Part 1: Using Brown and Olshansky’s (1997) model, describe what interventions you
plan to do during your first year of practice to help you navigate the changes described
during in each phase.
In this phase Laying the Foundation, after completing the program I feel it is important to
reflect and recover. Personally, to achieve this phase I will be taking some vacation time
to work on my new home. It is important to pass boards and find a job to begin my new
career, however I have already made great professional relationships to have options
for employment once I have completed my schooling. By preparing now for boards and
making these professional connections, should help with the transition after completing
school.
Launching phase, being a nurse in the ED, for several years, I have a good idea of
anticipating what the providers will order. Collecting urine, and blood samples. Giving
medications, assisting with procedures, and discharging, transferring, or admitting the
patient. As a provider I will be the one in charge of placing the necessary orders and
planning for the patient’s admission status. I anticipate this will be difficult depending on
which setting I end up practicing in. I will use the resources that have been taught to me
throughout this course.
Meeting the challenge, just like transitioning to an RN I had to gain confidence and
comfortability in my role as an RN. This will be the same for me for NP, it will take time
to gain confidence and to be comfortable in my role. I will create professional
relationships with other providers and a collaborative teamwork approach.
Broadening the perspective, this phase I will be comfortable in my role as an NP and in
practice. It will be important to continue my education and gain certificates. Also being
involved in local NP groups and national NP groups. After I have gained ample practice,
I will begin precepting FNP students to help them gain knowledge of standards of
practice.
Part 2: We are seeing rapid change in primary care as stakeholders are demanding
higher quality healthcare at reduced costs. After reading the Cuenca (2017) and Shi, et
al. (2017) articles, provide a synthesis-level evaluation of how you believe the patientcentered medical home and value-based payment models will: (1) impact your personal
practice as a nurse practitioner, and (2) transform the way primary care is delivered in
the United States.
After reviewing both articles it was really eye opening in the changes that occur in
healthcare. Just in the time I have been in healthcare I have seen significant change
occur. An area that I feel will impact personal practice as a nurse practitioner would be
the patient satisfaction surveys. This can impact the provider by having one negative
survey can affect the providers score very negatively based on the number of surveys
filled out. The aspect of value-based payments could benefit everyone if it doesn’t result
in a negative patient satisfaction score. This could occur because in the patient’s
perspective they might believe they should have received other treatment. But based on
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evidence-based practice the patient received other treatment. This could result in a low
patient satisfaction score. This is where value-based payments could negatively affect
the provider. But ultimately what matters is that the patient receives the proper care
regardless of the patient satisfaction score, as a future provider I would rather ensure
proper treatment of the patient than have great patient satisfaction scores.
Part 3: After reading the AANP (2015) and White, et al. (2017) articles, what are your
thoughts on the economic benefits of using nurse practitioners in healthcare practices?
How would you respond to this question if asked in a job interview? Support your
response in Part 3 with evidence from the literature.
In my opinion utilizing nurse practitioners helps to take the heavy load off physicians
and encourages a collaborative style of providing patient care. Economically this can
help because instead of facilities staffing 40 physicians, they could staff 20 physicians
and 20 mid-level providers, and the facility can provide greater intensity of care without
increasing total costs of care (Poghosyan et al., 2019). Physicians could focus on more
complete patients and ultimately spending more time focusing on each individual
patient. However, studies have been conducted that should the NP’s have been playing
a larger role in the primary care of medically complex patients with chronic conditions
(Morgan et al., 2019). When looking at data treatment of the medically complex patients
was associated with less use of acute care services and lower total costs when cared
for by an NP (Morgan et al., 2019).
Reference:
Brown, M., & Olshansky, E. (1997). From limbo to legitimacy: A Theoretical Model of the
Transition to the Primary Care Nurse Practitioner Role. Nursing Research, 46(1), 46-51.
https://uw.instructure.com/courses/812898/files/22971045/download
Morgan, P. A., Smith, V. A., Berkowitz, T. S., Edelman, D., Van Houtven, C. H., Woolson,
S. L., Hendrix, C. C., Everett, C. M., White, B. S., & Jackson, G. L. (2019). Impact
of physicians, nurse practitioners, and physician assistants on utilization and costs for
complex patients. Health Affairs, 38(6), 1028–1036.
https://doi.org/10.1377/hlthaff.2019.00014
Poghosyan, L., Timmons, E. J., Abraham, C. M., & Martsolf, G. R. (2019). The
economic impact of the expansion of nurse practitioner scope of practice for Medicaid.
Journal of Nursing Regulation, 10(1), 15–20. https://doi.org/10.1016/s21558256(19)30078-x
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Juan,
You bring up great points and provide an interesting first discussion for this course. In the first
phase of Brown and Olshansky’s model you bring up residency. Post graduate NP
residency/fellowship programs to achieve competence and successful transition to practice have
emerged and flourished (Kesten & Beebe, 2021). I too think that it could be difficult to find a
job, and residency is a great option to get some experience and possibly have a foot in the door
when it comes to obtaining a job in the NP world. You did not mention what you were going to
do to recuperate personally from school, I hope you do take some time for family and to relax.
Thank you for your post.
Reference:
Kesten, K. S., & Beebe, S. L. (2021). Competency frameworks for nurse practitioner residency
and fellowship programs. Journal of the American Association of Nurse Practitioners,
Publish Ahead of Print. https://doi.org/10.1097/jxx.0000000000000591
Olusola,
You bring up great points in your post and provide a great first discussion in the last course. It is
great that you are choosing to take time off after taking your boards to spend time with
family. I too feel like I have neglected my family throughout this program to focus on my
academics. The most eye-opening change in healthcare delivery I have discovered and
think it is amazing is tele health, tele health allows healthcare providers to deliver more
efficient and patient centered healthcare services to individuals who face barriers to access
care (Fathi et al., 2017). It is no doubt to me that health care will continue to change as will
the demographics and healthcare needs of the population (Fathi et al., 2017).
Reference:
Fathi, J., Modin, H., & Scott, J. (2017). Nurses advancing telehealth services in the era of
healthcare reform. OJIN: The Online Journal of Issues in Nursing, 22(2).
https://doi.org/10.3912/ojin.vol22no02man02
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