"NPs diagnose and treat a wide range of health problems.
They have a unique approach and stress both care and cure.
Besides clinical care, NPs focus on health promotion, disease prevention, health education and counselling"
(About NPs, 2011, FAQs about nurse practitioners section).
To secure the opportunity to serve as an Adult Nurse Practitioner in a clinical setting
Collaborate with physicians and other professionals working in the medical facility; upholding the goals, mission, and values of the contracting sponsor
To perform therapeutic and/or corrective measures, including urgent care for adults
To formulate and implement independent decisions concerning management and treatment of identified medical problems and concerns
To initiate and participate in relevant, credible research studies and projects
To instruct individuals as well as groups of clients about health-related topics
To proffer outreach health education services in the community
To serve as preceptor for medical, nursing, NP, an/or physician assistant (PA) students
To accept after-hours calls and address after-hours problems on a rotating schedule
To contribute to the development of pertinent health education materials and publish when warranted
To participate in creating clinical practice guidelines
To consult with other healthcare providers regarding established clients admitted to hospital, home care, nursing homes, or rehabilitation
To communicate with insurers, employers, government agencies, and other appropriate health-care providers regarding established clients as necessary
To manage care of adult patients; develop plan of treatment and/or follow up as well as monitor progress. When necessary, make referral to another provider or needed arrangements for further care.
To determine when hospital admission or emergency room visit proves mandatory as well as verify resolution of illness
To serve adult patients by focusing not only in disease treatment but also prevention of disease and potential complications as well as providing counselling; facilitating health promotion and health education (Buppert, 2011).
Maintain the quality of care for adults
Reduce medical care costs for adult patients
Augment access to primary care in underserved regions (Feder, Holahan, & Marmor, 1980)
COLLABORATIVE PRACTICE AGREEMENT
I. GENERAL INFORMATION
A. Nurse Practitioner
Name Jane Doe License Certification 00000000 CRNP-Adult
Date Designated 2011 Certifying Organization ANCC
B. Licensed Physician
Name James Smith, MD License/Certification
C. Description of Setting of Practice
1. Type of setting: The setting for the NP to practice comprises the ____ office/clinic/or of Jane Doe, MD, located at address in ____City, State .
2. Type and anticipated volume of patients: Patients consist of adult outpatients. Volume will fluctuate; typically three to five per hour; projected to replicate other
____ practices in the area.
II. Nurse Practitioner Functions Jane Doe, NP, will provide common preventive care and diagnosis as well as treatment of episodic, short-term, and stable chronic health problems. Provisions for referring patients with unstable or acute life-threatening conditions will include, however, may not be limited to:
A. Perform Comprehensive Physical Assessments of Patients as Needed Jane Doe, NP, will complete pertinent history and perform physical examination of any patient to set up a database and discover/identify the patient's immediate as well as comprehensive health care needs.
B. Prescribe Medications Prescribing of medications includes all classes applied for, excluding experimental drugs. Specifically, Jane Doe, NP, "prescribes analgesics, such as Tylenol with codeine, benzodiazepines, and certain weight reduction medications that include amphetamines. CDSs will be limited to short-term, acute episodes, such as migraine headache" (Buppert, 2007, p. 324)
C. Perform Therapeutic and Corrective Measures
Jane Doe, NP, will order and may perform such therapeutic measures deemed appropriate for an internal medicine practice. These may include, albeit, not be limited to "patient education, cleaning and dressing of superficial wounds, splinting, and irrigation of ears and eyes (Ibid.).
D. Emergency Care
Jane Doe, NP, will perform cardiopulmonary resuscitation as mandated until emergency vehicles arrive at destination. Jane Doe, NP, has successfully completed the m national cognitive and skills examination in accordance with the Standards of the American Heart
Association for Course C, Basic Life Support,
III. NURSE PRACTITIONER/PHYSICIAN RELATIONSHIP A. Referrals
Jane Doe, NP, will diagnose, evaluate, manage, and treat common acute and chronic stable conditions; seeking consultation when perceived necessary. When uncommon or unstable conditions occur, Jane Doe, NP, will record the history, complete the physical exam, acquire laboratory and other necessary data, and partake in the diagnosis with consultation. Jane Doe, NP, will then "determine to either refer to the physician consultant or to a specialty clinic or secondary treatment center or participate in dual management and treatment with a physician consultant or specialty clinic" (Buppert, 2007, p. 324). When confronted with acute life-threatening conditions, Jane Doe, NP, will complete the patient's history, conduct the necessary initial physical exam, effect a working diagnosis, execute emergency management, and immediately refer the patient to the closest emergency department.
