Feb 23, 2024 NURS 8100 Discussion: Federalism’s Impact on Policy
A Sample Answer For the Assignment: NURS 8100 Discussion: Federalism’s Impact on Policy In the state of Maryland some of the advanced practice registered nurses (APRNs) include certified midwives, nurse anesthetist, certified nurse practioner (NP) and a clinical nurse specialist. This should be similar to other states too. At a minimum and from personal experience Maryland board of nursing has to give permission to practice as an NP and there are basic requirements that have to be met to qualify to be certified. Not all the regulations that are set forth by the state of Maryland for APRN to practice are recent but they are however all currently used. Code of Maryland regulations (COMAR) are the compilation of the state of Maryland regulations that help govern the state, (Maryland.org, n.d). Health care is not an exception and APRNP have to abide by the COMAR regulations. According to COMAR, (2020), APRNs can perform multiple functions independently. These include comprehensive assessments, complete a death certificate, do not resuscitate orders, interpret diagnostic and laboratory tests, prescribe medications, provide care and give referrals to other providers. An NP can also practice as a registered nurse and for those who have certifications for mental health, they can admit a client on an involuntary basis for treatment. How State Regulations Are Supported within Place of Employment The place of employment has set standards at the same level of practice as expected by the state but for some treatment approaches the expectation is to defer to the primary physician or the medical director. Establishing this baseline helps achieve the expected standards and also remain in compliance with the COMAR and federal regulations. The place is very supportive that when the NP completes an admission assessment, the doctor does not have to double check unless there is a concern. Struggling to Meet Your Deadline? Get your assignment on NURS 8100 Discussion: Federalism’s Impact on Policy done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline As a nurse practioner, at the place of work there are multiple activities that can be performed independently. These tasks include but not limited to giving orders for medications and treatment, reviewing diagnostic tests, and responding to families as required. One task that is permitted by the state of Maryland but not encouraged at the place of work is signing of certificates of incapacity. (A. Speer, personal communication, July 26, 2021). The primary physician and the psychiatrist sign the Maryland order for life sustaining treatment (MOLST) also and only encourage the NP to sign it if they are not available. This is a task that is authorized by COMAR regulations. How States Differ in Terms of Scope of Practice Different states have different prescriptive authorities and conditions that they give to their APRNs. There are those states that are referred to as independent states which allow APRN independent prescribing and there are those which do not, (Schirle & McCabe, 2016). Barriers to practice are not uncommon even when the states are flexible, health care settings can still impose different strict policies and procedures. This leads to restriction of some aspects of patient care and limited access to providers despite the states having full practice authority, (Schorn, Myers, Barroso, Hande, Hudson, Kim & Kleinpell 2022). Impact on Professional Nurses across the United States. Some nurses have opted to relocate or work where there is more prescriptive authority. Some nurses also have opted not to relocate but get licensures in neighboring states that can give them more autonomy. There are also nurses who have opted to work in other areas where they are needed. These areas include working as lobbyists, researchers, nurse educators and consultants. In this aspect their full potential is more effectively utilized. References COMAR 10.27.07.00 (2020) Practice of the Nurse Practitioner , http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm Maryland.org (n.d), Division of state documents. http://www.dsd.state.md.us/COMAR/ComarHome.html Schirle, L., & McCabe, B. E. (2016). State variation in opioid and benzodiazepine prescriptions between independent and nonindependent advanced practice registered nurse prescribing states. Nursing Outlook, 64(1), 86–93. https://doi.org/10.1016/j.outlook.2015.10.003 Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a National Survey: Ongoing Barriers to APRN Practice in the United States. Policy, Politics & Nursing Practice, 23(2), 118–129. https://doi.org/10.1177/15271544221076524 NURS 8100 Week 8: Federal Role in Health Care Policy”> The fragmentation of the U.S. health care system, with its differing modes of financing and service delivery, is a reflection of a dispersed government structure. Policy making is shared and distributed across various branches and levels of government. As a result, policy making processes can be slow to respond, manipulated towards personal interests, and often redundant. Consider, for example, the public entitlement programs such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS), and the PPACA of 2010. Where is there overlap between these policies? How do they demonstrate a dispersed government structure? This week, you will analyze the role of the federal government in health care policy making. Three nurse colleagues provided feedback on the changes and benefits of the new American health