significant nursing activities of the family nurse practitioners in a primary care clinic

significant nursing activities of the family nurse practitioners in a primary care clinic

Most of the significant nursing activities of the family nurse practitioners in a primary care clinic, like in Lori’s case, comprise of preventive, restorative, and promoting activities. The aim of the establishment of this clinic is not only to provide affordable services but also to make care and services available to patients by supplementing the few services provided by the specialists and physicians in the community. I will be working along with a physician and attending to as many patients as possible in a day, which I believe will provide an excellent platform to achieve some of the clinical objectives and goals that I had set before.

During my first visit to the primary care clinic, I will discuss with physicians whom I will be working alongside. This is to be oriented about the clinic, the community, the activities, among other essentials things that take place in the clinic, and possibly how to go about or get certain services whenever I need. Also, I will discuss with the physician about my goals and objectives to make the physician aware and together discuss how we will collaborate to achieve them. My first short term goal was to develop interpersonal skills and abilities. The second goal, which was a professional one, was to develop clinical experiences, and the third goal was to acquire many certifications and hand-on training as possible within the shortest time, possibly one year. The long term objectives include securing a job as an independent family nurse practitioner, advance to a doctor of nursing, and lastly to organize and actively engage in community and academic programs. These are broad goals that are arrived at by achieving small tasks and activities in the primary care clinic while making positive impacts on patients and the community at large. I have prepared the practicum experience that I believed will drive me towards ultimately achieving these goals.

Journal for Week Five

Week five was my first day in the clinic as a nurse practitioner after I had been oriented. This is a busy clinic that sees nearly sixty pediatrics and adults in one day. I was determined to utilize this opportunity as much as I can to develop interpersonal skills and abilities. The primary care clinic is a great one, and among the best in the area. Its policies and values are amazing, and it seems the patients naturally conform to these great values and culture. This was evident by their orderliness, respect, and eagerness to create a therapeutic connection with their healthcare providers. Interpersonal relationships and effective communication skills are paramount in my entire career as a nurse practitioner.

Missing these opportunities within this busy and reputable clinic would be a loss of a golden chance. We were with the physician in the consulting room, ready to begin attending to our patients. I was to do examination and history taking as he does the analysis of the patient presenting complaint. The majority of patients were those who had chronic diseases such as diabetes and had come for routine check-ups. The physician knew my objectives, and the first short term objective was to develop and build interpersonal abilities, which necessitates effective interaction, engagement, and communication. He had given me this role objectively to help develop my interaction skills since history taking and examination involves much of the talking and interacting with patients. Patients were willing to give much information and maintain excellent interaction as if they had known me before. At some point, I felt that I had the best interpersonal skills and was doing great since not even one patient was reluctant to interact and let me know about their health information. We attended to many patients, and the physician realized something regarding how I was gathering information and professionally corrected me. He advised on gathering appropriate information for presenting complaints or examination focused. I needed to adjust on the same and began collecting on information that was relevant to presenting complaints, which I realized not only simplified but also made it easy to determine the possible presenting problems and perform an appropriate evaluation based on the patient’s chief complaint. Besides, I could quickly assess and determine some of the patients’ education needs regarding their presenting complaint, condition, management, and health promotion. I was starting to gain courage, and my interpersonal skills and abilities were on another level. The physician had no problem understanding my notes and information and always applauded my excellent interaction with patients.

We changed roles. I was developing differential diagnoses for presenting problems while prioritizing care as the physician take history and do some examination. We worked collaboratively, and he was very supportive and kept checking on my diagnoses to see if they were connecting to the patient’s history and presenting chief complaints. While this was not as easy, the physician kept by my side, and I learned more than I thought. He also acknowledged the eagerness and willingness that I had towards being perfect in diagnosis. After attending to about twenty patients, I was becoming better and could develop differential diagnoses that were closely linked to presenting complaints. I attended to five patients (initiating maintaining communication, taking a history, and doing the examination, and finally making the diagnosis) as the physician supervises. It was amazing collaborative and comprehensive care, and the satisfaction in patients’ facial expression was indicative. I could now develop accurate differential diagnoses and establish an accurate primary diagnosis based on the objective, subjective information. Besides, my information gathering and examination had become so appropriate and relevant.

