Role Description and the Organization
Sarah Kessler is a Family Nurse Practitioner working in a community clinic in Miami, Florida. The job of an FNP involves providing care to patients of all ages, from infants to elderly persons. The responsibilities of an FNP are to perform patient exams, order tests, interpreting diagnostic results, developing treatment plans, and prescribing medications (“Family nurse practitioner,” 2019). FNPs are also required to engage in disease prevention and health promotion by providing education and health advice to patients. Because of the vast age range of the target population, FNPs need an understanding of health-related changes that occur at various stages of life. They also have to apply the evidence-based treatment, prevention, and health promotion practices in their work.
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Sarah has the qualifications that make her fit for her professional role at a community clinic. She has a Bachelor’s Degree and a Master’s Degree in Nursing, and she followed the FNP track during her Master’s studies. She has received a national FNP certification from the American Nurse Credentialing Center. Sarah also has both the RN and ARNP licensure issued by the Florida Board of Nursing and the National Provider Identifier from the Centers for Medicare and Medicaid Services (CMS).
The organization where Sarah works is a community primary care clinic. The clinic employs three physicians and eight nurses, four of whom work in the FNP capacity. The clinic caters to the needs of various types of patients, including children, adults, and older persons. The organization provides a broad scope of services from examination and diagnosis to treatment and prevention. Most adult patients come in with acute symptoms or seeking chronic care services. Infants and children usually receive acute care for minor conditions or preventive services, such as immunizations.
Sarah estimates that she normally sees about 20-22 patients per day, whereas the daily capacity of the clinic is 100 patients. Given the number of care providers employed, this ensures sufficient appointment times even when the clinic is busy. Specific data on the annual number of patient visits to the clinic is not available, but it can be estimated to be between 25,000 and 27,000 visits per year.
As part of the project, a semi-structured interview with Sarah was conducted to better understand her role, goals, and values as an FNP. The complete list of questions with Sarah’s responses can be found in Appendix 1. The interview highlighted the importance of FNPs’ role in community health promotion, as well as some issues that could be addressed to improve nursing practice in Florida.
First of all, it was evident from Sarah’s responses that she has a strong desire to help families to become healthier. This was the main reason for her to enter the FNP career, and it guides her practice in a community clinic. The nurse states that her work is very different from that of other nurses because she works with patients of all ages. This allows her to provide more comprehensive care to families by targeting both children and adults. Sarah also mentioned that the significance of FNPs’ role is partly due to families’ trust. When families come in to see the same community care provider, they trust their recommendations and implement them, thus achieving positive changes in health.
Secondly, the interview addressed the importance of community clinics and FNPs for disadvantaged populations. As shown by Sarah, her community is predominantly black, and there are many low-income families who receive care through Medicaid and similar programs. Providing high-quality care to these populations is essential because it improves their quality of life. Furthermore, Sarah emphasized the necessity of preventive care and patient education for disadvantaged communities. According to the interview, preventing disease helps to make families healthier in the long term, reducing their need for care in the future.
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Finally, the interview also highlighted the need for changing nurse practitioners’ scope of practice in Florida. Sarah mentioned that there are limitations that affect her ability to provide holistic care to patients. Allowing nurse practitioner to practice independently from physicians would help to increase their role in health promotion. This, in turn, would have a positive influence on the continuity of care and people’s access to healthcare services.
Florida Scope of Practice Discussion
Nurse practitioners’ scope of practice in Florida is limited, which prevents nurses from providing comprehensive care to patients. The American Association of Nurse Practitioners (AANP, 2018) identifies Florida as a state with restricted NP practice. This means that at least one element of NP practice is restricted by state laws and that NPs require supervision throughout their career (AANP, 2018).
As mentioned by Toney-Butler and Martin (2019), the NPA allows nurse practitioners to order and perform diagnostic exams, prescribe most medications, and create treatment plans as long as they have a collaborative agreement with at least one physician. The intention of the policy is to improve oversight over nurses, but many scholars suggest that it has a negative influence on patient care. Peterson (2017) argues that the scope of practice barriers reduce patients’ access to comprehensive care, leading to adverse health and quality outcomes. These barriers also disrupt the continuity of care, which is of critical importance in community settings. Expanding nurse practitioners’ practice authority in Florida would help Sarah and other NPs to deliver high-quality care to patients.
American Association of Nurse Practitioners. (2018). State practice environment. Web.
Family nurse practitioner (FNP). (2019). Web.
Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74-81.
Toney-Butler, T. J., & Martin, R. L. (2019). Florida nursing laws and rules. Web.
Q1: What is the primary reason you decided to become a nurse practitioner?
A: I decided to become a nurse practitioner so that I could better help people in my community. In Florida, family nurse practitioners are among the critical points of contact for families who need assistance with health promotion and disease prevention.
Q2: How does your work differ from that of a regular registered nurse?
A: Regular registered nurses usually work in a specific area, and their scope of practice is very limited. As an FNP, I provide care to more patients and have more authority than an RN.
Q3: If you know any other advanced practice nurses in other roles, are your activities different from theirs?
A: Yes, I know other advanced practice nurses, and the main difference between my practice and theirs is that I see patients of all ages, whereas they only see adult patients.
Q4: Do you primarily work with a disadvantaged community and try to help it?
A: The community where the clinic is located is predominantly black, so there are a lot of families who are at a disadvantage when seeking care. Many of them receive insurance through the government or state programs, such as Medicaid. With disadvantaged families, I try to promote preventive care because it ensures well-being in the long term.
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Q5: Do you employ the latest evidence-based practice regularly in your work?
A: Yes, I use evidence-based guidelines in the diagnosis and management of both acute and chronic conditions. I also refer to research evidence for health promotion recommendations.
Q6: Do you try to create or test new methods to contribute to EBP?
A: No, because the clinic’s capacity for research is limited, and we usually rely on proven methods to provide the best care to patients.
Q7: What do you believe is your primary goal as a family nursing practitioner?
A: My goal is to ensure that families can enjoy the highest level of well-being possible for them, regardless of their financial capacity, health literacy, or current health condition.
Q8: Do you believe the family focus of your role is important? Do you work with entire families often?
A: I usually try to work with entire families because children’s health depends a lot on caregivers’ health literacy. The family focus of my work is essential because it allows addressing community health problems comprehensively.
Q9: Do you believe your efforts have led to positive change in the community?
A: Yes, I believe that my efforts and the efforts of fellow nurses have made our community healthier. I can see that families trust us and are willing to implement our recommendations to improve well-being.
Q10: Are there any policy changes you would like to see that would enable you to be more productive?
A: Scope of practice limitations concern most nurses in Florida because they create barriers for holistic care. Expanding nurses’ scope of practice would contribute to population health by improving the workflow.