Javier:

Week 8 Discussion

Since the Institute of Medicine (now the National Academy of Medicine) issued “The Future of Nursing: Leading Change, Advancing Health” in 2010, the nursing profession has come a long way in implementing its recommendations. There have been many achievements, but four will be examined. First, advanced practice registered nurses (APRNs) have greatly extended practice authority in nursing (Rehka, 2020). After the report was published, many states reformed their scope-of-practice regulations to enable APRNs to practice to the full extent of their education and training. Similarly, by 2023, over half of U.S. states will allow nurse practitioners with full practice authority (eliminating physician supervision). In rural and underserved areas, where they now provide primary care, APRNs’ role in addressing these healthcare access gaps has been particularly influential in this regulatory evolution.

Second, substantial progress has been made in the proportion of nurses with baccalaureate and higher degrees. The Campaign for Nursing’s Future, set in response to the IOM report, has an ambitious goal of 80 percent of nurses holding a BSN by 2020, as per Reynolds (2024). Although this goal was not 100% realized, the percentage of nurses with a BSN has substantially increased from just over 50% in 2010 to greater than 65% in many states. The advancement of education has been fostered by the development of unique academic progression pathways, including many RN to BSN programs and partnerships with community colleges and universities, allowing for seamless education transitions.

Third, nursing’s role in healthcare redesign and policy development has grown remarkably. Nurses now occupy more executive positions in healthcare organizations, serve on hospital boards, and participate in health system governance. Started in 2014, the Nurses on Boards Coalition has helped place thousands of nurses on corporate and non-profit boards. Furthermore, nursing has amplified its voice in policy-making by facilitating boards such as the American Academy of Nursing and increased recognition in federal advisory councils (Hassmiller et al., 2020). They have also been influential in nurses’ quality improvement initiatives and have aided in decreasing hospital-acquired conditions and readmission rates by implementing evidence-based practice.

Fourth, data collection and analysis on the nursing workforce have been substantially improved. In partnership with The National Forum of State Nursing Workforce Centers, the National Council of State Boards of Nursing conducts regular, comprehensive surveys of the nursing workforce to provide critical data on supply, demand, and demographic trends. Many states have set up nursing workforce centers that gather standardized data and thus provide a more accurate prediction of future needs. At the same time, these improved data systems have enabled targeted interventions to address nursing shortages in critical specialties and geographic areas, and they have assisted in fostering diversity to create a nursing workforce that more closely reflects the population it serves.

While presenting IOM achievements, DNP Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking has stood out. Aligning with nurses’ newfound assignments in healthcare remodeling, policy engagement, and management. Nurses are now taking up executive positions and being involved in health system governance, further strengthening quality improvement and healthcare’s strategic transformation delivery (DeNisco, 2023). DNP Essential VIII: Advanced Nursing Practice was also incorporated. This essential demands a push towards higher education levels as well as seamless academic pathways like RN to BSN programs to provide for advanced clinical competency. These skills are applied by DNP-prepared nurses during complex clinical situations and they also help to mentor future nursing professionals (DeNisco, 2023). Expanded leadership roles, implementation of evidence-based practice, advanced education, and more involvement in policy development have strengthened role-specific professionalism competency and reinforced nursing’s influence and accountability in healthcare.

References

DeNisco, S. M. (2023). Advanced practice nursing: Essential knowledge for the profession. Jones & Bartlett Learning.

Hassmiller, S. B., Beauvais, A. M., & Shellenbarger, T. (2020). The Future of Nursing Report 10 years later: Where is nursing and what work remains? Nursing Education Perspectives, 41(5), 272-273.

Rekha, S. G. (2020). The future of nursing: leading change, advancing health (2020). IP J Paediatrics Nurs Sci, 3(3), 60-3.

Reynolds, L. R. (2024). Factors Impacting BSN Degrees in Community Colleges in Illinois and Exploring Community Colleges to Address Nursing Education Reform: A Mixed Methods Study (Doctoral dissertation, DePaul University).

A SOAP note is a method of documentation employed by healthcare providers to record and communicate patient information in a clear, structured, and in an organized manner. This assignment will provide students with the necessary tools to document patient care effectively, enhance their clinical skills, and prepare them for their roles as competent healthcare providers.

