Student Name Chamberlain University NR-506: Healthcare Policy Prof. Name Date Week 7 Assignment: Summary of Healthcare Concern Presentation Guidelines and Rubric Purpose The primary purpose of this assignment is to develop a comprehensive summary of the presentation delivered to an elected official regarding a healthcare concern. This includes describing the official’s response, evaluating the outcomes, and proposing strategies for sustaining advocacy on the chosen issue. Meeting with the official—whether in person or through a virtual/telephone discussion—is a mandatory component. After this interaction, students are expected to prepare and present a PowerPoint™ presentation to their peers and faculty, reflecting on the advocacy process and outcomes. Due Date: Sunday, 11:59 p.m. MT, Week 7Total Points: 175 Requirements Description of the Assignment This assignment requires students to select a healthcare policy concern, advocate for change, summarize the meeting with an elected leader, and identify future plans for ongoing advocacy. The work should integrate policy knowledge with advanced nursing practice roles. Criteria for Content 1. Overview of Healthcare Policy in the Nursing Profession This section emphasizes the interconnectedness of healthcare policy and nursing practice. 2. Selected Healthcare Policy Concern and Resolution This section highlights the chosen healthcare concern, its relevance, and potential solutions. Element Details Description of Concern Clearly explain the selected issue (e.g., nursing shortage, mental health access, opioid crisis, telehealth expansion). Provide context and relevance to current practice. Impact on Population/Community Discuss the direct consequences on patient outcomes, healthcare costs, and community well-being. Proposed Resolution Outline actionable strategies such as policy amendments, funding allocations, or expanded training programs. Presentation Materials Reference the PowerPoint slides and handouts prepared for the official, ensuring they align with advocacy goals. 3. Description of the Meeting with the Elected Official NR 506 Week 7 Summary of Healthcare Concern Presentation Meeting Element Required Content Official’s Name & Position Include full name, role, and jurisdiction. Reason for Selection Explain why this official was chosen (e.g., relevant committee membership, history of supporting healthcare legislation). Meeting Details Provide the date, time, format (in-person/virtual), and any materials or reports shared. Official’s Response Describe their feedback, level of support, or any suggested revisions to the proposed solution. 4. Self-Reflection Self-reflection enables students to critically examine the advocacy process. 5. Future Plans Regarding the Selected Healthcare Concern Future advocacy efforts should focus on expanding the resolution’s reach and sustaining momentum. 6. Conclusion The conclusion should restate the importance of the healthcare concern, summarize the key policy solution, and reflect on the elected official’s response. It should also emphasize the role of nurses in driving sustainable policy change that improves both patient care and community health outcomes. Preparing the Assignment Grading Rubric Content Evaluation (150 Points) Criteria Exceptional (100%) Exceeds (88%) Meets (80%) Needs Improvement (38%) Developing (0%) Overview of Healthcare Policy (15 pts) Excellent explanation of policy impact, APN advocacy role, and population health Good explanation, some detail missing Basic coverage One element missing All unsatisfactory Policy Concern & Resolution (20 pts) Comprehensive detail with impact, solution, and slides Good, but less depth Minimal explanation One element missing Two+ elements missing Meeting with Official (30 pts) Excellent detail including name, rationale, meeting specifics, and response Good description, missing minor detail Minimal explanation One element missing Two+ missing Self-Reflection (35 pts) Insightful, covers all required aspects Covers but less depth Basic coverage One–two missing Three+ missing Future Plans (35 pts) Thorough discussion of advocacy, revisions, and nursing organization role Good, less detailed Minimal One missing Two+ missing Conclusion (5 pts) Clear, strong summary Adequate summary Limited coverage One missing Two+ missing Presentation Specifications (25 Points) Criteria Exceptional (100%) Exceeds (88%) Meets (80%) Needs Improvement (38%) Developing (0%) Presentation Specs (10 pts) ≤20 slides, ≥5 scholarly refs, current Meets 3 of 4 Meets 2 Meets 1 None met APA Format (10 pts) 0–1 errors 2–3 errors 4–5 errors 6–7 errors 8+ errors Citations (5 pts) 0–1 errors 2–3 errors 4–5 errors 6–7 errors 8+ errors Mechanics & Presentation (10 pts) Excellent grammar, style, visuals, notes Minor issues Moderate issues Many issues Unsatisfactory References World Health Organization. (2020). Nursing and midwifery: Key facts. https://www.who.int/news-room/fact-sheets American Association of Colleges of Nursing. (2021). Advocacy and policy priorities for nursing practice. Journal of Professional Nursing, 37(5), 857–861. https://doi.org/10.xxxxx Cherry, B., & Jacob, S. R. (2022). Contemporary nursing: Issues, trends, and management (9th ed.). Elsevier. NR 506 Week 7 Summary of Healthcare Concern Presentation Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning. Turale, S., & Kunaviktikul, W. (2019). The contribution of nurses to health policy and advocacy requires leaders to step up. International Nursing Review, 66(3), 302–304. https://doi.org/10.xxxxx

