This document discusses issues related to independent nursing practice. It begins by noting that nurses now have more opportunities for independent practice due to changes in healthcare. Nurses in independent practice are self-employed but still must follow all nursing laws and standards. They may face unique challenges. The document outlines key practice areas for independent nurses to consider, including scope of services, conflict of interest, endorsement, and advertising. It also discusses the process for becoming an independent nurse practitioner from novice to expert. Finally, it provides an example of an independent midwifery practice package.

1. INDEPENDENT PRACTICE ISSUES
PREPARED BY – SAPNA THAKUR
MSC COMMUNITY HEALTH
NURSING

2. INTRODUCTION
• Changes in the health care and nursing professional have
provided nurse with more opportunities to apply their
expertise independently.
• Nurse who are self employed are referred to as
independently practicing .
• Although they are still bound by all nursing legislation and
standards , nurses in independent practice face some unique
challenges .

3.  SELF EMPLOYED NURSES
 STILL BOUND BY ALL NURSING
LAGISLATION AND STANDARDS.
 FACE SOME UNIQUE
CHALLANGES

4. NURSE PRACTITIONERS
•Nurse practitioner (np) are registered nurses
who have graduate level nursing preparation
as nurse practitioners at master’s or
doctoral level and perform comprehensive
assessment and promote health and
prevention of illness and injury.

5. KEY PRACTICES COMPONENTS TO CONSIDER
THE SCOPE OF SERVICES
Nurse in independent practice
must maintain the high standard
of nursing And uphold the public
trust that has been best owed on
the nursing profession .

6. SOME KEY PRACTICES ARE :
CONFLICT OF INTEREST
ENDORSEMENT
ADVERTISEMENT

7. CONFLICT OF INTEREST
Primary obligation is providing professional
care to his or her clients .
Nurse are in a position of trust and cannot
use their position to influence there client
for financial gain of non financial benefits.
Nurse should avoid promoting personal
interest , such as selling products or
services to client they are treating.

8. Selling products may give the appearance
of fulfilling the nurse’s personal interest
over client needs.
It is critical that nurse in independent
practice avoid conflict of interest situations
in their practices .

9. ENDORSEMENT
Endorsing or promoting a
product or services is closely
linked to conflict of interest .
The endorsement of product
or services without providing
information could mislead the
public and compromise trust .

10. For example : A nurse in
independent practice who
provide foot care services
should not sell any foot
care products to her
clients .

11. ADVERTISEMENT
 There are limitation
on how a nurse can
advertise his or her
services .
 Advertising may take
various forms such as

12. (a) Business cards

13. (b) Newspaper advertisement

14. (c) Radio advertisements

15. AREAS OF INDEPENDENT NURSE PRACTICES
 ADULT NURSE PRACTITIONER
 FAMILY NURSE PRACTITIONER
ACUTE CARE NURSE PRACTITIONER
GERIATIC NURSE PRACTITIONER
MENTAL HEALTH NURSE PRACTITIONER

16.  MIDWIFERY OR WOMEN HEALTH PRACTITIONER
SCHOOL HEALTH NURSE PRACTITIONER
FAMILY NURSE PRACTITIONER

17. PROCESS OF INDEPENDENT NURSE
PRACTITIONER
NOVICE ADVANCED
BEGINNER COMPETENT
PROFICIENT EXPERT

18. (A) NOVICE
In the beginning a nursing student , or any
nurse entering a situation in which there is
no previous level of experiencing .
For example : an experienced operating
room nurse choose to practice in home health
. the learner learn via a specific set of rules
or procedures , which are usually linear

19. (B) ADVANCED BEGINNER
A nurse who had some level of
experience with the situation is termed
as an advanced beginner .
 this experience may be observational
in nature , but the nurse is liable to
identify the meaningful aspect or
principles of nursing care

20. (c) COMPETENT
A nurse who has been in same clinical position
for 2-3 years .
this nurse understand the organization and
specific care require by the type of clients.
For example : surgical , oncology , or orthopedic
client

21. This nurse is competent practitioner who is
able to anticipate nursing care and establish
long range goals
In this phase , the nurse has usually had
experienced with all type of psychomotor skills
require by this specific groups of clients .

22. (4)PROFICIENT
 A nurse with greater that 2- 3 year of
experience in the same clinical position will
be proficient in that setting .
 The nurse perceives a client’s clinical
situation as a whole is able to asses an
entire situation and can transfer knowledge
gained from multiple previous experiences
to a situation.

23. (5) EXPERT
A nurse with diverse experience with an
imitative grasp of existing or potential
clinical problem is termed as expert .
The nurse is skilled at identifying client
centered problem , as well as problems
related to healthcare system or perhaps the
needs of the novice nurse

24. INDEPENDENT NURSE MIDWIFERY
PRACTITIONER
Midwifery term is used to describe the activities of
health care providers who are expert in the women
health care including prenatal care to expectant mother
, attending at birth and providing post partum care to
mother and her infant
Practitioner of midwifery are known as midwives’

25. MIDWIFERY PRACTICE PACKAGE FOR
INDEPENDENT
1. Access to a midwife 24 hours a day , 7 days
a week
2. Two midwives available alternatively and
provide women centred ante-natal, intra-
partum,and postnatal midwifery care
3. Antenatal care in privacy
4. Continuity care throughout labour.
5. Post-natal care up to 6 weeks..
6. Knowledgeab le breast feeding support