Independent Advanced Nursing Practice

1. Independent Advanced Nursing Practice Rosemary Goodyear Ed.D, APRN-BC, FAANP Chair INP/APN Network

2. China 1983

3. Independent Advanced Practice Nursing • What is advanced practice nursing? • What is an Advanced Practice Nurse (APN)? • What is independent practice (IP)?

4. Independent Practice • IS A NURSING BUSINESS • that works within the professional, legal, socioeconomic, cultural and personal environments • that addresses the patient/client’s health needs for efficient, safe and cost-effective care

5. Independent Practice • IS A NURSING BUSINESS • that allows the nurse to demonstrate excellence in nursing care and provide job satisfaction • that offers direct patient/client care, education, research, administrative and/or consultative services.

6. Independent Practice • IS A NURSING BUSINESS • where the nurse is autonomous in decision making in the practice environment • where the nurse is responsible and accountable for all outcomes in the practice environment

7. Independent Practice • IS A NURSING BUSINESS • where the nurse is an entrepreneur – a risk taker!

8. Why Pursue IP Now? • BECAUSE-- • Nursing knowledge is advancing professional practice • The national health systems are changing their attitudes towards nursing • Liberal global trade agreements

9. Why Now? BECAUSE-- • Transformation of laws and scope of nursing practice • Patient populations are without access to care • Change in health needs of people are not being addressed

10. WHY NOW? BECAUSE-- • Many of the conditions necessary for a successful transition into independent practice are present today!

11. China 1983

12. Preparation for IP • Reasons • Research • Readiness • References • Resources

13. Reasons for Initiating IP • TO HAVE NURSES -- • Improve the quality of health care- • Become an integral part of the health care system- • Demonstrate quality professional practice-

14. Reasonscont. • TO HAVE NURSES-- • Demonstrate reduced health care cost • Implement a scope of practice that reflects current nursing knowledge • Demonstrate ethical practice and equality for nurses

15. Research before IP • Research of • Health Care System • Regulations/laws that govern nursing • Literature of similar ventures

16. Researchcont. • Health Care System: • Public or Private or mixed • Are nurses currently working independently within the system? • Does the system contract for nursing services verses employment?

17. Laws and Regulations for IP • System of regulation • In place to register, monitor and protect nurses • Is the power to regulate nurses within the profession or government? • Who writes the scope of practice? • Are nurses registered to practice as generalist?

18. Literature Review for IP • Through the library and internet explore prior studies of APNs • Information needed to submit a proposal • Successes and barriers to independent practice

19. Readiness for IP • Readiness • Business plan • Fiscal support • Collaborative support • Marketing and publicity • Operations

20. Business Plan Mission and goals Philosophy of care Services Target market Competition Business history Benefits Marketing Plan Facility advantages Management team Financial projections Budget Readiness

21. Readiness • Fiscal Support • Grants – usually philanthropic foundations; trust funds • Internal • Personal savings • Friends/colleagues • External • Loans-debt or equity • Venture capital

22. Readiness • Collaborative Support • Nursing colleagues and peers • Physician colleagues and peers • Professional colleagues in legal and business arena • Personal support – family, friends

23. Know your product Identify the market area Identify the competition Know the customer needs Establish a marketing plan Networking with colleagues Word of mouth In-kind service in the community Write for local paper Brochures Business cards Readiness – Marketing and Publicity

24. 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

25. China 1983

26. Reference • Brown, S A and Grimes, D E (1995). A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing Research, 44(6), 332-338.

27. Reference • Sanders, E. M. and Kingma, M. (2003). Handbook on Entrepreneurial Practice: Nurses Creating Opportunities as Entrepreneurs and Intrapreneurs11International Council of Nurses

28. Resources for IP • Resources • Personal entrepreneurial zeal • System of reimbursement • Physical setting • Support systems • Patient population

29. A Resource - Professional Nurse Associations • A comprehensive health system includes nurse entrepreneurial practice • The adoption of a scope of practice, standards and competencies for the APN is fundamental to protect the nurse and public

30. A Resource - Professional Nurse Associations • The legitimation of advanced nursing practice must be written into law/rules • Inform the public about the new advanced role of nurses • Support entrepreneurial nurses in policy manners such as equality of pay or reimbursement

31. A Resource - Professional Nurse Associations • Educate the policy makers about APNs and the entrepreneurial projects • Encourage APNs into membership through supportive activities/programs • Support advanced nursing through periodic research of trends and needs of health care

32. Independent Practice • Types of Independent Practice may include: • Solo/Private Practice • Collaborative Practice • Group Practice

33. Independent Practice • Solo or Private Practice • A single professional nurse and staff operate and manage an office/clinic serving the health needs of a patient population.

34. Independent Practice • Collaborative Practice • One or more independent health professionals work together through contract or consultation to provide services for their patient populations.

35. Independent Practice • Group Practice • A coalition of health care professionals form a business to provide services to a population of patients.

36. China 1983

37. Independent Practice What qualitiesmust an APN have to practice independently?

38. 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

39. Entrepreneurship cont. • Do you enjoy competing in a business environment? • Can you admit when you are wrong? • Are you a self starter who can work on your own? • Do you trust people and do they trust you? • Do you know how to quickly solve problems?

40. Positive Entrepreneurial Qualities • Like to be in control • Are goal oriented • Able to manage by aims and goals • Able to analyze situations to minimize risk • Creative thinkers • Can admit they are wrong • Believe in themselves

41. Negative Entrepreneurial Qualities • Lack management experience • Lack understanding of financial planning • Poor location of facilities • Poor fiscal management • Underestimates the personal time • Over expands too quickly • Over spends budget

42. 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 in the delivery of care? • Do you have the qualities of an entrepreneur? • Nurses can be more independent and in control of their practice and patient care when there is regulatory and professional support.

43. Conclusion Answers to these questions can lead nursing and health care of the people forward. What is your answer? Thank you Rosemary Goodyear rtgoodyear@gmail.com

44. Hong Kong Harbor 1983