Introduction
The recent advancements in medicine and the passage of the Patient Protection and the Affordable Care Act mean that the demand for qualified medical professionals is going to grow across the US (Hofer, Abraham, & Moscovice, 2011). As a nurse practitioner, I expect to be working in an outpatient department of a hospital providing services to the growing number of Medicaid and Medicare beneficiaries, as well as other patients.
Type of Organization and Patients
A state-run general hospital is a wide-profile medical facility providing treatment for a large variety of diseases and injuries. An outpatient department in such hospital provides diagnosis and care for the patients who do not require hospitalization. These departments are usually staffed by general practitioners, nurse practitioners, pediatric specialists and other broad-scope medical professionals. The services provided include examination, medical history review, diagnosis, prescriptions, discharged patients care, and preparations for hospital admissions (Kunders, 2008). Approximately 41 people in a hundred visit an outpatient department at least once a year. 45% of those visitors are serviced by nurse practitioners (CDC, 2011).
In a city like Miami, that means as many as 164000 visitors per year spread across all of the hospitals in the city. Since hospitals can expect patients from the whole metropolitan area, it is almost impossible to determine the exact population serviced. For example, in the case of Miami, with the metropolitan population of more than 5 million, high patient flow can be expected. The demographic is extremely varied. Patients of all income levels, ages, ethnicities and social standings can be expected. That makes a personalized approach to healthcare extremely important. Taking into consideration patients’ environment is a key factor to effective treatment and care in an outpatient department. The number of visitors is expected to grow as more and more Americans gain access to the healthcare services through the PPACA. That means that the outpatient departments can expect to service more poor and socially unprotected individuals in the future which will require more medical personnel and an adjusted approach to treatment.
Nurse Practitioner Role
In an outpatient department, a nurse practitioner can be expected to provide most of the required services on their own. These include diagnosis, prescriptions, physical examinations, health history reviews, screening services, healthcare education and condition monitoring. All of these services require extensive training and expertise to be carried out. Since nurse practitioners are highly skilled medical professionals, they are qualified to fill in the role of primary healthcare providers operating in the outpatient departments. The biggest barrier that exists for nurses willing to fulfill such roles is the state-based legislation, requiring them to sign collaborative agreements in order to exercise the full extent of their knowledge and abilities.
Individual hospital rules may also impede the nurse’s ability to be efficient (Fairman, Rowe, Hassmiller, & Shalala, 2011). At the same time, the outpatient care heavily relies on nurses. In Florida, nurse practitioners are required to collaborate with physicians in all of their activities, including diagnosis, prescriptions, and treatment. That means increased load for the physicians who are unable to fully delegate the patient care to the competent nurses, and the inability to fully act on their own for nurses themselves who are forced to verify all of their actions with the collaborator. However, since the legislation is unlikely to change in the near future, a nurse practitioner needs to find an efficient way to make the collaboration useful. That can be achieved by developing a relationship of trust with the physician and exchanging the experience to ensure that both parties learn by working together.
Florida Board of Nursing
According to the Nurse Practice Act, the Florida Nursing Board is an organization dealing with certification of nurses and supporting their role in patient care and health promotion. It consists of 13 members appointed by the Governor and confirmed by the Senate. The acts of the Board outline the competence and responsibilities of the nurses in Florida. The organization can also penalize the nurses for the violations of the approved practices. Nurse Practice Act states that advanced and specialized nurses “may also perform acts of medical diagnosis and treatment, prescription, and operation which are identified and approved by a joint committee composed of three members appointed by the Board of Nursing, two of whom must be advanced registered nurse practitioners” (Florida Board of Nursing, 2007). However, it seems that most of those actions are severely limited by the need to collaborate with physicians. It indicates that the Board is not fully capable of supporting the nurse practitioners and allowing them to work as efficiently as possible.
Conclusion
With the increasing number of people covered by the governmental healthcare programs, hospitals will need more qualified professionals to deal with the patient flow. I believe that as a nurse practitioner, I will be able to provide the primary care as a part of an outpatient department. While certain barriers may prevent me from fully applying my training and expertise to practice, I still think that these limitations may be overcome by building workplace relationships and being vocal about the potential of nurses in the healthcare system.
References
CDC. (2011). National Hospital Ambulatory Medical Care Survey: 2011 Outpatient Department Summary Tables. Web.
Fairman, J., Rowe, J., Hassmiller, S., & Shalala, D. (2011). Broadening the Scope of Nursing Practice. New England Journal Of Medicine, 364(3), 193-196.
Florida Board of Nursing. (2007). Nurse Practice Act. Tallahassee, FL: Author.
Hofer, A., Abraham, J., & Moscovice, I. (2011). Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization. Milbank Quarterly, 89(1), 69-89.
Kunders, G. (2008). Hospitals. New Delhi, India: Tata McGraw-Hill.