Main Discussion Post – CAREER GOALS: STRENGTHS AND CHALLENGES RELATED TO NURSING PRACTICE COMPETENCIES

Due to the fact that family nurse practitioners care for their patients over their lifetime, the nurse practitioner programs are rigorous, which presents the student with challenges and obstacles are to face while completing these program (McNelis et al., 2021). I have set many goals for myself throughout this program and my main goal is to prove to myself and my children that if you set your mind to something, no goal is too far out of reach. I expect throughout my time in the course to be able to analyze my professional growth and development as it related to the advanced nursing practice, examine conditions of the body systems of adult patients, develop the skills to formulate a diagnosis and treatment options for these patients, and develop the ability to provide competent care for an adult through their lifespan. 

 One of my greatest strengths is that most of my nursing career has been spent caring for adult patients. Taking care of adults is comfortable for me and I can relate and talk to this population. Another strength I possess is that I have cared for a wide range of patients during their hospital stay from inpatient rehab, at the end of their stay, to the intensive care unit during the most crucial time of their hospitalization. The experiences I’ve had as a nurse has allowed me to feel competent and confident in assessment, monitoring, and communicating with members of a team to care for these individuals. 

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Some of my greatest challenges in this course will be working with patients over their lifespan and following up on care. In my career, I have only worked with patients in the acute care setting. I have not had many opportunities to be able to follow up on an individual that has been discharged from the hospital and see how their current health status is. One of the major goals I have in this class is to feel more confident caring for patients over their lifespan. One objective that I hope to familiarize myself with is helping patients make lifestyle changes to improve their health and help prevent chronic illnesses from occurring. While in a primary care setting, it is important to not only educate patients on lifestyle changes they can make to better improve their health but offer them resources to help meet their goals. Many chronic diseases occur from patient nutritional and lifestyle statuses however, in the clinical practice it is rarely implemented (Chao et al., 2021). One obstacle that I would like to achieve is to help incorporate education on the importance of these lifestyle changes and support patients by offering the patients the tools and resources they need to live a healthier lifestyle to improve overall health. Offering patients nutritional and lifestyle changes education can help prevent chronic conditions such as cardiovascular disease, diabetes, and cancer (Chao et al., 2021). I hope to also find ways to motivate patients to want to improve their overall health and follow up on the strategies implemented. Another challenge for me is to learn barriers that patients face with access to healthcare and achieving health goals. In the hospital, patients are taken care of no matter their access to healthcare, but when patients are discharged, what barriers are faced and how can we help to eliminate these barriers? Chronic illnesses are the leading cause of premature mortality, disability, and morbidity (Morris et al., 2022). Chronic conditions also lead to a decreased quality of life, increases the need for health care services which in turn ends up inflating health care costs (Morris et al., 2022) What modifiable lifestyle changes can we as providers offer to these patients to help prevent these from occurring?  Is the barrier a lack of education from providers or how the education is being provided? I hope that throughout the time in this class, I can fully have a better understanding of the outpatient world and what I can do as a provider to offer support to these individuals.  

References 

Chao, A. , Zhou, Y. , Wei, X. , Wisdom-Goulbourne, T. , Dowd, M. & Compher, C. (2022). Nutrition Education in Primary Care Adult and Family Nurse Practitioner Programs. Nurse Educator, 47 (1), 47-50. doi: 10.1097/NNE.0000000000001050.
 

McNelis, A. M., Dreifuerst, K. T., Beebe, S., & Spurlock, D. (2021). Types, Frequency, and Depth of Direct Patient Care Experiences of Family Nurse Practitioner Students in the United States. Journal of Nursing Regulation, 12(1), 19–27. https://doi.org/10.1016/S2155-8256(21)00021-1
 

Morris, M., Halcomb, E., Mansourian, Y., & Bernoth, M. (2022). Understanding how general practice nurses support adult lifestyle risk reduction: An integrative review. Journal of Advanced Nursing (John Wiley & Sons, Inc.), 78(11), 3517–3530. https://doi.org/10.1111/jan.15344 

Initial Post

My expectation for this course is to gain knowledge and skills to make proper diagnoses and clinically manage healthcare needs for adults across the lifespan (Walden University, n.d.). In addition, I wish to build my Nurse Practitioner Core competencies to prepare myself for the ever-changing healthcare challenges and bring forth positive outcomes for my clients and health organizations (The National Organization of Nurse Practitioner Faculties, 2012).

As a nurse, I had the opportunity to work in different work environments: an acute adult psychiatric facility, a CV-ICCU unit at the local hospital, and a clinic-type setting at an adult state hospital. My strength is the knowledge and skills I have gained through these experiences and the challenges I have faced in patient care and working with upper management. Unfortunately, this is also my weakness. I have never worked with patients who were 17 or younger. A Family Nurse Practitioner (FNP) in a clinic-type setting will provide healthcare services to all age groups (AANP, 2019). I must gain the skills and knowledge to work with the younger population.