B. Drug and Medical Guidelines Jane Doe, NP, will collaborate with the James Smith, MD, to establish and review drug and other medical guidelines. Review of guidelines will be ongoing, albeit, at a minimum of once annually.
IV. Record Review
Every three months, Jane Doe, NP, and James Smith, MD, will review a representative sample of patient records to confirm that the practice of Jane Doe, NP, proves congruent with the identified practice protocol documents and texts. Both parties will sign and date summarized results of each review with records maintained in the nurse practitioner's practice site for potential regulatory agency review.
IV. Resolution of Disagreements Any disagreement that should arise between Jane Doe, NP, and James Smith, MD, regarding treatment and/or health management of a patient within the scope of practice of both parties shall be resolved by consensual agreement in accord with consulting with contemporary medical and nursing peer literature. In case of irreconcilable differences, the opinion of James Smith, MD, will prevail. If/when irreconcilable disagreements should arise between Jane Doe, NP, and a non-collaborating physicians, the opinion of the collaborating physician shall prevail.
VI. Alteration of Agreement The collaborative practice agreement between Jane Doe, NP, and James Smith, MD, shall be reviewed annually and may be modified and/or amended in writing in an agreement signed by both parties and attached to the current collaborative practice agreement.
Having read and understood the full contents of the Collaborative Practice Agreement, Jane Doe, NP, and James Smith, MD, the collaborating parties, hereto agree to be bound by its terms.
The following facts relating to the nurse practitioner contribute to the profession's revenue potential:
88% of NPs have earned graduate degrees
92% of NPs retain national certification
39% of NPs have secured hospital privileges with13% receiving long-term care privileges
96.5% of NPs prescribe medications; writing an average of 19 prescriptions each day
NPs hold prescriptive privilege in each state in the United States, including controlled substances in all but three states
NPs write approximately 556 million prescriptions annually
During 2008, the mean full-time NP base salary totalled $84,250, with the average full-time NP total income equalling $92,100
62% of NPs treat three to four patients each hour with 12% caring for more than five patients each hour
20% of NPs practice in frontier or rural settings
66% of NPs practice in a minimum of one primary care site; with 31% practicing in at least one non-primary care site like emergency, inpatient, surgical, or specialty practice
Malpractice rates for NPs prove to be low with only 1.4% named as primary defendant in a malpractice case
The average NP, a female (94.6%), is reportedly 48 years old; with a history of 10.5 years practice as a family NP (49%) ((About NPs, 2011, Nurse practitioner facts section).
The following four methods of payment depict contemporary ways utilized to pay employed NPs:
1. Straight salary
2. Percentage of net receipts
3. Base salary plus percentage
4. Hourly rate (Buppert, 2007, p. 315).
A nurse practitioner being paid a straight salary arrangement receives a specified, pre-determined amount to perform according to a specific job description. "In a percentage salary arrangement, an NP is paid the amount the NP bills minus accounts receivable, minus the NP'S portion of practice expenses (which includes the expense of physician consultation) (Buppert, 2007, p. 315). When a NP agrees to work for a base salary plus a percentage, the NP receives a guaranteed set salary. If the NP generates practice income over a designated set amount, albeit, the NP can earn additional salary. The NP working on an hourly basis receives payment only for the hours worked. Buppert (2007) further explains:
Straight salary and hourly are more commonly encountered arrangements than percentage or set salary plus percentage. The advantage of percentage-based salaries is the opportunity (or productive NPs to have some control over their earnings. The disadvantage is that the method sets up fellow providers in a practice as competitors for patients. No matter what arrangement an NP chooses, it is wise to focus on hard figures that document an NP'S monetary contribution to a practice and…
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