Journal for Week Six

Week six began quite well; however, I felt that I was going to be exposed to the most complex conditions and situations that required me to adjust accordingly. The physician also realized the same and told me not to worry because we would work collaboratively to provide the best care and service regardless of the situation. I was still happy about last week and how everything happened great, and this was motivating each minute I interacted with patients in the clinic. Thanks to my willing supervisor and mentor. The physician was ready and determined to teach and allow me to learn despite the situation. As usual, we began by distributing duties. This time, I was to gather patient information, examine, develop diagnoses, and identify patients’ needs and prioritize the needs. The physician, on the other side, was to identify and establish beneficial evidence-based non-pharmacological and pharmacological treatment for the patient’s presenting problems. However, before we began the day, we brainstorm on some essentials to achieving the objective of the week. The objective of this week was to develop clinical experiences that will allow me to be competent enough to work independently in a primary care setting. We began by working in different rooms where I could assess and diagnoses the patient and then send them to the physician. Occasionally, the physician could call me over to witness how he was developing the non-pharmacological and pharmacological management of the patient’s presenting problem and could allow me to do so under his close supervision. One thing that the physician made me understand is that developing patient management is not solely the task of the healthcare provider. As a nurse practitioner, I am supposed to prioritize patient care and always negotiate the plan of care with the patient to improve the management of the condition. He taught me the importance of collaborative care. He made me understand that patient-centered care is paramount and emphasizes on the active involvement of the patient throughout care. That patient must be one of the collaborators in every aspect of care. We had to move and work in the same room to fasten care provision while at the same time promoting learning. The physician gave me a chance to identify the patient’s needs and develop their most beneficial non-pharmacological and pharmacological management as appropriate to their presenting problems. He made the environment favorable for me to ask questions and clarifications as necessary. The following day, a male patient came in and was massively bleeding. The physician had confidence that I could manage the condition. The patient demographic and health information showed that he was Jehovah’s Witness patient. He was active, alert, and competent. I thought of administering tranexamic acid to inhibit the activation of plasminogen to plasma. The physician quickly came in and assisted me in immobilizing the bleeding. We applied some pressure on the bleeding site and raised the affected limb above the heart level, and then the physician left me to continue with other management as I deemed necessary. While quickly discussing with the patient about his plan of care, I learned that he did not want blood transfusion because his religion did not allow it. I was beginning to convince the patient when the physician came in and signaled me to remember the principle of autonomy and the constant conflict that it has been having with the principle of beneficence. Without wasting any time, administered tranexamic acid as an alternative to blood transfusion, then dispensed some iron supplements and advised the patient on an appropriate diet to replenish the lost blood. The physician made me understand that my work in such ethical dilemma situation is not to convince the patient to accept whatever treatment but to provide all the necessary information including the benefits of the treatment, and consequences of not accepting the intervention and leave the patient to decide as long as the patient is competent. Also, I learned the need to be sensitive about diversity to ensure that I deliver the most exceptional patient-based and evidence-based care. Critical thinking is crucial and should be fastened in case of an emergency. I learned that certain cases demand the first aid before rushing to comprehensive care. It is upon the healthcare provider to assess the case, thinking critically, and make a creative and sound decision regarding the priority care to the patient presenting problem. It is crucial to analyze the situation, determine the priority need, and initiate the cheapest and accessible care (whether non-pharmacological or pharmacological) to manage the situation. As a nurse practitioner, I am a health care provider and educator at the same time and must be an expert in handling both roles.

Journal for Week Seven

Week seven began with some signs predicting a shortage of resources and fear, which I attributed to COVID 19 that has impacted every aspect of care. Currently, efforts are directed towards curbing the pandemic to the extent that other patients may be less care for. Most qualified registered nurses and nurse practitioners are likely to help contain the COVID 19. This will leave junior and a few professionals to care for other patients. COVID 19 is pressurizing the healthcare in every corner. Resources such as personal protective equipment are much used in managing COVID 19 currently; thus, few of these resources may be left to be used for caring for other patients. Besides, the pandemic has led to the cessation of clinical practicums, and classwork which is likely to impact student knowledge and experience since this gap may cause relaxation among students; thus difficulty remembering. Licensing rules are also relaxed to allow more professionals to contain and fill possible gaps in the healthcare workforce. As a family nurse practitioner in the clinic, I must ensure that the best, safe, quality, and affordable care is provided to patients in the primary care office regardless of the situation.