My career goal is to provide healthcare services to underserved populations, such as those living in the jungles of Laos and Thailand, my parent’s homeland. I can become a better practitioner and make cognitive decisions for managing health concerns for all age groups by gaining knowledge, skills, and experience.

References

AANP (2019). Are you considering a career as a family nurse practitioner [Internet]? https://www.aanp.org/news-feed/are-you-considering-a-career-as-a-family-nurse-practitioner

The National Organization of Nurse Practitioner Faculties (2012). Nurse practitioner core competencies [Internet]. /courses/81882/files/5174143?wrap=1

Walden University (n.d.). Post-master’s certificate in Family Nurse Practitioner [Internet]. https://academics.waldenu.edu/catalog/nursing/post-masters-certificate/family-nurse-practitioner#s-lg-box-30485847

Nurse Practitioners are advance practice providers who provide high quality patient centered care. High quality care encompasses using critical thinking, evidence-based practice, and clinical expertise when diagnosing, treating, managing conditions, and educating patients. It is essential for nurse practitioners to develop a relationship with their patients based on trust and adhering to standards of practice that lead to positive patient outcomes. Nurse practitioners are a vital part of the interdisciplinary team where collaboration amongst other providers and the patient takes place to development the proper plan of care.

This course will set a foundation for putting into practice the knowledge that I have gained thus far in the FNP program and the past clinical experiences that I have as a registered nurse. My expectations are that my mind set will shift since I am the provider who will be diagnosing and treating my patients. As a staff nurse, I have collaborated with the provider when it comes to the patient condition and recommended what treatment would benefit my patient however I was not the provider entering the necessary orders and diagnosing the patient. As a nurse practitioner student, I expect that I will utilize the tools I have been continually developing to provide care as an independent clinician.

After reviewing the NP Core Competencies, I am able to identify where my strengths and challenges are. Being able to identify these will contribute to my motivation to learn and grow as a medical professional who delivers care across the healthcare delivery system. Scientific Foundation Competencies include the use of research in order to improve practice and outcomes, develop new practice approaches, and participates in professional organizations that impact advance practice nursing. I have been on committees within my hospital organizations where I have been part of an interdisciplinary team that comes together to evaluate the hospital processes and improve where needed. My strength is that I am able to communicate effectively with all levels of staff within the organization. I have confidence that I am a leader who is motivated to improve health outcomes necessary within the workplace. I have experience acting as a leader which will help me when it pertains to the NP leadership competencies. I am able to collaborate with an interdisciplinary team with the intent to improve health care using evidence-based practice which also coincides with NP Quality Competencies. I believe that it is crucial to have leaders who are providing direct care to be a part of the collaboration process in improving practice. I believe this is where the greatest and most impactful change is made because it involves the voices of the leaders who are directing interacting with the patients. It is difficult to create necessary change if the team who is creating change includes those not interacting and providing care to patients. Practice Inquiry Competencies include using clinical practice to improve practice and patient outcomes. I believe that having many years of clinical experience while adapting to the continuous innovative changes within healthcare is a strength that I have because I am able to use these experiences when I am on committees to improve organizational change. My experience has helped me to develop clinical skills while still being adaptable to learning new skills. As a nurse practitioner I will learn a different skill set that will provide different experiences than I have had before. I am open to learning every day and learning from those around me. I am able to understand policies set in place which is vital to adhere to legal and ethical guidelines which is part of the Policy Competencies. I feel that my strengths include being culturally competent to others backgrounds which helps me to develop relationships with my patients. I am able to provide compassion and display confidence in my clinical capabilities. I feel that being open minded to other diversities helps me to work with my patients to develop the plan of care that is most suitable for them with the best outcome. I have the utmost respect for my colleagues and patients.

While it is important to identify where my strengths are, it is equally important to identify where my challenges are. When we are able to identify challenges that we have, we are able to work through them more effectively. I know that a challenge that I will have will be when it comes to the financial aspect as a nurse practitioner. Understanding how to bill services is something that seems complicated because it involves coding. Carolyn Bupport, 2020, explains the rules to billing services which has helped me a bit in understanding the financial aspect of how NPs bill for services. Veenema et. al, 2022, provides an analysis showing that “the type of clinician, state practice authority policy, number of NPs, and percent of population 65 yrs and older an population size are positive predictors for services billed.”

These are components that I didn’t have to involve in my care thus far in my career. Having to understand how insurance works will have to be something that I need to work at in order to be compensated properly for my care. Another challenge I have is that I am not tech savvy, but I am excited when there are new advances in technology within the healthcare system. I am open to learning which is necessary because more advances will be taking place as time goes on. Being able to keep up with these changes will be beneficial for myself and my patients.