Student Name Chamberlain University NR-506: Healthcare Policy Prof. Name Date NP Scope of Practice Nurse Practitioner Scope of Practice in Florida In Florida, nurse practitioners (NPs) operate under restricted practice regulations, meaning they are required to work under the supervision of a physician or another healthcare provider to deliver patient care (AANP, 2020). However, recent policy changes have provided greater independence. In 2020, Governor Ron DeSantis signed legislation that permits experienced NPs—those who have completed at least 3,000 supervised practice hours—to practice independently without continuous physician oversight (Thomas, 2020). This represents an important step toward expanding NP authority and addressing healthcare access needs within the state. Prescribing Authorities Florida allows NPs to prescribe controlled substances, but prescribing authority is tied to physician supervision. A written collaborative agreement must be maintained for prescriptive authority, ensuring legal accountability. The details of NP prescribing rights in Florida are outlined below: Prescriptive Authority Requirements/Limitations Controlled substances Allowed under physician supervision Written agreement Required for prescriptive authority Schedule II substances Limited to a 7-day supply Psychiatric medications for minors Only psychiatric NPs may prescribe for patients under 18 Continuing education 3 hours required every 2 years on safe/effective prescribing (American Medical Association, 2017). This structured prescribing authority attempts to balance patient safety while expanding NP contributions to healthcare delivery. Limitations of Practice Even after certification, advanced practice registered nurses (APRNs) in Florida must maintain a protocol agreement with a supervising physician. This written document outlines clinical responsibilities such as diagnosing, ordering and interpreting diagnostic tests, and developing treatment plans. Although the supervising physician does not need to be physically present, they must remain reachable by phone for consultation when needed. Despite these restrictions, Florida law does acknowledge NPs as primary care providers, which recognizes their role in meeting growing healthcare demands, particularly in underserved regions (Scope of Practice Policy, 2020). Process for Obtaining Licensure in Florida To practice as an NP in Florida, candidates must first hold an active registered nursing (RN) license. They must then obtain national certification from a recognized specialty board, which requires proof of advanced education, clinical experience, application fees, and the successful completion of a standardized certification examination. Additional licensure requirements include: (NursingLicensure.org, 2020). Certification and Education Requirements The National Organization of Nurse Practitioner Faculties (NONPF) established a framework of nine core competencies that every NP is expected to master upon graduation from an advanced practice program. These competencies ensure NPs are adequately prepared to deliver safe and independent care. NONPF NP Core Competencies Scientific foundation Leadership Quality improvement Practice inquiry Technology and information literacy Policy advocacy Health delivery systems Ethics Independent practice (NONPF, 2012). By emphasizing these areas, NP education aligns with national standards that safeguard the quality of patient care across diverse clinical settings. NP Barriers Although studies confirm that NPs deliver high-quality and cost-effective care equivalent to physicians, they continue to face barriers in Florida due to regulatory restrictions. There are approximately 18,000 NPs practicing in Florida, with an additional 300–500 graduates each year (Florida Association of Nurse Practitioners, 2020). If NPs were permitted to practice to the full extent of their education and training, they could significantly reduce healthcare costs while increasing access for underserved populations. Unfortunately, current restrictions disproportionately affect vulnerable groups, such as Medicaid recipients and rural residents, where physician shortages are already severe. These barriers drive up healthcare costs and limit availability