For M.Sc nursing students

1. INDEPENDENT PRACTICE ISSUE–
INDEPENDENT NURSE MIDWIFERY
PRACTITIONER

2.  Advanced practice – deliver cost-effective
and high quality health care to chronically
underserved populations in particular.
 They work collaboratively with physicians
and other health professionals to co-ordinate
health services for the benefit of the client.

3.  Direct comprehensive care
 Support of systems
 Education
 Research
 Publication and professional leadership

4.  Advanced nursing practice:
“A practice based on knowledge and skills
required in a basic nursing education, through
licensure as a registered nurse, and in graduate
education and experience, including advanced
nursing theory, physical and psychological
assessment and treatment of illness”

5.  Certified nurse – midwives
 Clinical nurse specialist
 Certified registered nurse anesthetist
 Nurse practitioner

6.  Certified by the American College of
Nurse – Midwives.
 Provide independent care for women
during pregnancy, labor and delivery, as
well as care for the newborn.
 Gynecological services such as pap
smears, family planning, treatment for
minor vaginal infections.
 Practice in a health care agency that
provides medical consultation,
collaborative management and referral

7.  Traditionally practice in a hospital setting
 Specialize in diabetes, cancer, cardiac,
pediatrics, or gerontology
 Function as expert clinician, educator, case
manager, consultant and researcher.
 Domains of practice are followed

8.  Within the domains of CNS practice, Sparacinio
(2005) identified 7 core competencies
 Direct clinical practice
 Expert coaching and guidance
 Team building
 Consultation
 Research
 Clinical and professional leadership
 Ethical decision making

9.  RN with advanced training in anesthesiology
 Provide surgical anesthesia under the
supervision of a physician with advanced
knowledge of surgical anesthesia

11.  They are registered nurses who are prepared,
through advanced education and clinical
training, to provide a wide range of preventive
and acute health care services to individual of
all ages.Provides health care usually in an
outpatient, ambulatory care or community –
based setting.
 Provide comprehensive care

12.  In 1965, the first NP programme was
established by Loretta Ford and Henry
Silver; opened in the university of
Colorado.
 1979 – 20,000 nurse practitioners
available in the country
 Emergence of physician assistant.
 Function varies - community and public
health clinics, private practice, school
based clinics, industrial sites

13.  Curriculum is framed using Essentials of Master’s
Education for advanced practice nursing and
criteria for evaluation of nurse practitioners
program
 Requires master’s degree(1965)
 Now it requires either an associate of science
in nursing(ASN) – 2 year course/ a bachelor of
science in nursing (BSN) – 4 year course.

14.  Broad range of health care services.
 Treat both acute & chronic conditions
through history taking, physical examination,
interpreting lab results and x-rays, provide
health teaching, counseling and refer
patients if needed.

15. Adult NP
Family Nurse Practitioner.
Pediatric nurse practitioner
Acute Care Nurse Practitioner
Women’s Health Nurse Practitioner
Geriatric Nurse Practitioner

16. It depends on scope of practice, degree
of responsibility power and authority,
working conditions
 Private or joint practice
 Independent practice
 Nursing centres
 Parish nursing

17.  Government:
 Armed services
 Public health department
 School health service(colleges,
universities)
 Hospitals
 Hospice care
 Physicians or private medical practices

18.  Faith Community Nursing, also known as Parish
Nursing, Congregational Nursing or Church Nursing
 Is a movement of over 10,000 registered nurses,
primarily in the United States and Canada.
 Is the intentional integration of the practice of faith
with the practice of nursing so that people can achieve
wholeness in, with, and through the community of faith
in which faith community nurses serve.

19.  State licensure as RN is attained by
successful completion of the NCLEX-RN; the
candidate must complete a state approved
nursing education program that specializes in a
field such as family health, adult health, acute
care, women’s health

20. • License period varies by state
(biennial/triennial relicensing)
• In US CNS certification is sponsored by the
American Nurses Credentialing Center (ANCC)
once master’s degree is completed

21.  Ordering, performing and interpreting
diagnostic studies( e g: x-rays, ECGs)
 Diagnosing, treating, evaluating acute and
chronic illness and disease (DM, HTN)
 Counseling and educating patients on
health behaviors.

22.  Prescribing pharmacologic treatments,
physical therapy & other rehabilitation
treatments.
 Providing prenatal care and family
planning services
 Performing minor surgeries and
procedures

23.  Each state has an APN act that specifies who may be
designated a NP or APN and the practice privileges to
which the NP or APN is entitled.
 The boards of medicine have some control over the
ability of the NP to practice like agreement or protocol
between the nurse and the physician to direct
supervision (written/verbal)
 Practice agreement/ annual review of protocols.

24. Canadian Nurses Association
 Certification program
 Its based on experience and built on
professional relationship, responsibility &
accountability.
 Nurses must not act beyond their level
of competence & preparation.

25. Australian nursing council
 Establishes competency standard.
 Standards – clinical practice, management of
care, counseling, health promotion, client
advocacy, clinical teaching, supervising,
mentoring and research.
 NP’s are authorized to practice prescribing
medicines and initiate some investigations.

26. CHALLENGES

27. A) REIMBURSEMENT:
 Primary criteria – education & certification
 Unique Physician Identifier number (UPIN)-
direct reimbursement from Medicare(1997)
 Hold master’s degree and recognized by
certification agency.
 Those without certification should obtain
Medicare provider number; those who failed
were unable to receive direct reimbursement.

28.  B. EDUCATION:
o The American Association of Colleges of Nursing
stipulated by the year 2015 the educational preparation
for APN’s should be the doctor of nursing practice.
o The development of core & specialty competencies
through the national organization of NP faculties has
been a significant accomplishment that reaffirms need
for quality education
o Educational programs to reevaluate their curricula
and make necessary curricular adjustments.

29. C. ACCESS ISSUES:
 NP’s site access to clients is a significant barrier in
their ability to practice’
 1. Exclusion from provider panels
 2. Restrictive practice acts
 3. Opposition to independent nursing practice.
 4. Competition by other providers
 To overcome these obstacles legislative action,
education for stakeholder & aggressive grassroots
activism are required.

30.  Challenges are opportunities as well.
 If barriers are removed – opportunities for
independent practice & entrepreneurship.
 Participate in policy making, delivering quality &
cost effective health care.
 Outside hospital – traditional physician practice
and setting independent practices.
 Deliver primary health care:- screening, health
promotion, diagnosis, treatment of minor illness

31.  5 competencies all health care professional should
possess to bridge for quality health care
 Provision of patient centered care.
 Evidence based practice
 Inter disciplinary team
 Quality improvement
 Informatics

33.  Midwifery nurse practitioner is a nurse
who has completed an additional educational
program focused on midwifery, practitioners
work in all types of settings in which
women’s health and obstetrical services are
provided.

34. CERTIFIED NURSE
MIDWIFE
CERTIFIED
PROFESSIONAL MIDWIFE
DIRECT ENTRY MIDWIFE
LAY MIDWIVES

35.  CERTIFIED NURSE MIDWIFE:
 Known as nurse midwives.
 Received training as both a nurse and a
midwife
 B.Sc degree/M .Sc degree.
 Certified by the Nurse midwives
council.
 Work with obstetricians, prenatal care,
treat women in menopause, conduct
delivery in birthing centre/hospitals

36.  CERTIFIED PROFESSIONAL MIDWIVES:
 Trained in midwifery, but not in nursing.
 Hold a bachelor’s degree
 Full training in prenatal , intranatal and postnatal
care.
 LAY MIDWIVES:
 They don’t attend midwifery school and are not
certified.
 Receive training through self study and by working
as an apprentice to an experienced midwife.

37.  DIRECT ENTRY MIDWIVES:
 Trained – attending college, midwifery
school, gain experience through
apprenticeship.
 Have adequate training and work under
an experienced midwife for years before
going out on their own
 Many states do not license them

38.  A more natural birth experience
 Lower cost compared to a doctor.
 A lower rate of caesarean section
 Less interventions during labor and delivery.

39.  CONSULTANT MIDWIFE:-
 Expert practice
 Professional leadership and consultancy.
 Education, training and development.
 Practice and service development
 Research and evaluation

40.  Must have professional leadership.
 Provide evidence based, women centered
midwifery practice.
 Encourage and support professional
development in others
 Approachable role model.
 Provide support and training

41.  Promotes midwifery led care in all area.
 Act as a buffer to midwives from the system
to help them become better support women.
 Resource of knowledge and support.

42. “You have powers you
never dreamed of. There
are no limitations in what
you can do except the
limitations of your own
mind. You can do things
you never thought you
could do. --”