Index IntroductionIssues and trends in healthcareConclusionIntroductionThe healthcare profession is constantly in demand by healthcare professionals; Fortunately, mid-level practitioners are willing to step forward and fill this void. The number of nurse practitioner (NP) programs has increased significantly over the past two years. The problem isn't finding a program to attend or even job availability after completing a master's program, it's in the restrictions you face day to day in practice due to limitations set by the nursing board itself. no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay This paper will discuss two current issues related to healthcare delivery and healthcare policy, describe two strategies that can be implemented to improve these issues, as well as present the current state of healthcare costs, discuss implications related to access to care and quality of care and outline a legal and ethical aspect to consider in the provision of healthcare. Finally, it will describe how the adult gerontology acute care nurse practitioner can use five specific professional nursing qualities to influence evidence-based practice. Problems and trends in healthcare The first topic to address concerns the lack of a defined role that can be associated with the adult gerontology acute care nurse (AG-ACNP). The role of the professional nurse originates in a pediatric and family context. The emergence of an acute care nurse specialist is a new role that is becoming increasingly popular. While there is no clear universal interpretation of what an AG-ACNP scope of practice consists of, there are rules and regulations that vary from state to state designed to define NP practice (Lugo, O'Grady, Hodnicki & Hanson, 2007; Pearson , 2007). The rules and regulations for practicing as an advanced practice nurse (APN) are determined by the nursing license held, however numerous states go further by defining specific requirements and limiting who can use an advanced practice nursing title under state protection. (Hamric, Spross, & Hanson, 2005, p.407). The problem is that many states do not distinguish between various specialties of NP practice such as (family, pediatrics, adults, geriatrics, acute care) (Hamric, Spross, & Hanson, 2005, p. 407). Furthermore, they do not provide a list of skills, a list of tasks, or a list of acceptable procedures that the NP may perform in his or her specialty scope of practice (Hamric, Spross, & Hanson, 2005, p. 407). This is why there is such ambiguity regarding what the role of an AG-ACNP actually consists of. It has been reported by other practicing AG-ACNPs that hospital administrators and even physicians are not sure what differentiates an AG-ACNP from a family nurse practitioner (FNP), to them they are all the same thing (Hamric, Spross, & Hanson , 2005 , p. This becomes problematic because it will dramatically limit the AG-ACNP's scope of practice. It is therefore extremely important to educate all staff on the purpose of their role, the education required to fill the role, the training included in the training, and how the AG-ACNP can be used safely and efficiently. When describing the role you must outline what their practice consists of including: the nursing paradigm; interview/investigation skills; physical exam to create a treatment plan that addresses theholistic patient issues along with medical diagnosis; interventions that manage disease processes and promote health; create a discharge plan that covers medical and nursing care; and perform all AG-ACNP role skills applicable to your practice (Hamric, Spross, & Hanson, 2005, p. 430-31). Through education and role promotion, great strides can be made in developing powerful collaborative agreements with physicians and other members of the healthcare team to achieve superlative outcomes for patients (Hamric, Spross, & Hanson, 2005, p. 431). The second issue concerns limited prescriptive authority. In the state of Oklahoma, NPs are authorized to prescribe Schedule III – V Controlled Dangerous Substances (CDS) and may only prescribe a thirty-day supply without refills (Oklahoma Board of Nursing [OBN], 2012). In a typical emergency room setting where patients need to be seen for acute injuries, there will be instances where short-term narcotic prescriptions will be needed. Since NPs do not have full prescriptive authority, this dictates that a physician must be in the same vicinity for the patient to receive the appropriate medication. Another medication issue is that NPs are not permitted to order and push rapid-sequence intubation medications in respiratory emergencies. This limitation is not only harmful to the patient but also to the profession itself. One of these is less marketable if you cannot perform basic emergency room tasks such as rapid sequence intubations. The misconception that NPs are not proficient in this skill but then grant physician assistants the privilege of doing so is absurd when both are mid-level practitioners. Then it comes back to the governing body, the nursing council will need to be more open to change and