of primary care services (Florida Association of Nurse Practitioners, 2020). How Does Access to NPs Impact Healthcare Disparities? Access to nurse practitioners directly reduces healthcare disparities by expanding affordable and timely care. Millions of Americans lack consistent access to healthcare due to geographic, financial, or insurance barriers. NPs play a vital role in filling these gaps by offering services in rural, urban, and underserved communities where physician shortages persist. Their ability to provide preventive care, chronic disease management, and health education not only improves outcomes but also lowers the overall burden on emergency and specialty services. Consequently, expanding NP authority contributes to healthier populations and reduced disparities in healthcare delivery. References National Organization of Nurse Practitioner Faculties. (2012). Nurse practitioner core competencies. Retrieved from https://www.nursepractitionerschools.com/faq/what-are-the-np-core-competencies/ American Association of Nurse Practitioners. (2020). State practice environment: Florida. AANP. Retrieved from https://www.aanp.org NR 506 Week 6 NP Scope of Practice American Medical Association. (2017). State law chart: Nurse Practitioner Prescriptive Authority. AMA. Retrieved from https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdf Florida Association of Nurse Practitioners. (2020). The advanced practice nurse solution. FLANP. Retrieved from https://www.flanp.org/page/TheAPRNSolution NursingLicensure.org. (2020). Advanced Registered Nurse Practitioner requirements in Florida. Retrieved from https://www.nursinglicensure.org/np-state/florida-nurse-practitioner.html Scope of Practice Policy. (2020). Florida scope of practice policy: State profile. Retrieved from http://scopeofpracticepolicy.org/states/fl/ NR 506 Week 6 NP Scope of Practice Thomas, K. (2020). Florida nurse practitioners gain full practice authority. Daily Nurse: The Pulse of Nursing. Retrieved from https://dailynurse.com/florida-grants-advanced-nps-full-practice-authority/

Student Name Chamberlain University NR-506: Healthcare Policy Prof. Name Date Decision Making in Nursing Practice: A Concept Analysis You are a family nurse practitioner working in an outpatient primary care clinic affiliated with a large hospital system. The practice has been operating for more than 15 years, and most of the staff have been employed since its inception. You, however, have only been there for three months. During this short time, you have observed frequent heated arguments among the staff—even in patient areas. On one occasion, you overhear another argument and discover that a medical assistant (MA) failed to report a patient’s dangerously low blood pressure. When questioned, the MA admitted forgetting to notify you because she was engaged in the argument. Unfortunately, this behavior is not unusual in the practice. Such conflicts undermine patient safety, disrupt clinic operations, and prevent clinicians from dedicating sufficient time to patients. Case Study Responses 1. Analyze the case study for potential issues for members of the healthcare team from office conflict. Contrast the potential effects for each member of the healthcare team based upon the required readings from the week. Discuss the potential ethical and legal implications for each of the following practice members: Conflict is inevitable in healthcare settings; however, unmanaged conflict creates ethical, legal, and professional dilemmas. If not addressed promptly, conflicts compromise patient safety, damage staff relationships, and may lead to legal consequences such as malpractice or negligence claims. Each member of the team holds responsibility for maintaining professionalism, with patient safety as the top priority. Practice Member Potential Issues from Conflict Ethical Implications Legal Implications Medical Assistant (MA) Distracted by conflict, failed to notify NP of critical vital signs Violated beneficence (duty to do good) and nonmaleficence (avoiding harm) by neglecting patient safety Could face liability for negligence or malpractice if harm results Nurse Practitioner (NP) Responsible for patient oversight, but affected by dysfunctional workplace Faces ethical dilemma by tolerating unsafe behaviors; may fail beneficence by not intervening sooner Legally accountable for patient care outcomes, even when staff errors occur Medical Director Responsible for overseeing all staff and ensuring safe practices Failed justice, beneficence, and nonmaleficence by allowing unresolved conflicts to persist Practice leadership could be held accountable for systemic negligence Practice as a Whole Dysfunctional teamwork, compromised workflow, delayed care Lack of teamwork violates ethical standards of quality care and safety Exposed to malpractice claims if patient harm results from poor staff communication Effective teamwork is essential for safe and ethical care. As Hamid (2016) emphasizes, teamwork is a cornerstone of patient safety and positive outcomes. 2. What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes? To prevent recurrence of unsafe behaviors, structured strategies should be implemented. Step 1: Identify Root Causes Conflicts must be assessed to uncover underlying issues (AHRQ, 2019). Possible causes include poor communication skills, lack of conflict resolution training, or a toxic workplace culture. Step 2: Promote Communication Staff need training in professional and respectful communication. Arguments in patient areas are unacceptable. Establishing clear communication guidelines, encouraging active listening, and reducing barriers can enhance collaboration. Gluyas (2015) highlighted that communication directly impacts patient safety. Step 3: Strengthen Teamwork Recognizing every staff member as part of the healthcare team fosters respect. Studies suggest that effective teamwork reduces workload stress, improves patient safety, and increases job satisfaction (Kumar et al., 2014). Step 4: Teach Conflict Resolution Skills Staff should learn structured conflict resolution methods, such as active listening, professional dialogue, and problem-solving strategies. Addressing conflicts promptly prevents escalation into hostility (Johansen, 2014). Strategy Purpose Expected Outcome Identify Root Causes Understand underlying conflicts Tailored interventions to resolve issues Promote Communication Encourage respectful dialogue Fewer workplace arguments, improved collaboration Strengthen Teamwork Build trust and shared responsibility Enhanced patient safety and quality of care Conflict Resolution Training Provide staff with tools to resolve disputes Reduced hostility, supportive workplace culture 3. What leadership qualities would you apply to effect positive change in the practice? As a nurse practitioner, I would apply transformational leadership qualities to create a culture of trust, accountability, and collaboration. Transformational leaders inspire others, foster teamwork, and align staff with a shared vision of patient safety and high-quality care (Fischer, 2016). Key leadership qualities include: As Atkinson and Mackenzie (2015) note, leadership is critical to driving change. Without effective leadership, conflicts fester and negatively affect patient outcomes. References Agency for Healthcare Research and Quality. (2019). Identifying strategies. Retrieved from https://www.ahrq.gov/research/findings/final-report/ptflow/section4.html Atkinson, P., & Mackenzie, R. (2015). Without leadership there is no change. BMJ Leader, 1(1), 2-3. Fischer, S. (2016). Transformational leadership in nursing: A concept analysis. Journal of Advanced Nursing, 72(11), 2644–2653. https://doi.org/10.1111/jan.13049 NR 506 Week 5 Ethical and Legal Implications Ganta, V. C., & Manukonda, J. K. (2014). Leadership during change and uncertainty in organizations. International Journal of Organizational Behavior & Management Perspectives, 3(3), 1183. Gluyas, H. (2015). Effective communication and teamwork promote patient safety. Nursing Standard, 29(49), 50–57. https://doi.org/10.7748/ns.29.49.50.e10040 Hamid, S. (2016). Ethical issues faced by nurses during nursing practice in district Layyah, Pakistan. Diversity and Equality in Health and Care, 13(4), 302–308. Johansen, M. (2014). Conflict management style, supportive work environments, and the experience of work stress in emergency nurses. Journal of Nursing Management, 22(4), 552–562. https://doi.org/10.1111/jonm.12037 Johansen, M., & O’Brien, J. (2016). Decision making in nursing practice: A concept analysis. Nursing Forum, 51(1), 40–48. https://doi.org/10.1111/nuf.12119 NR 506 Week 5 Ethical and Legal Implications Kumar, S., Deshmukh, V., & Adhish, V. S. (2014). Building and leading teams. Indian Journal of Community Medicine, 39(4), 208–213. https://doi.org/10.4103/0970-0218.143020 Longo, J. (2010). Combating disruptive behaviors: Strategies to promote a healthy work environment. Online Journal of Issues in Nursing, 15(1). https://doi.org/10.3912/OJIN.Vol15No01Man05 Salas, E., Shuffler, M., Thayer, A., Bedwell, W., & Lazzara, E. (2015). Understanding and improving teamwork in organizations: A scientifically based practical guide. Human Resource Management, 54(4), 599–622. https://doi.org/10.1002/hrm.21628

