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FoundationsModulesWeek 6: Systems-Structure and Function
November 2017
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CHAMBERLAIN COLLEGE OF NURSING -NR 500 WEEK6
ASSIGNMENT
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This is a graded discussion: 50 points possible
due Dec 3
Week 6: Systems-Structure and Function
12 12 unread replies. 69 69 replies.
Many of you have experience in complex adaptive systems whether you realize it or not.
Thinking about your future practice specialty area, identify a situation in which an issue or
concern common to your future specialty would impact that system. (Note: This can be the
same practice issue identified in Week 5.) In your initial response, please identify your specialty
track, as well as the issue or concern. Discuss how this issue or concern will impact the system
at the micro, meso, and macro levels. How will you address this issue or concern at each of
those levels? What is the expected impact on each of these system levels using your solution(s)?
Remember you can use an information technology-based solution to address the issue or
concern.
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Reply Reply to Main Discussion
Collapse SubdiscussionShayna Richards
Shayna Richards
Nov 26, 2017 Nov 26 at 6:22pm
Manage Discussion Entry
My specialty track is Family Nurse Practitioner. A concern that impacts the system is the
increasing number of patients who are in need of primary care services as the population
continues to age and more Americans become eligible for healthcare. Primary health services
are important as health outcomes are improved and healthcare costs decreased when primary
care services are consistently utilized (Smolowitz et al., 2015). At the micro level, this has an
impact on each practitioner as their daily volume of patients may increase, therefore decreasing
the amount of time they have to spend with each patient. This affects the patient-provider
relationship and chance for patient education on their current and general healthcare needs. A
solution for this level would be to incorporate more RN’s into the primary care practice.
According to Smolowitz et al. (2015) only 10% of RN’s are utilized in the primary care setting.
RN’s can work on a team with the Nurse Practitioner and act as a case manager/educator
helping to keep track of necessary follow-up appointments, consultation reports, and educating
patients about general healthcare needs after the patient has seen the NP. This ensures the NP
has sufficient time to assess, diagnose, and devise a treatment plan, while the patient is still
receiving education by a qualified member of their healthcare team. At the meso level, the
primary care practice needs to figure out how to manage the increased volume of patients
looking for appointments so that wait times for getting an appointment are not too great. A
potential solution for this would be to have extended hours, for example appointment times
available from 7am to 7pm and having extra staff available to work the early hours and later
hours. This allows more appointment slots available to patients so wait times are reduced and
the later hours will be helpful for working family members who may need to bring their elderly
parents/grandparents for visits. At the macro level, there are more community members
needing primary health care who may be having difficulty being seen in a timely manner. A
solution to this would be to provide access to healthcare in the community via a mobile health
clinic staffed with Family Nurse Practitioners. Mobile health clinics offer urgent care,
preventative screenings, and management of chronic diseases right in the heart of communities
increasing timely access to healthcare while reducing healthcare costs (Yu, Hill, Ricks, Bennet, &
Oriol, 2017).
References
Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E., Ulrich, S., Hayes, C., & Wood, L. (2015). Role
of the registered nurse in primary health care: Meeting health care needs in the 21st century.
Nursing Outlook, 63(2), 130-136. doi: 10.1016/j.outlook.2014.08.004
,Yu, S. W. Y., Hill, C., Ricks, M. L., Bennet, J., & Oriol, N. E. (2017). The scope and impact of mobile
health clinics in the united states: A literature review. International Journal for Equity in Health
16, 1-12. doi: 10.1186/s12939-017-0671-2
Reply Reply to Comment
Collapse SubdiscussionRobin Kirschner
Robin Kirschner
Nov 27, 2017 Nov 27 at 12:12pm
Manage Discussion Entry
Shayna, are you identifying "costs" as a common concern for this discussion? I am wondering
how assigning other RNs to tasks that then free up the NP would actually reduce cost? Adding
personnel at this level will increase the cost to the practice. However, if you hire a medical
assistant, you may decrease that added costs. But, the way many practices work now is that the
NP completes all the processes on a tablet that inputs labs to the lab provider, sends consultant
with patient data and aligns the lines selected on the tablet to the ICD-10 codes for charges;
additionally, prescriptions are sent directly to the pharmacy or to the front desk printer. Think
about the salary including the malpractice insurance that you will need as a NP; now think
about how many patients per day you must see to break even and then how many for the
practice to make a profit....Once you complete a cost analysis you would be able to determine if
you can afford RNs or even medical assistants. Any thoughts? Dr.K
Reply Reply to Comment
Collapse SubdiscussionShayna Richards
Shayna Richards
Nov 29, 2017 Nov 29 at 7:36pm
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Dr. K,
My concern is there will be an influx of patients that need to be seen in a timely fashion
and how this can be accomplished without compromising patient-centered care or
opportunities for education. My solution was focused on how we can see more patients and
still have positive patient outcomes. According to Bauer and Bodenheimer (2017), 75% of
primary care visits address chronic illness. With a larger patient load, increase in chronic
conditions to manage, and the task of measuring and improving patient outcomes, it becomes
very difficult to provide excellent care (Bauer & Bodenheimer, 2017) by one practitioner alone.
Utilizing RN’s in a team-based delivery system to manage chronic disease is necessary and a
focus of 21st century healthcare where primary care practices are being held responsible for
“measuring performance of clinical quality, patient experience, and practice operations” (Bauer
& Bodenheimer, 2017, p.626). However, Bauer & Bodenheimer (2017) did discuss barriers to
RN’s in primary care are the cost of the RN salary and lack of reimbursement for RN services.
, One doctor describes his experience with utilizing LPN’s to perform ancillary tasks so that he
can focus on the patient and decisions that need to be made rather than managing the chart,
tests, and referrals. Anderson (2013), states he had a 15% increase in patient visits per half day
and increase in productivity and revenue since utilizing LPN’s. He also reports positive patient
feedback, such as, satisfaction with the doctor being able to focus his attention on them, ability
to get more things done in one visit, and increased efficiency which allowed more time available
for same day appointments.
These are two examples of how utilizing a team-based approach with a nurse can be of benefit
to a primary care practice that is facing a larger and more complex patient load. I acknowledge
the added salary that comes with an RN. A medical assistant salary is about half of that of an
RN and so this is a viable option assuming the use of a medical assistant can improve patient
outcomes.
References
Anderson, R. J. (2013). Optimizing the role of nursing staff to enhance physician productivity:
One physician’s journey. Family Practice Management, 20(4), 18-22.
Bauer, L. & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary care delivery
of the future. Nursing Outlook, 65(5), 624-632. doi: 10.1016/j.outlook.2017.03.011
Reply Reply to Comment
Collapse SubdiscussionRobin Kirschner
Robin Kirschner
Nov 30, 2017 Nov 30 at 1:16pm
Manage Discussion Entry
Shayna, thank you for the additional comments; I do not disagree with the idea that more help
could provide better care...my concern is that someone needs to pay for it. We find that these
great ideas are rarely sustainable over time--due to the finances. So, my thoughts were to look
at the whole picture to ensure that as an advanced practice nurse you will be able to
recommend viable solutions, even if the solution may not be your "first" choice. Does that
make sense? Dr.K
Reply Reply to Comment
Collapse SubdiscussionShayna Richards
Shayna Richards
Nov 30, 2017 Nov 30 at 3:04pm
Manage Discussion Entry
Dr. K,
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