support greater autonomy to secure the future of the profession. The only way change will happen is to bring it directly to the capital and lobby for what you want to change. The group of emergency medicine (EMP) physicians based in Tulsa, Oklahoma, traveled to the state capitol this year and affirmed the importance of NPs' role in intubation and the need to administer rapid-sequence medications to be able to do your job effectively. While not all medications, such as paralytics, were allowed to be used, they did allow etomidate and verse to be added to the list of medications that NPs can administer in an acute care setting. For greater autonomy such as full prescriptive authority to be achieved, this will require groups of NPs and healthcare advocates pushing to demonstrate the significant impact that change can have on the community. All in all, allowing NPs to have full practice authority along with prescriptive authority has the potential to open doors to allow greater access to healthcare in rural areas with the overall hope of improving Oklahoma's health and well-being ( Langley, 2015). The second topic of the discussion concerns the evaluation of complex issues regarding the delivery of health care. In 2014, U.S. health care spending grew by 5.3 to $3 trillion, or $9,523 per person (Centers for Medicare and Medicaid Services [CMS], 2014). Not surprisingly, there has been an influx of healthcare spending since the Affordable Care Act (ACA) was passed, which took effect within the last two years. As more people become insured and seek medical services, health care costs are out of control, so the reimbursement system, once based on quantity, will now evaluatepurchasing based on value and quality of care. The implications of accessibility to care are to improve overall care and promote quality health services (Office of Disease Prevention and Health Promotion [ODPH], 2016). The four parts of access to care include: coverage, services, timeliness, and workforce (ODPH, 2016). All four factors are necessary to ensure that people reach their full potential for optimal health and quality of life (ODPH, 2016). A significant aspect related to the quality of care received is that it is now based on the value and coordination of care rather than the quantity and reproduction of care compared to the past (CMS, 2014). The goal of the system reform is to emphasize the quality of care. healthcare system with the aim of simultaneously reducing healthcare costs (CMS, 2014). The shift in health care reimbursement has opened the door to legal and ethical dilemmas. Due to the implementation of value-based modifiers, facilities experiencing high rates of hospital-acquired infections along with high readmission rates will be penalized through payments (Page & Fields, 2011). This payment penalty could burden a facility and lead to falsification of documentation to avoid paying these fines. If falsification of documentation occurs, this could raise a legal issue of fraud. Furthermore, this is an ethical dilemma that staff may face or feel obligated to do by supervisors or administration. The ethical principle of loyalty would be violated. As nurses it is our job to advocate for the patient and to be sincere and honest in everything we do. We should maintain fidelity in everything we do, from patient care to documentation, everything is related to our core virtue of caring. The final topic of discussion is how the adult gerontology acute care nurse can utilize five nursing qualities including: caring, competence, communication, leadership, and professionalism to influence evidence-based practice. First and foremost, care is at the heart of our profession and that is why we do what we do. The adult gerontology acute care nurse practitioner differs from other healthcare professionals in that they use theoretical frameworks to model evidence-based practice, such as Jean Watson's theory of care, still incorporating care but also evaluating outcomes. Ultimately, what is most important is providing optimal patient outcomes, which can be achieved by building a pragmatic framework based on core nursing values ​​(American Nurse Association [ANA], 2010, p. 4). The nurse practitioner (RN) is expected to demonstrate competence throughout his or her practice, no less is expected of an NP. While pursuing higher education, they are expected to perform tasks and think critically within their scope of practice. As a new NP, there will be certain skills to evaluate before being able to perform these tasks independently, such as a certain number of intubations or central lines, to be performed under the supervision of a physician to ensure the NP is performing the task with competently and with the patient's best interest in mind. As evidence-based practice evolves in the years to come, the skills and standard protocols for practice will evolve as well. The American Nurses Association clearly defines competencies as situational and evolving; it can be both an end result and an ongoing process (ANA, 2010, p.12). Third, competent communication is another element.