DNP 840 Topic 4 DQ 2 How does a doctorally prepared advanced practice nurse advocate for patients as well as the nursing profession?

How does a doctorally prepared advanced practice nurse advocate for patients as well as the nursing profession? Is there a symbiotic relationship between the two goals? How is advocacy advanced effectively?

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Select one bill from DQ 1 and discuss how it aligns with quality, safety, experience, or financial metrics in your organization. Analyze how the alignment of the bill affects quality of care delivery in your organization. As a doctorally prepared nurse, describe how you can influence change in the bills or laws shared in DQ1 to improve nursing practice.

The one bill that aligns with quality and safety is the public reporting legislation, a tactic used in hospitals and other healthcare facilities to provide data such as outcomes to clinicians, patients, and payers. This bill has also enabled inadequate registered nurse staffing to be linked to poor patient outcomes. Notably, five states in the United States publicly report stating ratios; five are mandated by legislation, and the other three are elective. State and federal governments use public reporting to measure outcomes of mortality rates, provider performance, and hospital patient satisfaction. This information is available on varied government websites and used to assist consumers in decision-making. For example, Healthgrades provides data allowing patients to compare individual physicians and nurse practitioners. For hospitals, federally regulated data provide patients with information about a patient’s experience in a hospital, including satisfaction metrics. The National Committee for Quality Assurance (NCOA) evaluates healthcare quality, primarily of health maintenance organizations (HMOs). The impact of quality information is to maintain standards or stimulate improvements in quality care and enables organizations to measure and avoid risks ( ANA.org 2018).

An aspect of hospital quality is sufficient nurse staffing since evidenced-based articles suggest that inadequate numbers of registered nurses lead to adverse patient outcomes, which include but are not limited to urinary tract infections, patient falls, hospital-acquired pneumonia, cardiac arrest, central line-associated bloodstream infections, unplanned extubating, mortality, and increased length of hospital stay. Public reporting data allows for transparency of staffing and practices which may lead to better quality care. (de Cordova 2019). In alignment with care delivery in my organization, the comparative information about public reporting information is an acceptable way of improving accountability and quality. This information is used to ask critical questions relating to the content of the care target audience, and we make specific recommendations for maximizing the effectiveness of public reporting ( Bowblis & Ghattas 2017).

As a DNP holder, I must join other nursing organizations to advocate for the nurse-to-patient ratio in state laws and write petitions to state policymakers who oppose strong labor union advocacy for a mandated balance of nurse staffing. The American Nurse Association (ANA) in 2018 supported data transparency by submitting a recommendation to the Center for Medicare and Medicaid Services (CMS) that nurse staffing and staff skill kix data be added to the Hospital Inpatient Quality Reporting (IQQR) Program (ANA.org 2018).

Bowblis, J. R., & Ghattas, A. (2017). The impact of minimum quality standard regulations on nursing home staffing, quality, and exit decisions. Review of Industrial Organization, 50, 43-68.

de Cordova, P. B., Rogowski, J., Riman, K. A., & McHugh, M. D. (2019). Effects of public reporting legislation of nurse staffing: A trend analysis. Policy, Politics, & Nursing Practice, 20(2), 92-104.

American Nurses Association. (2018c). Public reporting of staffing measures. Retrieved from https://www.nursing-world.org/practice-policy/health-policy/regulatory/reporting-nurse-staffing/

Texas legislature bill is left pending in the House of Representatives (UT Health Houston, 2019). Still, its initiatives are paramount for managing not just diabetes but other chronic illnesses such as heart disease, hypertension, and cancer. In addition, worldwide obesity rates are increasing steadily with their adverse effects on the musculoskeletal and cardiovascular systems, thereby decreasing life expectancy(Ewens et al., 2022). Unfortunately, the correlation between type II diabetes and obesity is tremendous, with the lower socioeconomic populations having higher rates; hence, as the site’s population serves patients within this demographics passing this bill could begin a trickle-down effect, eventually including none border regions.

Unfortunately, the bill is at a stalemate, and it remains in the House of Representatives. For the bill to move to the senate, the Texas Congress may need to understand its implication on medical cost, quality, and safety.  For example, medical organizations continue to see an increase in hospital admissions with a diagnosis of obesity as either primary or secondary; hence, it stands to reason that the bill’s initiative to fund resources for efforts that educate, screen, and treat obesity is imperative. In addition, data shows that obese patients require a more complex nursing care plan that considers their comorbidities and the increases in body mass indexes that may complicate recovery, thus adding to the existing strain on human and financial resources.

