Discussion: Clinical Challenges for the NP

Each state has laws that differ in regard to the role of the Nurse Practitioner. They also may significantly impact the NP's practice. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes may significantly impact your scope of practice as a Nurse Practitioner. Remaining current with the laws in your state is essential.

For example, the recent change at the federal level changing hydrocodone-containing drugs from a Schedule III drug to a Schedule II drug has impacted NPs in some states. For states that allow for Nurse Practitioners to write Schedule III-V drugs, these NPs are now unable to write for hydrocodone- containing medications, which significantly impacts their ability to provide care for their patients.

The Pearson Report, which is updated almost annually, provides a national overview of each state's current legislature. As a future NP, you should become familiar with The Pearson Report and stay abreast of state and federal legislation.

For this Discussion, you will post an explanation that defines the legal implications for standard of care, the key components of a malpractice policy in regard to a case study. Additionally you will explain the collaborative agreements and rules for your state in regard to your NP practice and the case study you select.

To prepare:

Review the following case studies and select one to research in depth:

Case Study One: Dismissing the non-compliant patient.

Gwen, a 52 year old Caucasian LPN, recently joined your practice as a new patient. She currently has a BMI of 32, B/P of 142/88. Pulse is 89, Respiratory rate is 22, Pulse Ox is 96% on Room Air. She is taking Lisinopril 10mg po daily (when she can remember), Metformin 1000mg po BID and refuses lab work. Her physical exam is unremarkable and foot exam is normal. She refuses all vaccinations including Prevnar and Influenza. Gwen's last mammogram and pap smear were "years ago."

Case Study Two: Preventive care, why is it so important to document?

John, a 62 year old attorney, who has been a long-term patient of yours, comes to you to discuss his erectile dysfunction. You note that he has refused lab work for the past two years. He is a 30 pack/year smoker, and has not had a chest x-ray or ECG in three years. He does take his HCTZ 25 mg po daily. His BMI is 29 and all vital signs are within normal limits. He does agree to his Prevnar Vaccine today.

Case Study Three: Patient and professional relationships.

Jennifer, a 45 year old Caucasian returns to your clinic for a refill of her hydrocodone. She was diagnosed with Ovarian Cancer last year, followed by successful removal and treatment. All vital signs are stable and preventive care is up to date. She wants to discuss filing a lawsuit against the surgeon that initially turned her away and told her she had gastritis and needed to eat healthier.

Review the following articles found in this week's Learning Resources:

Miller, K. P. (2013). The National Practitioner Data Bank: An Annual Update. The Journal for Nurse Practitioners, (9)9, 576-580.

Stelmach, E. I. (2015). Dismissal of the Noncompliant Patient: Is this What We Have Come to? The Journal for Nurse Practitioners, 11(7), 723-725.

Review endocrine disorders and erectile dysfunction in your Primary Care Medicine text (Gorrol, Ah. & Mulley, A.G., 2009).

Consider strategies and treatment options that would be most effective for these patient scenarios to improve compliance and health outcomes.

Reflect on how to approach the non-compliant patient and the importance of a separate preventive care visit.

Post an explanation that addresses the following for the Case study you selected:

Identify and briefly summarize the case study you selected

Explain any legal implications for standard of care related to the case study you selected

Identify and explain the key components of a malpractice policy related to the case study you selected

Explain the collaborative agreements and knowledge the rules for your state in regards to NP practice the case study you selected