This class will help with my career goals in many ways. The class will help me set a foundation to be an independent practitioner who is able to competent to deliver high quality care for my patients. My career goals include being competent in the NP Core Competencies. The competencies will also help as a guide to self-reflect on where I have strengths and where I need to gain strengths.

Resources:

Buppert, C. (2020). How to bill for nurse practitioner services: The basicsLinks to an external site.. 

The National Organization of Nurse Practitioner Faculties. (2012). Nurse practitioner core competencies. Download Nurse practitioner core competencies.

Veenema, T. G., Zare, H., Lavin, R. P. & Schneider-Firestone, S. (2022). Analysis of trends in nurse practitioner billing for emergency medical services: 2015-2018. American Journal of Emergency Medicine, 62, 78-88.

Course Expectations

Throughout my career as a registered nurse, I have worked in various nursing settings ranging from Long-Term Care, hospitals, cardiac office settings, Coumadin, and heart failure clinics, and currently working as a case manager for an insurance company. My expectation of this course is to understand specific disease processes and how these different disease processes can be assessed, diagnosed, and care planned to meet the needs of each patient. Studies have shown that direct clinical practice while working with preceptors deepens clinical and psychosocial assessment skills (Schlunegger et al., 2023). Working as a case manager for the past 10 years, I have learned to focus on the positive aspects of patients, families, and their situations, for them to make up for their deficits. Understanding the case management process of intake and needs assessment, care service planning, monitoring, and evaluation to inspire patients to utilize their resources, skills, and goals to overcome challenges and achieve the desired health outcomes is a great background to any disease prevention and management process. With care coordination being central to my current position, it is one of my greatest strengths as I work towards embracing the competencies of comprehensive health assessment, diagnosing, care planning, coaching, and coordination as an Advanced Practice Registered Nurse (APRN). It is through effective comprehensive assessment, coordination, and collaboration with patients, patient families, and other providers that APRNs can build bridges to demonstrate competence in the management of patient illness (Schlunegger et al., 2023). There is a tremendous need to enhance nurses’ collaboration and coordination skills to achieve competency in evidence-based practice to ensure the highest quality of care and best population health outcomes (Melnyk et al., 2018).

Challenges and Nursing Practice Competencies

Although my current position equips me with the skills of being able to assess and collaborate with patients, patient families, and providers as a registered nurse, the main challenge will be to embrace nursing practice competencies as a leader and be able to integrate knowledge, research, and critically analyze patient situations to facilitate patient-centered care for health promotion. I am very curious and hope this class can help improve my fundamental skills to actively listen and identify patient barriers and utilize a holistic approach with diagnostic skills to be able to select appropriate individualized treatment strategies for each patient (Schlunegger et al., 2023).

Since acquiring leadership nursing competencies occurs over time, the integration of coursework and clinical learning in this class seems promising in shaping us to become competent APNs who can assist with continuous quality improvement and providing quality reliable health care (Heinen et al., 2019). It is through continued practice that I would hope to be able to embrace critical and diagnostic reasoning skills in clinical decision-making to help with obtaining a comprehensive physical examination, identifying normal and abnormal findings, and be able to prioritizing patient health needs. Although studies have shown that limited information is available regarding competencies in leadership, ethical decision-making, and evidence-based practice, I hope to get an understanding of these core competencies through mentorship, and practice experience in clinical, and didactic classes.

As for my career goals as an APRN, my heart’s desire has always been patient education on disease prevention and management. Studies have shown that core competencies for APRNs are acquired through mentored patient care experiences including independent and interprofessional practice collaboration (American Association of Colleges of Nursing, 2010). This course will help me accomplish my goals through clinical education, knowledge, and skills, and embracing the scope of practice as an APRN. I am looking forward to polishing my leadership skills while learning from my colleagues, my mentors, preceptors, and my professor’s experiences.

References

Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative

review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378-2392.

Melnyk, B. M., Gallagher‐Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A.

(2018). The first US study on nurses’ evidence‐based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence‐Based Nursing, 15(1), 16-25.

NurseJournal.org (March 21, 2023). What are the NP Core Competencies?

https://nursejournal.org/resources/what-are-the-nurse-practitioner-core-competencies/Links to an external site.

Practitioner. (2010). Adult-Gerontology Primary Care Nurse Practitioner Competencies

[brochure], American Association of Colleges of Nursing (AACN), https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/adult-geropccomps2010.pdf?hhSearchTerms=Adult-GeroPCComps2010+and+pdf

Schlunegger, M. C., Aeschlimann, S., Palm, R., & Zumstein‐Shaha, M. (2023). Competencies of

nurse practitioners in family practices: A scoping review. Journal of Clinical Nursing, 32(11-12), 2521-2532.