Student Name Chamberlain University NR-506: Healthcare Policy Prof. Name Date Week 4: Obesity Health Policy Analysis Problem Statement Should government officials proactively promote obesity interventions, programs, and education within rural areas? Yes. Government officials should actively encourage obesity-related interventions and programs in rural regions. These communities often face limited access to healthcare, fewer recreational facilities, and higher poverty rates, which directly contribute to increased obesity levels. Proactive policies such as school-based health education, funding for nutritious foods, and community exercise opportunities can help reduce obesity prevalence while promoting long-term wellness. Background Knott County, Kentucky reflects a concerning picture of obesity-related challenges. These figures indicate a pressing public health concern that requires multi-level intervention to reduce disparities and improve quality of life (County Health Rankings & Roadmaps, 2020). Landscape The obesity crisis involves several stakeholders, each influenced by political, economic, social, and quality-of-care factors. Key Stakeholders Stakeholder Analysis Stakeholder Role/Interest Political Social Economic Legal Practical Quality-of-Care Healthcare Providers Committed to addressing obesity in patients No Yes Yes No Yes Yes Food Industry Key driver in obesity crisis Yes Yes Yes No Yes No Health Insurance Industry Benefit from healthier populations Yes No Yes No Yes Yes Politicians & Lobbyists Advocate for obesity policies Yes Yes No Yes Yes No Both Democratic and Republican leaders have presented legislative measures targeting obesity. For example, Bill H.R. 1530 (Democratic) and Bill S. 595 (Republican) were introduced in Congress to address obesity-related health concerns (Library of Congress, 2019). Options Several intervention strategies are available to mitigate obesity: Recommendation Educating School-Age Children on Obesity Risks and Preventative Measures Education is the most effective strategy because it instills lifelong healthy habits. By reaching children early, schools can influence both the younger generation and their families. Implementing lessons on nutrition, portion control, and physical activity can reduce obesity rates over time. NR 506 Week 4 Obesity Health Policy Analysis Nonetheless, education remains the cornerstone for sustainable change, fostering prevention rather than treatment. References Carty, S. A., Mainvil, L. A., & Coveney, J. D. (2017). Exploring family home food environments: Household resources needed to utilize weekly deliveries of free fruits and vegetables. Nutrition & Dietetics, 74(2), 138–146. Cedeno, L. (2019). Global implementation of soda taxes: Is there a better solution for combatting obesity? Brooklyn Journal of International Law, 45(1), 229–365. County Health Rankings and Roadmaps. (2020). Explore rankings. Retrieved from https://www.countyhealthrankings.org/app/kentucky/2020/rankings/knott/county/outcomes/overall/snapshot NR 506 Week 4 Obesity Health Policy Analysis Edwards, M. B., Jilcott, S. B., Floyd, M. F., & Moore, J. B. (2015). County-level disparities in access to recreational resources and associations with adult obesity. Palaestra, 29(2), 39–54. Library of Congress. (2019, March 16). Current legislation. https://www.congress.gov/search?q={%22congress%22:%22116%22,%22source%22:%22legislation%22,%22search%22:%22obesity%22}&searchResultViewType=expanded&KWICView=false

Student Name Chamberlain University NR-506: Healthcare Policy Prof. Name Date Quality Healthcare: Controlling Hypertension Hypertension remains one of the most pressing health challenges in the United States, as it significantly contributes to cardiovascular disease, stroke, and premature deaths. Often referred to as a “silent killer,” hypertension is usually asymptomatic until severe complications occur. Because of its impact, the National Committee for Quality Assurance (NCQA) has identified hypertension as a key indicator within the Healthcare Effectiveness Data and Information Set (HEDIS), categorized under the effectiveness of care domain (NCQA, 2020). Addressing hypertension effectively requires coordinated efforts between patients and healthcare providers. Family Nurse Practitioners (FNPs), in particular, are central figures in implementing interventions, monitoring outcomes, and coaching patients to adopt healthier behaviors. Through patient-centered interventions, FNPs not only improve long-term outcomes but also reduce costs and enhance satisfaction with care. Patient Interventions and Measuring Outcomes What interventions can patients use to control hypertension? Successful hypertension management requires active participation from patients. In the U.S., around 30% of adults suffer from hypertension, while worldwide, over one billion individuals are affected (Liyanage-Don, Fung, Phillips, & Kronish, 2019). Empowering patients to adopt self-care practices ensures better adherence to treatment. Three widely used interventions for controlling blood pressure include: FNPs play a vital role in reinforcing these strategies by providing education, monitoring progress, and developing individualized care plans. Table 1 Patient Interventions for Controlling Hypertension Intervention Description Expected Outcome Supporting Evidence Home Blood Pressure Monitoring Patients check and log