Instructions:

SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. The episodic SOAP note is to be written using the attached template below.

For all the SOAP note assignments, you will write a SOAP note about one of your patients and use the following acronym:

S =Subjective data: Patient’s Chief Complaint (CC).O =Objective data: Including client behavior, physical assessment, vital signs, and meds.A =Assessment: Diagnosis of the patient’s condition. Include differential diagnosis.P =Plan: Treatment, diagnostic testing, and follow up

Click here to access and download the SOAP Note TemplateDownload Click here to access and download the SOAP Note Template

Submission Instructions:

• **SOAP note will be on a pediatric patient visiting a nurse practitioner’s pediatric primary care clinic.**
• Your SOAP note should be clear and concise and students will lose points for improper grammar, punctuation, and misspellings.
• You must use the template provided. Turnitin will recognize the template and not score against it.

Develop a PowerPoint presentation on a clinical case that was seen during your experience or a topic that is of interest to you.

1. Select a health problem that primarily affect the older adult population. Suggested Topics: Anemia of Chronic Disease, Rheumatoid Arthritis, Restless Legs Syndrome, or Hypertension.
2. Provide information about the incidence, prevalence, and pathophysiology of the disease/disorder to the cellular level.
3. Educate advanced practice nurses on assessment and care/treatment, including genetics/genomics—specific for this disorder.
4. Provide patient education for management, cultural, and spiritual considerations for care must also be addressed.

Submission Instructions:

• Presentation is original work and logically organized. Followed current APA format including citation of references.
• Power point presentation with 10-15 slides were clear and easy to read.
• Speaker notes expanded upon and clarified content on the slides.
• Incorporate a minimum of 4 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to APA style (the library has a copy of the APA Manual).

 

1. Review the 5 individual rights guaranteed by the HIPAA Privacy Rule. 
2. Have you or someone close to you utilized any of the 5 rights? 
3. What are some circumstances when you would want to utilize each of the 5 rights?

You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts. 

Minimum 150 words each reply with references under each reply. 

Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).

Discussion 1

The Role of Nurses in Addressing Workforce Culture Issues through Health Policy

Healthcare remains a dynamic industry fraught with complexity, as it integrates technology and human wellbeing while balancing efficiency and compassion. Nurses are arguably the most impacted and critical group within this structure. Today, nurses bear the burden of a persistent challenge in the workforce culture, which is burnout. Moreover, they have little power to change it, due to insufficient levels of organizational structure. This reality stifles adaptability and policy level flexibility across most healthcare systems.

From Mason et al. (2016), we understand how inadequate policy engagement amongst nurses results in a lack of workforce policies that directly target the nurse’s mental and physical health and does reclaim them as a priority. To plug this policy gap, he proposes organizational wellness initiatives that avoid confronting the fundamental issues—the nurse-patient ratio and mental health leave policies. This is in line with the prevailing approach towards safeguarding concepts which further endangers nurses’ mental wellbeing. The impacts of such guarded approaches are evident in Californian hospitals, where staff-patient ratio mandates have paradoxically improved job satisfaction, reduced burnout, and heightened patient satisfaction metrics. Despite the overwhelming need for inclusive advocacy which enables practical implementation of legislation such as these that enable markedly better work conditions for nurses, such protective policies need to be more widely adopted.

Nurse voice exclusion from organizational leadership and policy development is another cultural problem in healthcare. Nurses, who make up the largest portion of the healthcare workforce, are frequently left out of administrative and policy making positions at hospitals and are not included in policy think tanks. According to Mason et al. (2016), political competence is imperative for nurses. Nurses can navigate and influence the processes that govern their workplaces by forming coalitions and partnerships. The text recommends participating actively as a nurse into professional organizations as one of the main strategies to shift the balance of power in their favor.

Misinformation and lack of inclusion also persist as barriers. A nurse population that reflects the local population is needed to provide culturally competent care and to foster an inclusive work environment. However, the organizational hierarchies continue to be dominated by white leaders, with little to no change for nurses of color. Mason et al. (2016) argue that the lack of leadership opportunities for minority nurses can be addressed through policy changes that increase their educational sponsorship, mentorship, and leadership training. Nurse leaders need to actively support change at the national and institutional level by adopting policies that promote equity and eliminate systemic discrimination to advancement.

