2. Nurse practitioner
Nurse practitioners are licensed, independent practitioners
who practice in ambulatory, acute, and long-term care as
primary and/or specialty care providers.
Nurse practitioners assess, diagnose, treat, and manage
acute episodic and chronic illnesses.
3. INP(Independent Nursing Practitioner)
An INP is defined as, “A registered nurse who provides
professionals nursing services as a proprietor of a business,
through direct patientcare, education, research,
administration or consultation
4. NP’s focus largely on:
Health maintenance
Disease prevention
Counselling and
Patients’ education However, they are fully qualified to be
involved in patient diagnosis and treatment, which also
includes same prescriptive authority.
Scope of an NP’s practice varies depending upon state
regulation
5. HISTORY OF INDEPENDENT NURSING
PRACTICE
The nurse practitioner’s role had its inception in the mid-1960s
in response to a shortage of physicians. The first NP program
was developed as a master’s degree curriculum at the university
of Colorado’s School of Nursing in 1965, founded by Loretta C
Ford, Nursing faculty member and Dr Henry K Silva a
pediatrician.
6. Program were developed across the country to provide additional
education for experience nurse to enable them to provide Primary
Health Services to large undeserved population. The program who
are in pediatrician and they soon spread too many other
Healthcare specialties.
During 1970-1971, Federal legislation recommended certificate
program for nurses to deliver Primary Health Care gradually
certificate program to master's degree
7. In response to health care reform in 1990s, 3 INPs peace program
were developed to meet the demand of primary care services.
By 1994,248 programs Centre were developed for INP in US
In 1995, 49000 nurses were employed as INPs.
American Academy of nurse practitioner in 1993 developed standard
and guideline for practice of INPs which are still followed.
8. Today 200 Universities and colleges are offering INP program all
over the world
70,000 nurses are working as NP in US.
9. Development of independent nursing
practitioner and its development in India
The Indian Nursing Council (INC), the parent body of the nursing council
in the country, has rolled out an initiative, which is the early
implementation stage and has been forwarded for approval to the Union
Health ministry.
Independent nursing practitioner trained in midwifery has been introduced
to bring down the high maternal mortality rate (MMR) and infant mortality
rate (IMR) in rural areas. The National Population Policy 2000 includes
reduction of maternal and infant mortality as one of the sociodemographic
goes to the achievement achieved by 2010. The single most important way
to reduce maternal death in India would be to ensure that our skilled health
professional is present at very every birth.
10. So, in order to ease the impact of shortage of Gynecologist in in
Community Health Care IMC performed a pilot study of “Independent
Nursing Practitioner Project” in West Bengal at SSKM Hospital’s
female Medical and surgical ward. The project provides an 18-month
rain training in midwifery, besides an additional training in emergency
of obstetric care to candidate who has completed their BSc in nursing
and have two- or three-year clinical experience in ob-gyn to take care of
ANM in rural sectors. these nurses are called independent nursing
practitioner as they are trained to prescribe medicine following approved
protocol and take decision independently in absence of Gynecologists.
11. The results of the pilot study have been submitted to health ministry E and
the Government of India in currently examine the proposal to extend this
project all over India. INC is finalizing a curriculum with senior of Static and
gynecologist for the training of independent nursing practitioner module.
12. Explains T Dileep Kumar, president INC “In ruler areas through a community
Health Centre should be maintained by physician surgeon pediatrician and
gynecologist, the community health center it is usually found facing a
shortage of Gynecologist it is in such a scenario that the role of independent
nurse practitioner gains importance hear auxiliary midwives are trained
independent nurses practitioner should be regarded as a part of solution for
improving quality essays and cost of care and continuing education.
13. Basic requirements of independent nursing
midwife practitioner
Becoming independent practitioner is one of the important challenges as
it needs specialized qualification the based requirement are mentioned
below:
Basic nursing education
Registered nurse
Advanced nursing certificate (master degree in Obstetrics & Gynecology
nursing)
Collaboration with any Hospital/Agencies referral & reimbursement.
14. Independent nurse practitioners work in a variety of settings, including
Community clinics and health center
Nurse managed centers
Private practices (eithers by themselves or together with a physician)
Hospitals
Nursing homes
Birthing centers
Women’s health clinics
15. Home healthcare agencies/ Home nursing
Schools or colleges-based health clinics
They often provide care to underserved populations in rural areas
or inner-city setting.
16. What’s independent nurse practitioners can
do?
