Reply Posts

For the reply post, select a posting from one of your classmates that chose a different competency and discuss how your preceptor demonstrated proficiency with this competency during your clinical practice and what you have gained from that experience. If you have not worked with a preceptor yet, you may choose an example of an NP who you have worked with, or an NP who you have observed. If you are having difficulty identifying a personal story, please feel free to demonstrate your understanding of a second competency through an evidence-based essay that adds depth to a peer’s initial post.

In this discussion, you are asked to provide exemplars that are personal experiences. For the reply posts, the rubric includes having two references. If you do not have two references that is ok; you will not be graded down.

Please refer to the Grading Rubric for details on how this activity will be graded.

PLEASE RESPOND TO THESE TWO DISCUSSION POSTS

RESPOND TO DISCUSSION  1 on Policy

The purpose of this post is to discuss ways a student has or can begin to exemplify a National Organization of Nurse Practitioner Faculties (NONPF) core competency. The NONPF developed nine competencies for nurse practitioners for many health and science programs, including advanced practice nursing (Tractenberg et al., 2019). The sixth competency is called policy, which refers to the guidelines that manage and support decisions related to patient care (The National Organization of Nurse Practitioner Faculties [NONPF], 2017). It includes seven objectives and expectations such as demonstrating an understanding of the interdependence of practice and policy; advocating for ethical policies that promote access, quality, equity, and cost; analyzing legal, ethical, and social factors that influence policy development; contributing to the development of health policy; analyzing the implications of health policy across disciplines; evaluating the impact of globalization on healthcare policy development; advocating for policies for safe and healthy practice environments (NONPF, 2017). According to Thomas et al. (2019), preparing nursing students to engage in health policy is essential because it can help shape the health policies in the United States at the local, state, and national levels. A way a student can exemplify policy competency is by educating themselves and advocating for the implementation of the full practice and licensure laws in Ohio that will allow all nurse practitioners to independently evaluate, diagnose, order and interpret diagnostic tests, initiate and manage treatments, including prescribing medications and controlled substances under the licensure of the state board of nursing (American Association of Nurse Practitioners [AANP], 2022). An example includes a previous clinical instructor on an association currently advocating for changes in the Ohio law that will allow nurse practitioners to practice independently. At this time, Ohio is a reduced practice state where nurse practitioners must have a collaborative agreement with another health provider in order for the nurse practitioner to provide patient care (AANP, 2022). Having independent, full practice authority improves patient access to healthcare, especially in rural and underserved areas, decreases healthcare costs, streamlines care, makes delivery more efficient, and protects patient care (AANP, 2022). The nurse practitioner student can recognize the value of policy by engaging and educating themselves on health policy and become competent to help with decision-making that shapes the health care system. This action will support the overall population’s health and well-being.     

References

American Association of Nurse Practitioners. (2022). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

The National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner core competencies content. https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf

Thomas, T., Martsolf, G., & Puskar, K. (2019). How to engage nursing students in health policy: Results of a survey assessing students’ competencies, experiences, interests, and values. Policy, Politics, & Nursing Practice, 21(1), 12–20. https://doi.org/10.1177/1527154419891129

Tractenberg, R. E., Wilkinson, M. R., Bull, A. W., Pellathy, T. P., & Riley, J. B. (2019). A developmental trajectory supporting the evaluation and achievement of competencies: Articulating the mastery rubric for the nurse practitioner (MR-NP) program curriculum. PLOS ONE, 14(11), e0224593. https://doi.org/10.1371/journal.pone.0224593

