, M. D., & Martsolf, G. (2018). Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. Health Affairs, 37(6), 908-914.

Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25(1), 6-19.

Buppert, C. (2017). Nurse practitioner's business practice and legal guide. Jones & Bartlett Learning.

Carter, A. J., & Chochinov, A. H. (2007). A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department. Canadian Journal of Emergency Medicine, 9(4), 286-295.

Fealy, G. M., Casey, M., O'Leary, D. F., McNamara, M. S., O'Brien, D., O'Connor, L., & Stokes, D. (2018). Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers. Journal of Clinical Nursing, 27(19-20), 3797-3809.

Forrester, K. (2017). an introduction to legal aspects of nursing practice. Contexts of Nursing: An Introduction, 153.

Kerr, D., Milnes, S., Ammentorp, J., McKie, C., Dunning, T., Ostaszkiewicz, J., ... & Martin, P. (2020). Challenges for nurses when communicating with people who have life‐limiting illness and their families: A focus group study. Journal of Clinical Nursing, 29(3-4), 416-428.

Kilpatrick, K., Reid, K., Carter, N., Donald, F., Bryant-Lukosius, D., Martin-Misener, R., ... & DiCenso, A. (2015). A systematic review of the cost-effectiveness of clinical nurse specialists and nurse practitioners in inpatient roles. Can J Nurs Leadership, 28(3), 56-76.

Knott, R. J., Clarke, P. M., Heeley, E. L., & Chalmers, J. P. (2015). Measuring the progressivity of the pharmaceutical benefits scheme. Australian Economic Review, 48(2), 122-132.

MacLellan, L., Higgins, I., & Levett‐Jones, T. (2015). Medical acceptance of the nurse practitioner role in Australia: A decade on. Journal of the American Association of Nurse Practitioners, 27(3), 152-159.

Madler, B., & Helland, M. (2017). Establishing a Viable Workforce Pipeline of Primary Care Nurse Practitioners. Nursing Administration Quarterly, 41(1), 20-28.

McMurray, E. (2016). Getting through the shift: navigating moral distress in acute care nursing (Doctoral dissertation).

McTiernan, K., & McDonald, N. (2015). Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a D Dublin region. Journal of Psychiatric and Mental Health Nursing, 22(3), 208-218.

Meyers, D. J., Chien, A. T., Nguyen, K. H., Li, Z., Singer, S. J., & Rosenthal, M. B. (2019). Association of team-based primary care with health care utilization and costs among chronically ill patients. JAMA Internal Medicine, 179(1), 54-61.

Morris, Z. S., Boyle, A., Beniuk, K., & Robinson, S. (2012). Emergency department crowding: towards an agenda for evidence-based intervention. Emergency Medicine Journal, 29(6), 460-466.

NMBA. (2016). Registration standard: Endorsement as a nurse practitioner. Retrieved from https://www.nursingmidwiferyboard.gov.au/Registration-Standards/Endorsement-as-a-nurse-practitioner.aspx

Parker, J. M., & Hill, M. N. (2017). A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong special administrative region (SAR), China. International Journal of Nursing Sciences, 4(2), 196-204.

Scanlon, A., Cashin, A., Bryce, J., Kelly, J. G., & Buckely, T. (2016). The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian, 23(1), 129-142.

Sellers, K., Leider, J. P., Harper, E., Castrucci, B. C., Bharthapudi, K., Liss-Levinson, R., & Hunter, E. L. (2015). The public health workforce interests and needs survey: The first national survey of state health agency employees. Journal of Public Health Management and Practice, 21(Suppl 6), S13.

Trezona, A., Rowlands, G., & Nutbeam, D. (2018). Progress in implementing national policies and strategies for health literacy—what have we learned so far?. International Journal of Environmental Research and Public Health, 15(7), 1554.

van der Biezen, M., Wensing, M., Poghosyan, L., van der Burgt, R., & Laurant, M. (2017). Collaboration in teams with nurse practitioners and general practitioners during out-of-hours and implications for patient care; a qualitative study. BMC Health Services Research, 17(1), 589.

Wang, T. K., & Brower, R. (2019). Job satisfaction among federal employees: The role of employee interaction with work environment. Public Personnel Management, 48(1), 3-26.

Yeo, M., Moorhouse, A., Khan, P., & Rodney, P. (2020). Concepts and Cases in Nursing Ethics–Fourth Edition. Broadview Press.

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