system. The feedback centered upon the three healthcare models that have expanded the role of nursing. This section will summarize the feedback and provide a forecast of the future nursing role. Two of the nurse colleagues agreed with my view regarding the changing role of nursing. The three of them support the reform in health care, which seeks to expand care accessibility and centers more on disease prevention than cure. However, one of them foresees problems with the new healthcare models. The nurse colleagues are from Brooklyn Hospital Center’s surgical/rehab unit. In this medical facility, nurses provide services that ensure continuity of care, which the health reform in the U.S. is promoting. The facility focuses more on the Brooklyn area and provides care using a multidisciplinary approach. It has created some standards of excellence that nurses must comply with to ensure the best care. Nurses in this facility are innovators and leaders who focus on improving care provision in Brooklyn. The hospital provides a supportive work environment for nurses and latest technologies that greatly improve care provision. The first nurse who provided feedback came to the United States several years ago from Afghanistan. He described his nursing experience in Afghanistan, saying that in the country, nurses are strictly front-line care givers and do not make critical decisions in healthcare. They follow the directions of physicians. This nurse says that the role of nursing differs with time and place. She agrees that the role of community health has increased with the current health reforms in the U.S. This implies that nursing is becoming increasingly important in the country. The nurse states that the health care systems of other countries are adopting reforms similar to that of the United States, which provides more opportunities for the nursing career. The nurse is optimistic about the health reform and the three healthcare models. He supports the increasing role of nurses in community care and decreased role in acute care settings. Health centers managed by nurses are critical in achieving the goals of community-based care. Nurses can make critical decisions independently in the community settings. In such contexts, nurses are self-directed and can engage in critical thinking. The nurse’s feedback mostly focuses on nurse-managed health centers, where nurses play leadership roles in health planning, provision, and policy. Thus, the new healthcare reforms have provided a different perspective to the role of nursing, which is now contributing innovative ideas that greatly ameliorate care provision. The second nurse colleague has also recognized the benefits provided by health reform in the U.S. She agrees that nurses have an essential role in transforming healthcare. She believes that reform is important in the management of chronic diseases, where prevention works better thank curative measures. Medical homes, health centers managed by nurses, and accountable care organizations help in preventing of chronic conditions in the community settings. The models are critical in making the public aware of the need to prevent chronic diseases and reducing the cost burden posed by treatment measures. Preventive care also implies more opportunities for nurse practitioners, who will take more leadership and other positions. Thus, reform helps in providing a better structure to the healthcare system, with nursing playing more specialized roles. The reforms also ensure that health care provision is centered more on the patient, which is critical in improving outcomes in healthcare. Nurses can have a role in collaborating with other healthcare providers and be innovative on strategies that improve health care. This nurse is confident that the new healthcare delivery models are reaching more underserved people, which is a significant benefit. The third nurse who provided feedback has a slightly different view about the American healthcare reform and the three inherent models. While he is hopeful about improvement in healthcare services, he is anxious about what will happen to the quality of care when the models attracts more patients. Hospitals will have more patients when the models operate on a full scale, which might result in problems with efficiency in care provision. Managing an increased number of Medicare patients will involve a lot of paperwork and will result in increased administrative cost. Care and disease management will also present increases in cost, as well as a deficit in nursing providers. Quality of care necessitates matching the needs of the reform with more trained and qualified nursing providers. Therefore, according to this nurse, healthcare reform should focus on quality rather than quantity. In conclusion, nurses contribute the most to implementing reforms in the health care system. Their role has changed and expanded over the years following the creation of new health care delivery models. The entire U.S. health care system has changed from acute care to community settings, which has provided benefits for many underserved people. Nevertheless, it is imperative to ensure that information and knowledge regarding the health reforms is provided to everyone to ensure smooth transition from the old to the new system. The feedback by the three nurse colleagues accentuate the need for the reforms in the U.S. healthcare system, but it is imperative to ensure that there are more nurses to ensure quality healthcare outcomes in the future. To prepare: Review this week’s