RESPOND TO DISCUSSION  2 on Ethics

The purpose of this discussion post is to discuss the ways a student has already or can begin to exemplify a National Organization of Nurse Practitioner Faculties (NONPF) Nurse Practitioner (NP) Core Competency. These core competencies identify the competency based curriculum recommended for education of nurse practitioners (Chan et al., 2020b). The purpose of these core competencies is to “reflect the knowledge, skills, and attitudes that NPs need for independent practice” (Chan et al., 2020a, p. 189). The eighth competency listed by NONPF is ethics, which details three competency areas including the integration, evaluation, and application of ethical principles and solutions to healthcare decisions (NONPF, 2017). Ethics education and training is meant to prepare nurses to be “competent ethics consultants who are worthy of the trust of” their patients, families, as well as other healthcare professionals (Sawyer et al., 2021, p. 127). The provision of ethical nursing care continues to be challenging due to ever changing policies and politics, an aging population requiring more advanced care, as well as the advancement of healthcare technology creating new ethical dilemmas, including how long do we sustain a life. One strategy to aid ethical development and decision making of nurses is through “strengthening professional competencies,” as the assumption is nurses will act ethically if they are “professionally competent” (Haghighat et al., 2020, p. 2).

Neonatal nurses face many ethical dilemmas in the course of their nursing experience including issues of infant viability, advanced life saving measures and complex care required for extremely pre term or ill infants, removal of life sustaining support, and parent quality, understanding, participation, and decision making ability (Famuyide et al., 2020). Nurses can improve their ethical competency by participating in professional ethics trainings and understanding the value and benefit of accessing their facility’s ethics committee when difficult decisions arise such as in the case of healthcare team disagreements or when any lack of care is noted (Famuyide et al., 2020). Asking for assistance related to ethical issues demonstrates an understanding of the complexity of healthcare decisions and the need for a comprehensive, interdisciplinary decision making process. Evaluating clinical research on these topics can aid nurses in making ethical decisions related to patient care. Helping with the development of ethical practice frameworks in areas such as viability, support removal, parent difficulties, and end of life issues can also help to improve care quality and reduce ethical dilemmas. Nurses must also remember their crucial role as patient advocate and their responsibility for ensuring patient autonomy, even when it may contradict wishes of a patient’s family or other healthcare professionals (PoÅ¡kutÄ— et al., 2022). These exemplars identify a few of the ways nurses have or can begin to demonstrate ethical competency in their clinical practice. 

References

Chan, T. E., Lockhart, J. S., Thomas, A., Kronk, R., & Schreiber, J. B. (2020a). An integrative review of nurse practitioner practice and its relationship to the core competencies. Journal of Professional Nursing, 36(4), 189–199. https://doi.org/10.1016/j.profnurs.2019.11.003

Chan, T. E., Lockhart, J. S., Schreiber, J. B., & Kronk, R. (2020b). Determining nurse practitioner core competencies using a Delphi approach. Journal of the American Association of Nurse Practitioners, 32(3), 200–217. https://doi.org/10.1097/JXX.0000000000000384

Famuyide, M., Compretta, C., & Ellis, M. (2019). Neonatal nurse practitioner ethics knowledge and attitudes. Nursing Ethics, 26(7/8), 2247–2258. https://doi.org/10.1177/0969733018800772

Haghighat, S., Borhani, F., & Ranjbar, H. (2020). Is there a relationship between moral competencies and the formation of professional identity among nursing students? BMC Nursing, 19(1), 1–7. https://doi.org/10.1186/s12912-020-00440-y

PoÅ¡kutÄ—, M., BartkienÄ—, A., Fatkulina, N., & Gefenas, E. (2022). The contribution of professional autonomy in advancing ethical behaviour: A narrative review of studies in nursing. Journal of Nursing Management (John Wiley & Sons, Inc.), 30(7), 2301–2307. https://doi.org/10.1111/jonm.13842

Sawyer, K. E., Dundas, N., Snyder, A., & Diekema, D. S. (2021). Competencies and milestones for bioethics trainees: Beyond ASBH’s Healthcare Ethics Certification and Core Competencies. Journal of Clinical Ethics, 32(2), 127–148. https://doi.org/10.1086/jce2021322127

The National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner core competencies content. https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf