independent apn practice

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IndependentAdvanced Nursing

PracticeRosemary Goodyear Ed.D,

APRN-BC, FAANPChair INP/APN Network



China 1983



Independent Advanced PracticeNursing

What is advanced practicenursing?

What is an Advanced PracticeNurse (APN)?

What is independent practice(IP)?



Independent Practice

IS A NURSING BUSINESS

that works within the professional,legal, socioeconomic, cultural andpersonal environments

that addresses the patient/client’shealth needs for efficient, safe andcost-effective care





that allows the nurse to demonstrateexcellence in nursing care andprovide job satisfaction

that offers direct patient/client care,education, research, administrativeand/or consultative services.





where the nurse is autonomous indecision making in the practiceenvironment

where the nurse is responsible andaccountable for all outcomes in thepractice environment





where the nurse is anentrepreneur – a risk taker!



Why Pursue IP Now?

BECAUSE--

Nursing knowledge is advancing

professional practiceThe national health systems are

changing their attitudes towards

nursing

Liberal global trade agreements



Why Now?

BECAUSE--Transformation of laws and scope of

nursing practice

Patient populations are withoutaccess to care

Change in health needs of people arenot being addressed



WHY NOW?

BECAUSE--

Many of the conditions

necessary for a successfultransition into independent

practice are present today!



China 1983



Preparation for IP

Reasons

Research

Readiness

ReferencesResources



Reasons for Initiating IP

TO HAVE NURSES -- Improve the quality of health care-

Become an integral part of the healthcare system-

Demonstrate quality professionalpractice-



Reasons cont.

TO HAVE NURSES-- Demonstrate reduced health care cost

Implement a scope of practice thatreflects current nursing knowledge

Demonstrate ethical practice andequality for nurses



Research before IP

Research of

Health Care System

Regulations/laws that governnursing

Literature of similar ventures



Research cont.

Health Care System:

Public or Private or mixed

Are nurses currently workingindependently within thesystem?

Does the system contract fornursing services versesemployment?



Laws and Regulations for IP

System of regulation In place to register, monitor and protect

nurses

Is the power to regulate nurses withinthe profession or government?

Who writes the scope of practice?

Are nurses registered to practice asgeneralist?



Literature Review for IP

Through the library and internetexplore prior studies of APNs

Information needed to submit aproposal

Successes and barriers toindependent practice



Readiness for IP

Readiness

Business plan

Fiscal support

Collaborative support

Marketing and publicityOperations



Readiness

Business Plan

Mission and goals

Philosophy ofcare

Services

Target market

Competition

Business history

Benefits

Marketing Plan

Facility

advantages

Management team

Financial

projections Budget



Readiness

Fiscal SupportGrants – usually philanthropic

foundations; trust funds

Internal Personal savings

Friends/colleagues

ExternalLoans-debt or equity

Venture capital



Readiness

Collaborative Support

Nursing colleagues and peers

Physician colleagues and peers

Professional colleagues in legaland business arena

Personal support – family,friends



Readiness – Marketing and Publicity

Know your product

Identify the market

area

Identify thecompetition

Know the customer

needs Establish a

marketing plan

Networking withcolleagues

Word of mouth

In-kind service inthe community

Write for local paper

Brochures Business cards



Readiness

Operations Location

Materials and personnel necessary for

operations A management plan to include contracting,

price of services, billing systems as well

as meeting the regulations for the

business operations Personnel rights, responsibilities and

benefits



China 1983



Reference

Brown, S A and Grimes, D E (1995).A meta-analysis of nurse

practitioners and nurse midwivesin primary care. Nursing Research,44(6), 332-338.



Reference

Sanders, E. M. and Kingma, M. (2003).Handbook on Entrepreneurial Practice:Nurses Creating Opportunities as

Entrepreneurs and Intrapreneurs 11 International Council of Nurses



Resources for IP

Resources

Personal entrepreneurial zeal

System of reimbursementPhysical setting

Support systemsPatient population



A Resource - Professional Nurse

Associations

A comprehensive health systemincludes nurse entrepreneurial practice

The adoption of a scope of practice,

standards and competencies for theAPN is fundamental to protect thenurse and public




Associations

The legitimation of advanced nursingpractice must be written into law/rules

Inform the public about the newadvanced role of nurses

Support entrepreneurial nurses inpolicy manners such as equality of payor reimbursement




Associations

Educate the policy makers about APNsand the entrepreneurial projects

Encourage APNs into membershipthrough supportive activities/programs

Support advanced nursing throughperiodic research of trends and needsof health care




Types of Independent Practice mayinclude:

Solo/Private Practice

Collaborative Practice

Group Practice




Group Practice

A coalition of health care

professionals form abusiness to provide servicesto a population of patients.



China 1983




What qualities must an APN

have to practiceindependently?



Independent Practice Qualities

Entrepreneur – Self Assessment

‘one who organizes and manages a

business undertaking, assuming risk for

the sake of profit’… Decision-making and/or taking charge

Self discipline and self direction

Stamina Able to communicate and negotiate



Entrepreneurship cont.

Do you enjoy competing in abusiness environment?

Can you admit when you are wrong?

Are you a self starter who can workon your own?

Do you trust people and do they trust

you?Do you know how to quickly solve

problems?



Positive Entrepreneurial Qualities

Like to be in control

Are goal oriented

Able to manage by aims and goalsAble to analyze situations to

minimize risk

Creative thinkersCan admit they are wrong

Believe in themselves



Negative Entrepreneurial Qualities

Lack management experience

Lack understanding of financialplanning

Poor location of facilities Poor fiscal management

Underestimates the personal time

Over expands too quickly Over spends budget



Conclusion The future is bright to move nursing forward

Where is nursing in your nation?

Do you want to move nursing into a partner role inthe delivery of care?

Do you have the qualities of an entrepreneur?

Nurses can be more independent and

in control of their practice and patientcare when there is regulatory andprofessional support.



Conclusion

Answers to these questions can leadnursing and health care of the people

forward. What is your answer?

Thank you

Rosemary Goodyear

[email protected]



Hong Kong Harbor 1983

independent apn practice

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