Recent orders
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Prescriptive Practice Safety and Quality Assignment
Prescriptive Practice Safety and Quality Assignment
Background
In the recent years, policy reforms in the APN’sboard proceeds across the country. Sixteen states have tabled new laws and changed existing laws influencing APN’s legitimate power to practice. One state has instituted positive corrections influencing the repayment of APN’s, and other three states have ordered alterations to current law, which will decidedly influence their prescriptive power. Connecticut passed a bill commissioning APNs to ask for, sign for, gain, and apportion physician recommended pill tests. New Jersey’s state lawmaking body passed a bill that was marked into law giving APNs power to launch regulated substance prescription/orders (as per joint conventions) in all circumstances, with no confinements.
Introduction
Advanced practice nursing is a broad division in the health sector that deals with direct care and management of patients, health policy development and implementation. In the state of New Jersey, APNsare certified health practitioners, under a statutory-mandated joint convention with medical doctors, obliged to perform diagnosis of diseases, patient management and the prescription of recommended medicines. On the other hand,medicinal services, health training, and sickness counteractive action are given by health experts of different foundations. The cooperation of both APNs and Physicians result to efficiency and improved care within the sector. Leadership training and expansion of clinical education of APN’s in the state of New Jersey, is a symbol oftrust and progress in the health sector. Every year, APN’s excitedly foresee the progressed work on nursing. Their input is significant and the state of New Jersey is currently working industriously to change laws permitting them to practice at their full potential.
Collaboration, oversight, and authority to prescribe controlled danger
In New Jersey, a joint convention is a state-authorized agreement that provides the necessary tools and gadgets for an APN member in a particularwork-related setting. This agreement provision must have the consent of both the APN member and medical practitioner. It must be audited, redesigned and co-marked every twelvemonth. However, the terms of agreement, are subject to scrutiny and evaluation from the New Jersey state Board of Nursing regulations.
Recently in New Jersey State, a new bill was introduced in the legislature to allow advanced practice nurses prescribe medication without the constraining condition of a joint protocol with a consulting physician. This bill recognizes the significance of the advanced practice nurses and their vital role in the health care system. Their role is also expected to grow with the introduction of federal Affordable Care Act.
The entry of the Affordable Care Act (ACA) will encourage insurance cover as it will reduce the cost of health cover. Uncovered state citizens will be incentivized into health insurance cover, raising their numbers. The Act will “push avoidance, wellness, and general society health” (Legislative Counsel, 2010). With the projected increase in demand of health care services, the need for authorized APN’s practices is wanting. The Association of American Medical Colleges assesses a deficiency of 46,000 essential forethought doctors by the year 2025 (Rouston, 2010).
Medical attendant practitioners can effectively venture with full-practice rights to help cover up the deficit gap. There is as of now 150,000 attendant professionals in the United States, and 5,500 specialists graduate consistently (Rouston, 2010). State lawmaking bodies, on the other hand, control Advance Practice Registered Nurses (APRN), and 16 statesat present have allowed for APRN prescriptive rights. For APRNs to completely watch over patients at the essential consideration level, state lawmaking bodies must uproot prescriptive limitations all around the United States.
Implication
The necessity to measure quality is a profound concern to patients and qualified doctors. Primary care physicians have expressed their concerns over the quality of patient care if APN’s are left to work independently without collaborating doctors. They claim that the quality of Medicare is likely to be soiled if the two groups don’t work in a joint venture.
On one hand, this could be seen as a cynical argument by the physicians who reap maximum benefits working in such a monopoly-like environment. If such prescriptive limitations are lifted, APN’s is likely to charge much affordable fees for their services as opposed to the physicians. On the contrary, there is need to additional primary health providers, the rising demand for health services by patients is likely to be met by additional health providers. This is an implication that the patient need for care is likely to be met. This allows more patients to have access to health care and also removes barriers for other clinicians who participate in treating the general public.
An increased number of licensed health practitioners guarantees the safety of clients. Often, the limited number of health practitioners put them in a strenuous position. Having a limited timeframe with a whole list of patients to deal with is likely to result in work-related accidents, such as wrong dosage administration or a miscalculated prescription. Haste in treating as many patients as possible creates an unsafe area of practice. If the APN’s are permitted to perform similar functions as the physicians, the number of patients to doctor ratio will reduce, creating an ample environment for accurate dealing with clients. Safety in this context is guaranteed not from the skills applied but from other work related factors such as a peaceful environment for effective control over the subjects.
Advanced practice nurses are highly trained. They are graduates trained to diagnose and treat chronic diseases. Part of their training involves interpreting lab tastes and X-rays, immunization, physical examinations and counselling among other courses. With such skills, it is highly unfair to question the quality of their services. Their training covers the essential aspects of study, analysis and evaluation of the human body; very priceless skills in determining the quality of patient care. Not only is the quality of the care taken into consideration but also the client’s safety. Such knowledge is highly valuable in right prescription that would not turn out to be hazardous to the patient.