Learning Resources focusing on the France article and the textbook readings. Identify two nursing or health care policies that address similar needs, one passed at the federal level and the other at another level of government (state or local). By Day 3 Post a cohesive response that addresses the following: Provide an example of two policies that address similar needs, passed at two levels of government (i.e., federal, state, or local). What are the advantages and/or disadvantages of this duplication? How does this example reflect the implications of federalism? Provide support from the literature for your position. To what degree should the federal government get involved in health care policy making? Provide concrete examples to support your position. Read a selection of your colleagues’ postings. By Day 6 OF Discussion: Federalism’s Impact on Policy Respond to at least two of your colleagues in one or more of the following ways: Ask a probing question, substantiated with additional background information, evidence or research. Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives. Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library. Validate an idea with your own experience and additional research. Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings. Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence. Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria. Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues. ORDER NOW FOR ORIGINAL PAPER NURS 8100 Discussion: Federalism’s Impact on Policy NURS 8100 Week 8: Federal Role in Health Care Policy How does the organization and structure of government, including the existence of multiple levels (federal, state, local), promote or hamper effective policy making and implementation? What role does the federal government, in particular, play in the development of policies that affect nursing practice in today’s health care organizations? This week, you will examine how federalism has influenced the current health care system. You will consider the positive, or negative, implications of redundancy in health policy resulting from different levels of government. Learning Objectives Students will: Assess the implications of federalism in health care policy making Analyze the politics and issues surrounding a current health care policy Photo Credit: [Anuska Sampedro]/[Moment]/Getty Images Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical. Chapter 15, “Health Care Reform and National Health Insurance”Chapter 15 discusses the history of legislating national health care insurance in the United States. The chapter focuses on the different methods of financing a national health care reform, from a single-payer government fund to employer and individual mandates. Chapter 16, “Conflict and Change in America’s Health Care System”Chapter 16 highlights the historical relationships between health care purchasers, insurers, providers, and suppliers. Over the decades, these stakeholders have battled for control of the U. S. health care system, as health care costs increase and more people remain uninsured. France, C. (2008). The form and context of federalism: Meaning for health care financing. Journal of Health Politics, Policy & Law, 33(4), 649–705. doi: 10.1215/03616878-2008-012 Note: You will access this article from the Walden Library databases. The author argues that the United States’ unique form of federalism works negatively within a fragmented societal context to create an equally fragmented and dispersed health care system. The article highlights the United States health care system by comparing it with systems in Canada, Germany, and Australia. Frankel, M. S. (2009). Commentary: Public outreach by the FDA: Evaluating oversight of human drugs and medical devices. Journal of Law, Medicine & Ethics, 37(4), 625–628. Note: You will access this article from the Walden Library databases. Kennedy, E. M. (2005). The role of the federal government in eliminating health disparities. Health Affairs, 24(2), 425–428. Note: You will access this article from the Walden Library databases. In this article, the late Senator Kennedy discusses health care disparities among marginalized groups in the United States. He proposes the expansion of Medicaid and State Children’s Health Insurance Program (SCHIP), increased cultural competency among health care providers, health care research related to marginalized groups, and an increased public health investment by the United States. He includes a brief history of government involvement in reducing health care disparities. Rubric Detail NURS 8100 Discussion: Federalism’s Impact on Policy Select Grid View or List View to change the rubric’s layout. Name: NURS_8100_Week8_Discussion_Rubric Grid View List View Excellent Good Fair Poor RESPONSIVENESS TO DISCUSSION QUESTION Discussion post minimum requirements: *The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct. 8 (26.67%) – 8 (26.67%) Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*. 7 (23.33%) – 7 (23.33%) Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*. 6 (20%) – 6 (20%) Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*. 0 (0%) – 5 (16.67%) Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*. CONTENT KNOWLEDGE 8 (26.67%) – 8 (26.67%) Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course. 7 (23.33%) – 7 (23.33%) Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course. 6 (20%) – 6 (20%) Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills
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