Although lawmakers focus on budget for the care provider, our altruistic nature shifts our concern to humanity by ensuring quality and safety in our care. Treatment quality and safety opportunities are often evidenced in acute care settings where equipment that accommodates obese patients is often lacking (Ewens et al., 2022). It stands to reason that inefficiencies in equipment will ultimately affect the quality of care that the nurse provides and the patient’s safety (Satti et al., 2021). Therefore, the bill’s initiative to add treatment and prevention improves patient quality and safety. Hence, for the Doctor of Nursing, proposing and supporting bills that focus on the big picture’s minor details is crucial (UT Health Houston, 2019). In addition, lawmakers are politicians whose educational backgrounds may need to be grounded in medicine to understand the financial and safety issues that obesity incurs fully; therefore, the DNP’s advanced education allows for a more insightful input into healthcare legislation.

References

Ewens, B., Kemp, V., Towell-Barnard, A., & Whitehead, L. (2022). The nursing care of people with class III obesity in an acute care setting: a scoping review. BMC Nursing, 21(1). https://doi.org/10.1186/s12912-021-00760-7

Satti, K. F., Tanski, S. E., Jiang, Y., & McClure, A. (2021). Improving Care for Childhood Obesity: A Quality Improvement Initiative. Pediatric Quality & Safety, 6(3), e412. https://doi.org/10.1097/pq9.0000000000000412

UT Health Houston. (2019). Index. Sph.uth.edu. https://sph.uth.edu/research/centers/dell/87th-texas-legislative-session

In the previous discussion, the Whistleblower Protection Act (WPA) was discussed. WPA protects a healthcare professional that raises a concern about wrongdoing within their healthcare organization. This wrongdoing can be based on abuse, gross mismanagement, waste of funds, or any other violation of the law. Hence, this sort of advocacy can positively influence quality, safety, and financial metrics.

Systemic failures in healthcare can lead to poor patient outcomes or even death and cost up to $20 billion dollars annually (Rodziewicz et al., 2022). Therefore, when healthcare workers identify these failures and “blow the whistle” it allows organizations to review their care delivery models and processes to ensure they align with current healthcare standards. This review fosters improvement in the quality of care that is delivered. As part of the organizations safety culture, they should encourage good reporting as safety will not be improved without valid reporting.

The WPA aligns with patient safety as it allows for transparency and creates an environment where clinicians feel they are supported in reporting safety concerns (Cypher, 2021). In turn, when failures are reported organizations can work towards mitigating risks and putting preventative measures in place. These measures can protect patients and the clinicians working in the organization. From a financial perspective, unsafe care can be very costly to the patient and the organization. Under the WPA clinicians can report financial fraud or abuse which, in the long run, can help decrease waste and improve cost savings for the organization.

The healthcare industry relies on legislations to influence care delivery and improve patient outcomes. Hence, the doctoral prepared nurse is in a great position to do this by engaging in health policy. One avenue is for the doctoral prepared nurse to lead professional nursing organizations. These organizations lobby on various levels of the government to influence safety and the well being of nurses. Another avenue is by participating in health policy development (Heinen et al, 2019). The doctoral nurse can use their leadership skills and knowledge of evidence-based research to ensure policies are in alignment with current standards of care. Overall, the doctoral prepared nurses are content experts and can use their knowledge and skill to shape health policy to improve quality of care.

References

Cypher, R. L. (2021). Whistleblowing in healthcare. Journal of Perinatal & Neonatal Nursing, 35(1), 12-15. https://doi.org/10.1097/jpn.0000000000000537

Heinen, M., 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

Rodziewicz, T., Houseman, B., & Hipskind, J. (2022, May 1). Medical error reduction and prevention – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK499956/

REPLY

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course.

Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed

• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource

Name:  Discussion Rubric

• Grid View
• List View

		Excellent 90–100	Good 80–89	Fair 70–79	Poor 0–69
Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.		40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources.	35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references.	31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references.	0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references.
Main Posting: Writing		6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style.	5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style.	4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Posting: Timely and full participation		9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date.	8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date.	7 (7%) – 7 (7%) Posts main Discussion by due date.	0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date.
First Response: Post to colleague’s main post that is reflective and justified with credible sources.		9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.	8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	7 (7%) – 7 (7%) Response is on topic and may have some depth.	0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
First Response: Writing		6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English.	4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
First Response: Timely and full participation		5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	3 (3%) – 3 (3%) Posts by due date.	0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Second Response: Post to colleague’s main post that is reflective and justified with credible sources.		9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.	8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	7 (7%) – 7 (7%) Response is on topic and may have some depth.	0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
Second Response: Writing		6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English.	4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
Second Response: Timely and full participation		5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	3 (3%) – 3 (3%) Posts by due date.	0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Total Points: 100

Name:  Discussion Rubric