Regulating body of APN practice in jersey
The New Jersey State Board of Nursing is the sole state regulating body of APN practice in New Jersey. It participates in policy making, building the capabilities and confirmation necessities for APNs (NP, CNM, CRNA, and CNS). The body regulates the nursing curricula and professional practices. Any medical attendant who wishes to practice as a medical practitioner or clinical medical attendant expert, has to be permitted or authorized by the body.For instance, a member of the APN in New Jersey has prescriptive power and is obliged to have a joint convention with a medical practitioner who is authorized in New Jersey, before endorsing any pharmaceutical or therapeutic gadget.
References
David M. et al. (2004). Health Policy Report: Medical Malpractice, 350 NEW ENG. J. MED. 283, 284.
Legislative Counsel. (2010, May 1). Compilation of Patient Protection and Affordable Care Act. Retrieved February 13, 2014 from http://www.healthcare.gov/law/full/
Rouston, J. (2010, November 2). The Future of Primary Care: Nurse-managed Health Centers. HealtheCarreers.com. Retrieved February 13, 2014 from http://www.healthecareers.com/article/the future-of-primary-care-nurse-managed-health-centers/158450
The employees affected have mainly been found in healthcare, food services and in beauty services
Over the last decade, many employees have developed allergies related to the use of latex. “The employees affected have mainly been found in healthcare, food services and in beauty services.” As employees in these areas, as well as other areas have learned of the potential risk from the contraction of disease leading to death, caused by the exposure to bodily fluids, they have realized that the use of products to stop the exposure is absolutely essential. This has substantially increased and spread the use of latex products, mainly gloves. “The use of so many is very costly, so many employees turned to third world countries who produce a cheaper, untreated latex, which although it cannot be blamed alone for the development of latex allergies, does contribute to the problem.”
The repeated use of latex in the work place can lead to allergies that affect the worker’s ability to function both at work and at home. “The allergies developed can result in degree from a minor irritation to an anaphylactic shock. Out of the many types of allergic reactions only two types, Type I and Type IV have been observed as being related to latex. Type IV reactions have proved to be a response to additives used by the manufacturer. They are uncomfortable, but not life threatening. This is the opposite of Type I reactions. Type I reactions are caused by an antibody called IgE which recognizes the cause of the allergy from previous exposure.”
“The Type I allergens in latex products exist naturally. They remain in the latex during processing. Three proteins found to be involved with the latex allergies are Kd-14, Kd-20 and Kd-27. The proteins can be airborne through powder residue on the gloves, so they can be transmitted through the air. The proteins are also water-soluble. The reactions from Type I include eye, nose, and respiratory symptoms. If left untreated the reaction may be life threatening.”
“The death count associated with Type I reactions up until 1995 is 16 due to latex.” These deaths prove that the latex allergies that are being developed are a serious risk to employee health, and the matter needs to be dealt with seriously. Both employers and government need to take charge of the issue to ensure the safety of the employees.
The employer needs to provide policies and procedures to reduce the exposure to latex. Until recently latex gloves were the automatic protection worn by all employees dealing with people, or products for people, and in many places this is still the case. This has to stop, and employers are the ones who must implement other options. “This is extremely important because those employees most at risk are the ones who frequently use latex products, and once the allergy is developed, it does not ever go away.” “Other people who are at high risk are those who apply latex gloves while their hands are still wet.” Since the proteins are water-soluble, the skin can absorb them more easily once they are part of the water. “More groups of people at high risk are those who suffer from various other allergies, and those who use latex products when they have a rash or any other skin disorder, because it gives the proteins an entrance to the body.” Employers need to make sure that employees use alternatives to latex as much as possible, and must ensure that employees know about the potential allergies and the best ways to avoid them. From the employee’s point of view, their knowledge of these issues is the key to the protection of their health.
Employees’ lives will be changed forever once they develop latex allergies. Those employees such as nurses and doctors, who must use latex gloves throughout their job, will no longer be able to provide adequate care to the patients unless there is an alternative available to use. This however, is obviously through no fault of their own. “Other gloves, that are latex free are available, and employees need to provide them, regardless of the cost. Latex gloves that do continue to be purchased need to be certified by the Canadian General Standards Board to ensure the safety of employees.” If measures are taken to reduce latex risk, fewer workers will develop allergies. “Often allergies are so severe that working in an environment where latex proteins may be airborne is no longer possible.” The employees have to find new jobs, with less latex contact. This is hard on the employee, especially today, where not only a good job, but also any job at all is extremely difficult to find. The biggest part of looking for a new job would be acquiring the necessary skills, because the employees are searching for something new, something that they are not trained for.