blood pressure at home to detect changes. Helps detect “white coat hypertension,” ensures timely adjustments in care. Liyanage-Don et al. (2019) Heart-Healthy Diet Reducing sodium, refined sugars, and processed meats while increasing intake of fruits, vegetables, and omega-3 fatty acids. Decreases blood pressure, reduces obesity risk, and improves heart health. Dinu, Pagliai, & Sofi (2017) Regular Exercise Performing moderate aerobic activity for 30 minutes, 5 days per week. Promotes weight control, lowers BP, enhances cardiovascular endurance. Deka, Pozehl, Williams, & Yates (2017); Kristanti & Prihartono (2019) Measuring NP Performance in Patient Outcomes How can FNPs measure whether interventions are successful? FNPs assess both self-reported and performance-based outcomes to evaluate the effectiveness of interventions. Table 2 Tools for Measuring Patient Outcomes Measurement Tool Patient Role NP Role Benefit Blood Pressure Logs Monitor BP daily at home. Analyze readings and adjust medication. Identifies hypertension patterns, reduces misdiagnosis. Food Journals Record meals and nutrient intake. Assess dietary adherence, provide counseling or referrals. Detects nutritional deficiencies and supports dietary compliance. Exercise Tolerance Tests Perform guided exercise tasks. Evaluate endurance, monitor improvements. Demonstrates functional progress and cardiovascular health. By combining these approaches, FNPs can tailor care plans, address barriers, and support patients in sustaining long-term changes (Blumenthal et al., 2017). Improved Patient Outcomes and Cost Savings How do patient interventions contribute to cost savings? Patient-centered strategies that emphasize self-monitoring, diet, and exercise not only reduce blood pressure but also help prevent complications like stroke, kidney disease, or heart failure. These conditions are costly to manage, making preventive interventions financially beneficial for both patients and the healthcare system. FNPs frequently integrate the Institute for Healthcare Improvement’s Triple Aim Framework, which emphasizes: When hypertension is controlled, hospitalizations, emergency visits, and costly treatments decline, allowing healthcare providers to allocate resources more efficiently. Improved Patient Ratings Patient satisfaction is closely linked to clinical outcomes. Medicare and insurance providers increasingly factor in patient satisfaction when determining reimbursement, making it a critical quality metric (Lindsay, 2017). When patients are included in decision-making and given tools to manage their condition, they gain confidence, adhere better to care plans, and trust their providers more. For example, patients who successfully manage hypertension with home monitoring often report higher satisfaction and are more likely to recommend their providers. Conclusion Managing hypertension requires a collaborative and patient-focused approach. Key strategies such as home monitoring, diet modification, and regular exercise significantly lower the risk of complications. FNPs are instrumental in reinforcing these behaviors, monitoring progress, and adapting care based on patient needs. Ultimately, these interventions lead to better clinical outcomes, reduced costs, and greater patient satisfaction. Empowering individuals to take responsibility for their health turns hypertension management from a clinical obligation into a sustainable lifestyle commitment. References Blumenthal, J. A., Sherwood, A., Smith, P. J., Mabe, S., Watkins, L., Lin, P., … Hinderliter, A. (2015). Lifestyle modification for resistant hypertension: The TRIUMPH randomized clinical trial. American Heart Journal, 170(5), 986–994. https://doi.org/10.1016/j.ahj.2015.08.006 Deka, P., Pozehl, B., Williams, M. A., & Yates, B. (2017). Adherence to recommended exercise guidelines in patients with heart failure. Heart Failure Reviews, 22(1), 41–53. Dinu, M., Pagliai, G., & Sofi, F. (2017). A heart-healthy diet for hypertension prevention and control. Nutrients, 9(9), 1060. https://doi.org/10.3390/nu9091060 Kristanti, D., & Prihartono, N. (2019). Obesity as a predictor of hypertension in adult population: A 14-years retrospective cohort study. Indian Journal of Public Health Research & Development, 10(6), 491–497. Lindsay, R. W. (2017). Linking reimbursement to patient satisfaction: Is the tail wagging the dog? JAMA Facial Plastic Surgery, 19(3), 173–174. NR 506 Week 3 Quality Healthcare: Controlling Hypertension Liyanage-Don, N., Fung, D., Phillips, E., & Kronish, I. M. (2019). Implementing home blood pressure monitoring into clinical practice. Current Hypertension Reports, 21(2), 14. National Committee for Quality Assurance. (2020). HEDIS measures. Retrieved from http://www.ncqa.org/hedis/measures/ Verma, A., & Bhatia, S. (2016). A policy framework for health systems to promote triple aim innovations. HealthCarePapers, 15(3), 9–23.

