Advanced Practice Registered Nurse (APRN)

 

Every Advanced Practice Registered Nurse (APRN) should develop a personal development plan (PDP). A PDP includes a written evaluation of the regulations and requirements needed to obtain licensure and practice in the APRNs designated geographical area. The PDP should also include a personal action plan that reflects the results of one’s self-assessment, including one’s strengths, weaknesses, goals, and objectives. In order to develop a PDP, the APRN should be aware of and understand the state in which they plan to practice educational, regulatory, and licensure requirements. This paper aims to describe the APRNs scope of practice in the state of Florida, a personal assessment using Benner’s self-assessment tool, tactics for marketing and networking, a Curriculum Vitae, and a summary of the information acquired for the PDP.

APN Scope of Practice

Every state decides the guidelines or requirements for licensure, accreditation, certification, and education, also known as LACE, by which an APRN must abide by to practice in that state. Unfortunately, not all states are equal when it comes to the requirements for LACE and how much autonomy the APRN is allowed. In Florida, the Nurse Practitioner (NP) applicant must have a valid RN license, a master’s degree or a certificate in a nurse specialty area from a post master’s program, have completed at least 500 clinical hours, and have a national advanced practice certification from an accepted nursing specialty board (FLBON, 2017).

Per the American Association of Nurse Practitioners (AANP) (2017), nursing regulations and practice laws are set by each state. There are three levels at which an NP can practice: Full practice, reduced practice, and restricted practice (AANP, 2017). Full practice means the NP works under the authority of the state board of nursing (AANP, 2017). An NP who works in a state that allows full practice can evaluate and assess patients, diagnose, set up a treatment plan and manage the treatment plan, order diagnostic testing and interpret diagnostic results, and prescribe medications (AANP, 2017). Full practice for NPs is the scope recommended by the National Council of State Boards of Nursing and by the Institute of Medicine (AANP, 2017). Reduced practice means the state reduces the NPs ability to practice by at least one element (AANP, 2017). In reduced practice states, NPs must have a collaborative agreement with a healthcare provider before they can practice (AANP, 2017). Restricted practice means the state restricts the NP in at least one element of practice and it requires the delegation, supervision, and/or team management by a healthcare provider (most often a physician) before the NP can practice (AANP, 2017).

Florida is a restricted practice state. Per Florida’s administrative code, Rule 64B9-4.010(1), an ARNP “shall only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol between the ARNP and a Florida-licensed medical doctor, osteopathic physician, or dentist” (FLBON, 2016, para. 1). The protocol delineates the professional agreement between the physician and the ARNP. Protocols must include the ARNPs information, the physician’s information, the practice’s information, a description of the ARNPs duties such as procedures the NP can perform, conditions for which the ARNP is allowed to manage and treat, medications the ARNP may prescribe, and situations in which the NP must contact the physician (FLBON, 2016). Currently, NPs in Florida are also restricted from signing a Baker Act, signing a death certificate, certifying DNR orders, and are not recognized by Medicare and Medicaid as primary care providers (FLBON, 2016). In March 2017, bill HB 7011 was presented during the March legislative session; this bill recommended independent practice for ARNPs (FLANP, 2017). As of April 2017, the bill is in the House, specifically being evaluated by the Health and Human Services Committee (The Florida Senate, 2017).

One exciting landmark for NPs in Florida came in April of 2016; bill HB 423 passed, which allows NPs and PAs to prescribe schedule I, schedule II, and schedule III controlled substances (FLBON, 2016). As of January 2017, NPs were allowed to apply for a DEA license. However, there were some stipulations put in place with the passing of this bill. NPs must have an updated protocol filed with the Florida Board of Nursing (FLBON) stating the NP has the authority to prescribe controlled medication (FLANP, 2017). NPs must complete a minimum of three continuing education unit (CEU) hours relating to the safe and effective prescribing of controlled substances (FLBON, 2016). The NP must distinguish on their practitioner profile that they prescribe controlled medications. If the NP prescribes a schedule II medication, they are restricted to prescribing for a maximum of seven days (FLBON, 2016). Lastly, unless the NP is a certified psychiatric nurse, NPs cannot prescribe psychotropic medications to anyone under the age of 18 (FLBON, 2016).

Personal Assessment

Completing a personal assessment tool is beneficial for anyone; they can help determine one’s strengths, weaknesses, goals, and objectives. For NPs, personal assessment tools also allow them to explore their interests, discover passions, and to determine which areas of practice would suit them best. To care for others, one must have a true understanding of themselves, from what they want in life to what their strengths and weaknesses are.

