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Should an NP who is educationally prepared as an acute care NP work in an adult primary care setting?
A nurse practitioner (NP) who is educationally prepared as an acute care NP should not work in an adult primary setting because of several reasons. All NPs have to be certified in a specific way. Klein (2007) underlines that the opportunities for NPs to work in acute-care settings continue generating new questions due to the narrow practice arena and limited competencies. Graduation of NPs presupposes the possibility to work under a specialty focus that is acute, episodic, or critical conditions.
Therefore, even being educationally prepared, nurses do not have enough knowledge, experience, and rights to work out of the scope of the chosen practice, diagnose adult patients who ask for primary care, develop treatment plans, and establish follow-up. The environment of primary care varies from one of acute care. Any NP will be challenged by the necessity to promote safety, meet the expectations of patients and their families, and offer required help.
Another important aspect of the scope of practice for NPs includes licensing and certification. Despite the existing nationwide standards in nursing education, laws and regulations may vary across the states (Perloff, Clarke, DesRoches, OReilly-Jacob, & Buerhaus, 2017). The state can place some limits on NP autonomy to improve the quality of care that should be offered by physicians. However, the list of standards to which NPs may be held is long.
Therefore, it is expected to use the offered certificates to validate if a healthcare provider meets all criteria and understand the scope of the chosen practice. The National Organization of Nurse Practitioner Faculties is the author of the current core competencies for some NP specialties (Klein, 2007). These competencies promote frameworks for NPs from different nursing fields. Nurses can always address this source to find out if they are competent enough to change the scope of practice and start working with patients in new settings.
Is it within the scope for an FNP to diagnose and treat uncomplicated mental health conditions like depression, anxiety, and ADHD?
Many patients with attention deficit disorder (ADHD) suffer from anxiety or depression from time to time. As a rule, comorbid mental health complications predict poor outcomes and treatment resistance (Coplan, Aaronson, Panthangi, & Kim, 2015). Therefore, the special attention of a psychiatrist and a physician is usually required. However, when these mental health conditions are defined as uncomplicated, it is within the scope for a family nurse practitioner (FNP) to diagnose and treat depression, anxiety, or ADHD in the context of primary care.
The recognition of this context promotes an opportunity to develop a special treatment to patients and their needs. Depression or another above-mentioned disorder may be caused by different situations, reactions, or factors. The competency of an FNP allows working with patients who do not have complications. As soon as such a condition as bipolar disorder is proved, the skills of FNPs are not enough to continue working with patients.
The scope of FNP practice is usually defined during the program. As a rule, certification exams occur at the end and define the setting where an FNP can work (Hanlon, 2015). Even if nurses are not able to diagnose and treat patients independently, they are informed about the benefits of collaboration and information exchange. A mental health provider is responsible for developing a diagnosis and a treatment plan, and an FNP may participate in periodic management to improve the experience and gain new knowledge without serious complications and unwanted responsibilities.
Are there any restrictions for the FNP to treat patients with mood disorders and to prescribe them antipsychotics or SSRIs?
FNPs have to be ready to work with different patients, conduct exams, diagnose, and prescribe medications during their careers. As a rule, after a thorough examination of a person and special attention to the past medical history, allergies, and other genetic peculiarities, an FNP can provide the necessary care. Psychiatry is the field that turns out to be within the scope of FNPs. As well as primary care physicians, they can prescribe some psychotropic medications.
However, prescribing antipsychotic medications may not always be within the scope of practice for FNPs. It is required to review the Scope of Practice for a particular state before considering the possibility of these medications prescriptions to children especially. Many FNPs remain poorly trained or not licensed to diagnose patients beyond basic mental health conditions. Therefore, the prescription of antipsychotics or SSRIs is possible only in case a patient has an uncomplicated condition. In other cases, the main restriction is to invite a mental health care provider or primary care provider to avoid mistakes and complete the goal that is to coordinate care properly.
In general, FNPs may face several ethical and legal complications and concerns about medication prescriptions in some states. However, nurses understand the scope of their practice and make decisions regarding their professionalism and experience (Hanlon, 2015). They take responsibility for each step in a treatment plan of a patient. There should always be a chance to address a mental health specialist who can prove or disprove the chosen way of treatment and prescribed medications. If an FNP feels uncomfortable or unconfident in dealing with some mental disorders and health conditions, the case should be delegated to a mental health specialist. The role of an FNP is to deal with medical conditions, and there are many ways to complete this task in a special medical setting.
References
Coplan, J. A., Aaronson, C. J., Panthangi, V., & Kim, Y. (2015). Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World Journal of Psychiatry, 5(4), 366-378. Web.
Hanlon, A. (2015). Improving healthcare outcomes and accessibility in the USA: The advanced practice nurse. Obzornik Zdravstvene Nege, 49(2), 84-89.
Klein, T. A. (2007). Scope of practice and the nurse practitioner: Regulation, competency, expansion, and evolution. Topics in Advanced Practice Nursing eJournal, 6(3), 1-10. Web.
Perloff, J., Clarke, S., DesRoches, C. M., OReilly-Jacob, M., & Buerhaus, P. (2017). Association of state-level restrictions in nurse practitioner scope of practice with the quality of primary care provided to Medicare beneficiaries. Medical Care Research and Review. Web.
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