Nurse practitioner is a registered professional nurse, with a current
license to practice, who is prepared for advanced by nursing practice
by virtue of knowledge and skills obtained through a post basic or
advanced education program of study acceptable to the State board of
nurse examiners: -
17. Midwifery nurse practitioner is prepared to practice in an expanded role to
provide primary care to women, to well-women related to reproductive
health, conduct annual gynecological exams, provide education regarding
family planning and provide menopausal care.
He/She provides care in variety of settings including, but not limited to
homes, hospitals, institutions, community agencies public and private
clinics, she is capable of solo practice with clinically component skills and
are legally approved to provide a defined set of services without assistance
or supervision of another professional.
18. Nurse practitioners are uniquely qualified to resolve unmet needs in
primary healthcare by serving as an individual’s point of first
contact with the healthcare system. This contact provides a
personalized, client-oriented, comprehensive continuum of care and
integrates all other aspects of aspects of healthcare over a period of
time. Their focus of care is on health surveillance (promotion and
maintenance of wellness), but it also provides for management of
complication in order to maintain continuity
19. Where Do Nurse Practitioners Work?
Most NPs specialize in family practice. While NPs work in nearly
every healthcare setting, they are most likely to work in hospital
outpatient (14.4%) or inpatient (13.3%) departments, or in private
group practices (11.6%).
20. Hospital Outpatient
NPs generally serve as primary care providers or specialists in hospital
outpatient settings, assessing and diagnosing patients, prescribing
treatment, advising patients on care, and referring patients to physicians
for additional care when needed.
Hospital Inpatient
In a hospital inpatient setting, NPs also assess and diagnose patients and
prescribe treatment as part of a patient's ongoing care. They may also lead
nursing teams and oversee the work of other clinical staff.
21. . Program Description
The NP program is a Nursing residency program with a main focus on Competency
based training. The duration is of two years with the curriculum consisting of
theory that includes core courses, advanced practice courses and clinical courses
besides clinical practicum which is a major component.
22. Standards/Requirements to start the NP
program
Standards/Requirements to start the NP program The teaching
institution must accept the accountability for the NP program and
its students and offer the program congruent with the INC
standards. The hospital should be a parent tertiary care centre with
a minimum of 500 beds and above having Medical ICU, Surgical
ICU, Cardio/thoracic ICU and Emergency care unit with a
minimum of 10 beds and above in each ICU, to a total of 40-50
ICU beds in the hospital
23. ISSUES IN INDEPENDENT NURSING
PRACTICE
1. lack of understanding of the nurse practitioner role.
2. Conflict of interest: -
Primary obligation is providing professional care to his/her clients.
In a position of trust and cannot use their position to influence their clients for
financial gain of non-financial benefit.
Avoid selling products or services to clients they are treating.
Avoid conflict of interest situations in their practice, particularly when it comes to
the endorsement and advertising of products.
3. Public perception
24. 4. Advertising.
There are limitations on how a nurse can advertise his or her services.
Advertising may take various forms, such as business cards listing in
telephone directories, announcements in newspapers and periodicals, and
promotional materials.
It can include information such as a description of services and nursing
credentials, practice experience, fee, address and phone number.
25. 5. Attitude towards the independent nurse practitioner.
6. Lack of carrier advancement.
7. Prescriptive authority.
Nurse practitioners have the authority to prescribe and can write prescriptions
(including ones for controlled substances) without any physician involvement.
However, some believe that there should be collaborative prescribing agreement
between nurse practitioners and physicians.
27. CHALLENGES OF INDEPENDENT
NURSING PRACTICE
1. Policy
2. Allowing staff to develop Professional autonomy.
3. Involving staff in all decisions.
4. Establishing collaborative procedures between staff and management.
5. Making available work environment structures.
6. Characteristics of the transformational leadership style.
.
28. 7. Psychological stage.
8. Professional knowledge, accountability.
9. Education.
10. Responsibility to carry their scopes of practice
29. CONCLUSION
A nurse practitioner (NP) is an advanced practice registered nurse and a type
of mid-level practitioner. NPs are trained to assess patient needs, order and
interpret diagnostic and laboratory tests, diagnose disease, formulate and
prescribe treatment plans. NP training covers basic disease prevention,
coordination of care, and health promotion, but does not provide the depth of
expertise needed to recognize more complex conditions.
The scope of practice for a NP is defined by legal jurisdiction. In some
places, NPs are required to work under the supervision of a physician, and in
other places they can practice independently.
