Scope of Practice, Credentialing, and Negotiation

Scope of Practice, Credentialing, and Negotiation

Note: In this course, some Discussions will have two parts:

Part I will consist of a specific topic related to the week’s content.

Part II will consist of a pharmacology review of approximately 250 words. Please submit each posting separately but within the same Discussion thread.

You will be assessed on your posting and responses to both parts.

As medical care evolves, so does the role and scope of practice of the advanced practice nurse in acute care settings. When providing patient care, however, you, as an advanced practice nurse, must always ensure that you are working within the scope of practice outlined by your state’s laws and institution’s regulations. For this Discussion, you examine these laws and regulations and consider how they might affect your future clinical practice, consider the credentialing process for your area, and discuss negotiation techniques you may use in a job search.

To prepare:

Locate a collaborative practice agreement. Based on this agreement, consider the scope of practice of an advanced practice nurse in your state.

Locate and select at least two hospitals where you would be interested in working at once you obtain your licensure.

Locate the hospitals’ credentialing documents and investigate the scope of practice at each hospital.

Note: All hospitals do not have the same scope of practice even if they are located within the same city and state.

Consider how the laws and regulations of the state and hospitals might affect your practice with medical and surgical patients in acute care settings.

Think about how you would negotiate your first Advanced Practice role. Consider issues such as salary range, Continueing Medical Education (CME), license and DEA costs, insurance, hours, on call requirements, etc.

Post on or before Day 3 an explanation of the scope of practice of advanced practice nurses, as outlined in the collaborative practice agreement. Then, identify the two hospitals of interest that you selected. Based on the credentialing documents, explain the scope of practice for acute care advanced practice nurses at each hospital. Explain how this might affect your practice in terms of caring for medical and surgical patients in acute care settings (i.e., medical treatments, procedures you can perform, interpreting diagnostics, etc.). Finally, describe job negotiation considerations.

Note: To support your Discussion post, you must include references (with URL links) from the state and the hospitals you selected.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on 2 different days who selected a different state or hospital from yours. Share additional insights or alternative perspectives.

Discussion Part II: Pharmacology

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

Chalikonda, S. A. (2009). Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events. AANA Journal, 77(2), 103–108.

Retrieved from the Walden Library databases.

Frankenstein, L., Katus, H. A., Grundtvig, M., Hole, T., de Blois, J., Schellberg, D., … Agewall, S. (2013). Association between spironolactone added to beta-blockers and ACE inhibition and survival in heart failure patients with reduced ejection fraction: A propensity score-matched cohort study. European Journal of Clinical Pharmacology, 69(10), 1747–1755.

Retrieved from the Walden Library databases.

Hao, G., Wang, Z., Guo, R., Chen, Z., Wang, X., Zhang, L., & Li, W. (2014). Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled studies. BMC Cardiovascular Disorders, 14, 148.

Retrieved from the Walden Library databases.

Levy, P. D., Laribi, S., & Mebazaa, A. (2014). Vasodilators in acute heart failure: Review of the latest studies. Current Emergency and Hospital Medicine Reports, 2(2), 126–132.

Shi, C. (2013). Blood pressure lowering efficacy of alpha blockers for primary hypertension. International Journal of Evidence-Based Healthcare, 11(3), 204–205.

Retrieved from the Walden Library databases.

Tocci, G., Battistoni, A., Passerini, J., Musumeci, M. B., Francia, P., Ferrucci, A., & Volpe, M. (2015). Calcium channel blockers and hypertension. Journal of Cardiovascular Pharmacology and Therapeutics, 20(2), 121–130.

Retrieved from the Walden Library databases.

Toppen, W., Sareh, S., Satou, N., Shemin, R., Hunter, C., Buch, E., & Benharash, P. (2014). Do preoperative ?-blockers improve postoperative outcomes in patients undergoing cardiac surgery? Challenging societal guidelines. American Surgeon, 80(10), 1018–1021.

Retrieved from the Walden Library databases.

Wang, A. (2012). Efficacy of class III antiarrhythmics and magnesium combination therapy for atrial fibrillation. Pharmacy Practice, 10(2), 65–71.

Retrieved from the Walden Library databases.

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

Alpha agonists

Alpha blockers

Beta blockers


Calcium channel


ACE versus BBlocker with spironolactone in CHF

ACE versus ARB

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by Day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

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