Student Name Chamberlain University NR-506: Healthcare Policy Prof. Name Date NR 506 Week 2: Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study Case Study Questions 1. What are the potential ethical and legal implications for each of the following practice members? In this case study, ethical and legal concerns arise for each member of the healthcare team. These concerns highlight the importance of professional boundaries, accountability, and adherence to both clinical and legal standards. To provide clarity, the ethical and legal implications for the medical assistant, nurse practitioner, and medical director are summarized in the table below: Practice Member Ethical Implications Legal Implications Medical Assistant (Stephanie) Violated nonmaleficence by making a clinical decision without proper training, risking harm to the patient. Demonstrated dishonesty and lack of professional integrity by falsifying a prescription. Practiced outside her legal scope. Forged the nurse practitioner’s signature and misused prescriptive authority. Possible consequences: license suspension, fines, imprisonment, and loss of eligibility to practice in other states (Office of Professional Licensure and Certification, 2017). Nurse Practitioner Breached the principle of justice by failing to ensure fair and safe care. Did not adequately supervise the assistant’s clinical actions. Legally liable for negligent supervision. Failure to verify prescription renewals or monitor staff behavior could result in malpractice claims (Office of Professional Licensure and Certification, 2017). Medical Director Lacked accountability for employee oversight and training. Failed to ensure ethical standards in the workplace. Legally responsible under respondeat superior (“Let the Master Answer”). May face lawsuits, fines, or regulatory action against the practice (Cornell Law School, 2020). This analysis shows that while the medical assistant directly violated ethical and legal standards, both the nurse practitioner and medical director hold supervisory responsibility that also carries serious implications. 2. What strategies would you implement to prevent further episodes of potentially illegal behavior? To minimize future risks of unethical or illegal behavior within the practice, several strategies should be implemented: Implementing these strategies not only reduces the likelihood of ethical breaches but also ensures compliance with regulatory standards, thereby protecting both patients and providers. 3. What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice. As an Advanced Practice Registered Nurse (APRN), promoting positive organizational change requires strong leadership skills. The following qualities are critical: Creating a culture built on integrity, fairness, and continuous learning will positively transform the practice environment, improving patient outcomes and protecting the reputation of the healthcare organization. References Cornell Law School: Legal Information Institute. (2020). Respondeat superior. https://www.law.cornell.edu/wex/respondeat_superior Emergency Care Research Institute. (2015). Scope of practice laws for nurse practitioners and physician assistants. https://www.ecri.org/components/PPRM/Pages/LB5.aspx?tab=2 Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. (2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378–2392. https://doi.org/10.1111/jan.14092 NR 506 Week 2 Case Study Office of Professional Licensure and Certification: New Hampshire Board of Nursing. (2017). Statements related to lying, fraud, theft. https://www.oplc.nh.gov/nursing/lying-fraud-theft.ht

Student Name Chamberlain University NR-506: Healthcare Policy Prof. Name Date NR 506 NP Week 1 Discussion Barriers to Practice as an Advanced Practice Nurse (APN) Advanced Practice Nurses (APNs) face numerous obstacles that prevent them from practicing at the highest level of their education and clinical training. These barriers exist across both state and federal levels, influencing licensure, prescriptive authority, reimbursement models, and public acceptance of the APN role. The differences in state regulations result in a lack of uniformity in the scope of practice, ultimately affecting patients’ access to high-quality, patient-centered care. 1. Practice Barriers for APNs: State and National Level In Kentucky, nurse practitioners (NPs) are granted the ability to practice without direct physician oversight in many clinical areas. However, they face restrictions regarding prescriptive authority. For controlled substances, such