Collaboration is thus essential with patients and healthcare providers as well as the community to ensure that every patient receives the best care while exploiting the available resources to provide the patient care and services. Throughout the previous weeks, with the help of the physician, I have learned that it is not about the resources that a clinic has which determine the care it provides but how the facility uses the available resources. It is the time that, as a nurse practitioner who will be in charge of a clinic or work independently, I must put into practice this knowledge to give the best for patients regardless of the pressure that the healthcare system is currently facing. I ensured that patients and healthcare workers were screened at the gate before getting into the hospital and that everyone ensured hygiene. The waiting room was regularly fumigated, and resources were available and used accordingly by healthcare providers. With the help of the physician, we trained the healthcare providers to ensure safety first and understand that there is no emergency in a pandemic. Sometimes physicians could not report to work but guided me on what to do since he had to help contain the virus elsewhere. This was an excellent opportunity to learn and be familiar with most of the managerial activities and skills which are mandatory for an independent nurse practitioner. I often met the whole team every morning, prayed, organized, and ensured that everyone was distributed to his or her area of work and had every resource that was needed before we could begin providing care and services to beloved patients. This was also to help know of the possible deficit and find ways to fill the gap as early as possible to ensure continuous and proper care transition.

Summary: I have chosen to discuss the case study, one involving Lori, who is a certified family nurse practitioner certified by the American Nurses Credentialing Center. The Prescription Authority for certified family nurse practitioners includes patient evaluation, diagnosis, ordering, diagnostic test interpretation, and initiating and managing treatment, including drug prescriptions. However, the scope still depends on the state where the nurse practitioners work.

Lori has to register with the Drug Enforcement Administration (DEA) because one of the responsibilities of a nurse practitioner includes administration and prescription of the drug (Drug Enforcement Administration, Department of Justice, 2018). The process involves applying online through the United States Department of Justice website. Still, Lori can as well call the DEA Headquarter Registration Unit at 800-882-9539 and request for the order form, which will be mailed within ten working days. Lori will complete the requisition form, often known as the DEA Form 222a, and send it back within thirty days from the date the form was mailed to the recipient to DEA Registration Unit. DEA often gives the applicant the address to mail the form after completion.

Practicing in Florida will necessitate that Lori applies for licensure in Florida and has to provide accurate proof of his National certification. Additionally, Lori must have malpractice insurance to work in Florida unless he is qualified for exemption, which is often listed on the financial responsibility form. Lori must complete and file with the board office before he is granted the APRN certification. The Florida Board of Nurse requires that the physician supervising the advanced practice registered nurse to report the number he or she is supervising. Besides, the nurse practitioner must attain two separate licenses, including one for a registered nurse and the other for ARNP license. Florida law requires that nurse practitioners utilize the prescription drug monitoring program database that will collect all the controlled substance prescription records from all dispensers. The primary care clinic is one of the operating pain management clinics and has this database developed. Since the Florida Nurse Practice Act do not specifically address the nursing duties and responsibility, Lori will have the option of filing a petition for declaration statement to determine their scope of practice. Florida nursing board allows Lori to have a prescription pad, and the pharmacy rules the nurse practitioner must include all the necessary information to label the prescription container be on the prescription correctly.

The pharmacist will have to put the prescriber’s name on the medication label. Florida State requires nurse practitioners to contact the Board office to be authorized to dispense drugs as long as they want to dispense drugs on their own protocols for free. However, Lori must know that, according to the Florida Board of Nurse legislature, dispensing involves writing and filling a prescription and then selling the medication to a patient, which giving sample does not qualify as dispensing. Additionally, Lori will have to renew the dispensing license when renewing APRN licenses. Lastly and importantly, Florida-licensed APRNs are incorporated in the 24-month renewal cycle and are required to complete 24 hours relevant continuing education every renewal period. This 24 hours education comprises of at least two hours learning about prevention of medical errors, two hours education in Laws and Rules that guide the practice of nursing, two hours learning about human trafficking and two hours education on learning and recognition of impairment in the workplace which should be done every four years. These are just part of the learning hours as there are others that Lori will as well need for a full biennium.

Lori should observe the following prescription practices to ensure a safe prescription. Firstly, Lori should establish, evaluate and define the patient presenting problem, determine the drug therapy’s therapeutic objective, select the most appropriate medication and then provide comprehensive information to the patient regarding including the warnings and instruction (Lowery, Scott, & Swanson, 2016). Also, Lori should monitor the patient regularly, determine and consider the cost of drugs during prescription, if possible, go for the cheapest drugs that will achieve the same desired outcome. Lastly, Lori use exploits relevant tools, including prescription software and electronic drug reference, during a prescription to lessen prescription mistakes.