Knowing one’s strengths is the first step to having a true understanding of who they are. The strengths this author possesses are good communication skills, good listening skills, determination, and patience. These strengths, especially communication and listening, are important to anyone wanting to work in the healthcare industry. Effective communication and listening skills are vital to ensuring one accurately assesses, diagnoses, and treats the patient. Aside from diagnosing and treating the patient, patients want to feel as if their concerns have really been heard. How a patient perceives the provider will influence the message they receive and ultimately their care. If the patient feels the provider does not listen, cuts them off, or is too hasty in their diagnosis, it is likely the patient will not fully comply with the treatment options, lifestyle changes, and/or follow-up appointments ordered by the provider.

Just as everyone has their strengths, everyone also has weaknesses. The good thing about weakness is that it can be turned into a strength. If one is aware they are weak in certain areas, one can work on improving in these areas until they are no longer weaknesses. The weaknesses this author deals with are the fear of being an advanced beginner and time management skills. According to Benner’s Novice to Expert Model, the advanced beginner is one who has some clinical knowledge but they still require support and assistance, such as a mentor/preceptor who can help set priorities and give constructive feedback (Davis & Maisano, 2016). Luckily, time builds knowledge and confidence; the new NP should keep in mind that over time they will navigate through all of Benner’s stages. Time management skills are essential if one wants to provide quality care. New NPs often feel they must be the one to complete all tasks, which makes time management even more difficult. The new NP needs to learn that delegating certain tasks is actually beneficial to their patients because it allows the NP to spend more time with them.

Having career goals is important for the NPs professional development. Most often, people have long-term goals and short-term goals. One should always be evaluating their goals and revising them as necessary to make sure they continue to be relevant as they move forward in their life and their career. This author’s short-term goal is to work in Dermatology once NP school is complete; a long-term goal is to become a knowledgeable and confident NP that can help other new graduates find their way. Being a preceptor/mentor to new NPs would be a way of giving back to the profession as well as helping patients.

Having objectives is important because they will help one meet their goals. There are objectives that one should have when seeking a job and once they secure that job. This author’s objective is to obtain clinical sites where employment is of interest. This would be a way of networking. With so many NPs going out into the workforce, one has to think of ways to stand out. It is very difficult to apply to jobs and rely on resumes alone. When an NP student is allowed to do their clinical hours in places they can envision working in one day, they can show the potential employer exactly why they should be hired.

Networking and Marketing Strategies

The new NP must network and market themselves in order to find employment after they obtain certification. Marketing and networking are also an important part of the professional development plan. The NP should begin networking while still in school. There are a number of national and local professional nursing associations that advertise employment opportunities for NPs. Some of the professional nursing organizations in Florida include the Florida Nurse Practitioner Network (FNPN), the Florida Association of Nurse Practitioners (FLANP), and the Tampa Bay Advanced Practice Nurses Council (TBAPNC). These organizations provide a plethora of information, for new and seasoned NPs, with options such as employment opportunities, upcoming events in the area, important information on new bills that are being presented to the legislature, rejected bills, and passed bills, rules and regulations, ways to connect and network with other NPs in the area, access to a preceptor list, and the opportunity to volunteer to be a preceptor. The Florida Nurses Association (FNA) is another website Florida NPs can utilize for help finding employment as well as other resources. The FNA is actually a division of the American Nurses Association (ANA) and it is the only nursing organization that provides information for all nurses in all specialties and all areas of practice (About the Florida Nurses Association, 2012).

Nationally, the American Association of Nurse Practitioners (AANP) is the largest professional membership organization that provides full service to NPs in all areas of practice. For example, the AANP provides information on current healthcare topics and policy updates, advocacy at the state and national levels, employment, resources to assist with professional growth, resources for new graduates as well as retiring NPs, conference information, and free CEUs (“Membership Categories & Benefits”, 2017). The AANPs job link allows non-members access to the available jobs although, members are able to see job postings five days before non-members. Another national organization NPs can utilize is NP Central. Not only does NP Central provide information on job opportunities, it also provides CE opportunities, classes on how to improve your practice, access to certain resources such as Medicare information, legislative contacts, press releases, and product and book reviews. NP Central is also a resource NPs can use to meet other NPs. When googling “local and national organizations that advertise employment opportunities”, this author found an article listing the 75 top professional organizations for nurse practitioners; AANP and NP Central were both listed in the top five choices (“75 Top Professional Organizations for Nurse Practitioners”, 2017). These days, social media is also a great way to network and market oneself; some of the popular websites/applications include Facebook, LinkedIn, and Doximity.

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