Effective collaboration across generational and professional lines shapes the workplace culture. In healthcare, as Mason et al. (2016) point out, there is a growing reliance on team-based care which demands integrating communication style and value cross boundaries of age and profession. Nurses can promote a culture of respect and shared governance by supporting interprofessional education and collaborative leadership policies in clinical and academic settings.

To summarize, the issues of culture in the healthcare workforce are intricate and enduring, but nurses have the optimal opportunity to address them beyond the bedside, by taking part in policy and politics. Nurses need to amplify their voice as advocates and, together with Mason et al. (2016), call for policy action to redefine nurses’ workspaces, making them healthier and more equitable, all to enhance patient care delivery.

Discussion 2

The connection between politics and advanced practice nursing is complex and deeply rooted in long-standing power structures. Advanced practice nurses are highly educated and capable providers, yet their ability to practice independently is often restricted by laws that do not reflect their training or the needs of patients. These restrictions are not just clinical, they are political.

Advanced practice nurses face significant difficulties when trying to influence the laws that govern their profession. In many cases, legislative decisions about their practice are made by individuals who are not familiar with what these healthcare providers do. Medical associations often have more political influence and resources. They use this power to maintain control over healthcare regulations, including those that limit advanced practice nurses’ scope of practice. This imbalance creates an uneven playing field. These providers must work harder to be heard by lawmakers. Unlike larger, well-funded medical groups, advanced practice nurses often lack strong lobbying organizations and political action committees. Without these tools, it is difficult to counter the influence of competing interests that benefit from maintaining the status quo (Schorn et al., 2022). 

Power dynamics between healthcare stakeholders make progress slow. Physicians, hospitals, insurers, and even some legislators have competing priorities. For example, some physicians view independent APRN practice as a threat to their professional territory or income. This leads to resistance, even when the evidence clearly supports the safety and effectiveness of APRN-led care. Federal regulations also play a major role in shaping APRN practice. Medicare and Medicaid reimbursement policies are key examples. These programs are controlled at the federal level and often reimburse APRNs at lower rates than physicians, even for identical services. This affects not only income but also the willingness of employers and systems to fully integrate APRNs into care models (Kleinpell et al., 2022).

The Centers for Medicare & Medicaid Services is one of the most influential federal organizations in this area. It controls payment structures and plays a large role in how APRNs are utilized in hospitals, clinics, and long-term care settings. The Department of Health and Human Services also influences practice through funding priorities and program regulations. These agencies impact everything from how APRNs are trained to where they are most needed. In addition to agency-level influence, major federal legislation also shapes the APRN landscape. The Affordable Care Act, for example, created new pathways for APRNs to serve in primary care roles through funding for community health centers and expanded access initiatives. It also emphasized preventive care and team-based models, which align with the strengths of APRN practice. However, the success of these provisions depends heavily on state-level implementation and political support, which varies widely. As such, national legislation can be a powerful tool for expanding APRN impact, but only when it is backed by state-level policies that remove scope-of-practice barriers (Phillips, 2024). 

Federal funding sources, such as grants from the Health Resources and Services Administration, can help expand APRN roles in underserved areas. However, the availability and distribution of these funds are often tied to political agendas. Changes in administration can shift priorities, creating uncertainty about long-term support for APRN initiatives. All of these challenges show how tightly APRN practice is tied to politics. It is not enough to rely on clinical evidence alone. Advocacy and political engagement are essential. APRNs must become active in shaping health policy. That means joining professional organizations, contacting legislators, and supporting policy reform that promotes full practice authority (Kleinpell et al., 2022). 

More APRNs are now running for public office, serving on healthcare boards, and participating in grassroots campaigns. These efforts matter as they not only push for policy change but also increase public awareness of APRN contributions. When APRNs take leadership roles in political spaces, they help shift the conversation toward a more equitable and effective healthcare system. The future of the profession depends on this kind of bold and sustained advocacy.