When employees develop latex allergies, it affects their ability to function at work, but also to function at home. “Latex is found in many household products such as sponges and cleaning/kitchen gloves. Even something as simple as putting a bandage on a child or cleaning up toys, such as teething rings, becomes a health hazard. A regular rubber band could also cause a reaction.” The employee (as well as the average consumer), as an individual, must find alternative products to these things. He/she must search for special products. “Other items like balls parents use to play with their children, balloons, and braces for teeth pose a health risk. More personal items like condoms, diaphragms, and clothing that contain latex also become a health risk for those who have developed latex allergies.” Latex allergies have been proven to affect work, home, and leisure life. “In one case study, a dental assistant who developed an allergy to latex, through contact with moist skin from hand washing, experienced a severe anaphylactic reaction when putting her gloves on. In another case, a health care worker experienced an anaphylactic reaction from the handle of her squash racquet. She lost consciousness within ten minutes after the match ended. She was treated at a nearby Emergency Center; however, the handle of her racquet could have cost her her life.” These examples show the effects that latex allergies can have on employees and shows that it is crucial for employers to do everything possible to avoid having employees develop these allergies.
Once an employee has developed a latex allergy it affects every aspect of their life, including when they are treated as a patient. It is very important that anyone taking care of the employee from a doctor/dentist to a hairdresser is made aware of the allergy. “Some common products that contain latex in the healthcare environment are air masks, blood pressure cuffs, catheters, dressings, bandages and I.V. tubing.” These are just a few of the commonly used products, however, there are thousands more. “In one scenario in a hospital a healthcare professional was admitted for routine abdominal surgery. Her allergy to latex was known but the latex in the mask used for the induction of the anesthesia was overlooked. This caused an anaphylactic reaction that would have been fatal had it not been treated so quickly. The surgery was later re-done in a latex-free environment.” “Another healthcare worker who developed an allergy to latex had a similar experience at an orthodontist.” The severity of these reactions does not only show the need for employers to give employees with latex allergies a latex-free environment to work in but also the need to reduce the risk of developing the allergy to latex all together.
The employer needs to take responsibility for decreasing the percentage of employees that develop latex allergies but they are not alone. The government needs to be involved also. The government needs to enforce standards for latex production to ensure a higher quality of latex processing to reduce the risk of allergy. “In 1992 the Medical Devices Bureau began discussing the growing problem of latex allergy. Their goal was to minimize health risk, however today, four years later employees are still developing the allergies.” “A new law requiring the labeling of latex gloves was implemented in May 1995 but did not become effective until month later. The labels include how to minimize health risk and how well the gloves were processed.” From the employees’ point of view, this is an improvement but it is not nearly enough. Latex that is not processed and treated to a high standard should be illegal. Until it is, the employers still have the option of using cheaply processed latex. This means that those out to “make a buck” will still choose price over employee safety; unfortunately many do. This is not morally right and it is only through government legislation that this will be corrected.
The government needs to not only enforce standards of latex, but also increase awareness of latex allergies by distributing information. A lot of the awareness currently distributed to workers focuses on information about how the workers should be careful when dealing with those who have latex allergies; however, very little of the information distributed is directed at the employees and how they and their employers need to minimize the risk of allergy development. If the employers are not aware of how to protect their employees, they cannot effectively do so. This adds to the number of employees who develop allergies and increases the number of employees that employers lose. “The importance of this awareness is demonstrated by noting that in 1995 over 250 000 healthcare workers were found to be allergic to latex.” These may be good and efficient employees but they have simply become allergic to their jobs.
“Many of the employees who develop severe reactions to latex, cannot find a job that they can practice safely. As a result they end up on disability allowance.” As well as being costly to the employer and to the government, this is also costly to the employee. “It costs the employee their normal way of life and can make them feel less valued. Not being able to function in their work environment can have many psychological effects.” “When it is at all possible, an alternate job is found for the employee, but even this option is costly. It costs the employer the employee’s work and the cost or retraining.” It costs the employee time and often a pay cut. This seems unjust to the employee, as he is not responsible for the situation in which he finds himself. These costs to the employee are the main reason that the government needs to become involved in this issue.
It is not possible to stress enough the importance of the prevention of latex allergies. The great cost it has on each employee affected is enough to determine what action must be taken now. Suggesting that employers should provide employees with protection is not sufficient; it needs to be the law. The government, employers, workers’ unions, and employees all need to work together so that the destruction of the lives of the employees can be stopped. Improperly treated latex poses a risk to the employee and must be banned from the workplace. As well, unnecessary use of latex gloves should be discouraged. In places where latex must be used, precautions must be taken to ensure those who are using them are at the least risk. If all these things are done and the issue is taken seriously, the costs may be high, but the lives that are saved as a result will be more than worth it.
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