ADVANCED NURSING PRACTICE

The purpose of this paper is to discuss four distinct questions relating to the advanced nursing practice. The discussion involves an analysis and/or comparison of material presented in "Advanced Nursing Practice: An Integrative Approach" (Hamric, Spross & Hanson, 2000).

COLLABORATION WITH PHYSICIANS AS AN APN

Collaboration between physicians and NPs are essential for the benefit of smooth patient care. So how does an NP/APN best achieve effective collaboration? Since it is generally up to the APN to ensure that collaboration works, it is in the best interests of patient care that an APN formulate effective strategies. This entails first and foremost that the NP recognizes the adversarial nature that is inherent between the physician setting and the APN/NP practice. In today's healthcare environment, many cost containment measures threaten physician salaries and job security. This makes it hard to embrace the possibility of competition from the APN (pp. 730-731).

Thus, it is important for the APN to stress the benefits of collaboration, both economically and professionally. From an economic point of view, the APN should stress the possibility of referral. This specifically relates to areas that are outside the scope of practice of the APN when it comes to taking care of patient needs. A joint practice where frequent informal consultation between physician and APN exists benefits the patient. Different perspectives on care can result in

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thical decision-making competency involves pain management. Typically, a nurse monitors the patient, interprets symptoms, and administers medication to provide relief from either undesirable or intolerable symptoms. As an APN, it becomes problematic when a physician is reluctant to acknowledge the severity of a patient's problem and/or prescribe an adequate amount, or strength, of medication to alleviate a patient's suffering (Ramirez, 1996). Many physicians prescribe Tylenol, or similar, for pain, while the patient is crying out for heavy-duty pain medication, such as Vicodin. This poses a serious dilemma for a sympathetic and emphatic nurse. Regardless of the level of involvement, the APN must support the best interests of the patient and uphold the ethical concepts of informed consent and truthfulness (pp. 358-359). Conflict between physician and nurse, e.g. regarding pain relief medication, can be resolved when ethical knowledge is tempered with compassionate and effective communication skills, and a collaborative stance is adopted with the objective of achieving a mutually satisfactory solution. Barriers to ethical practice arise out of ignorance of a professional code of ethics, i.e. confusion between personal and pro

Category: Medical - A