as opioids and other narcotics, a collaborative agreement with a physician is still required (Kentucky Board of Nursing, 2020). This restriction limits the autonomy of APNs, particularly in rural areas where physicians may be unavailable, resulting in treatment delays for vulnerable populations. At the national level, APNs encounter reimbursement challenges. For instance, Medicare reimburses nurse practitioners at lower rates than physicians—approximately 29% less, despite both providers performing the same services (Perloff, DesRoches, & Buerhaus, 2016). This payment gap reduces the perceived economic value of NPs and influences hiring decisions made by health organizations. Another significant barrier is public perception. Many patients still assume that physicians provide superior care, creating hesitancy in accepting APNs as primary providers. This misconception persists even though numerous studies confirm that APNs provide safe, effective, and often more accessible care than physicians (Renshaw, 2019). 2. Competition Affecting APN Practice Competition from other healthcare professionals—especially physicians and physician assistants—remains a major factor restricting APNs’ independence. Physicians often oppose granting APNs broader scope of practice rights, citing patient safety concerns, despite extensive research demonstrating comparable outcomes between APN- and physician-led care (Davis, 2019). Furthermore, healthcare facilities sometimes prefer hiring physicians or physician assistants due to patient demand or traditional hierarchical structures within healthcare. This not only limits employment opportunities for APNs but also undermines recognition of their advanced education and expertise. In specialized areas such as emergency care, APNs may face skepticism regarding their preparedness, despite being adequately trained (Corso, Dorrance, & LaRochelle, 2018). 3. Key State Lawmakers The regulatory environment for APNs is heavily shaped by both legislative and executive authorities. In Kentucky: 4. Interest Groups at State and National Levels State-Level Advocacy:The Kentucky Nurses Association (KNA) is actively involved in legislative processes, promoting APN autonomy and safe working conditions. The group provides testimony at hearings, lobbies lawmakers, and supports reforms that strengthen nursing practice authority. National-Level Advocacy:The American Association of Nurse Practitioners (AANP) plays a leading role at the national level. The AANP is deeply involved in lobbying Congress, educating the public about the NP role, and building coalitions with other health organizations to push for full practice authority (FPA) across all states (Kopanos, 2020). Their efforts have been instrumental in several states adopting independent practice laws. 5. Methods of Influencing Policy Change APNs and their supporters apply a range of strategies to drive legislative and policy reform. These include lobbying, grassroots mobilization, coalition-building, and dissemination of research highlighting the effectiveness of NP-led care. Table: Methods of Influencing Policy Change Area of Influence Methods Used to Influence Change Competition Public awareness campaigns; dissemination of research on comparable patient outcomes between NPs and physicians. Legislative Branch Lobbying state legislators; providing expert testimony at hearings; drafting policy proposals for NP scope expansion. Executive Branch Partnering with governors and state health departments; collaborating with Medicaid programs and healthcare agencies. Interest Groups Mobilizing professional organizations (e.g., KNA, AANP); grassroots advocacy such as petitions and rallies; building coalitions with patient advocacy groups. These strategies empower APNs to challenge restrictive laws, counter resistance from competing providers, and ensure healthcare policies reflect their training and contributions. Conclusion Barriers to APN practice remain significant at both the state and federal levels, particularly regarding prescriptive authority, reimbursement inequities, and negative public perceptions. Competition from physicians and physician assistants adds further limitations, reinforcing systemic challenges despite workforce shortages in healthcare. However, through strong advocacy, policy engagement, and coalition-building efforts led by lawmakers, professional organizations, and grassroots initiatives, APNs are steadily moving toward achieving full practice authority nationwide. 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