Independent Advanced Nursing Practice Rosemary Goodyear Ed.D, APRN-BC, FAANP Chair INP/APN Network

China 1983

Independent Advanced Practice Nursing What is advanced practice nursing? What is advanced practice nursing? What is an Advanced Practice Nurse (APN)? What is an Advanced Practice Nurse (APN)? What is independent practice (IP)? What is independent practice (IP)?

Independent Practice IS A NURSING BUSINESS IS A NURSING BUSINESS that works within the professional, legal, socioeconomic, cultural and personal environments that works within the professional, legal, socioeconomic, cultural and personal environments that addresses the patient/client’s health needs for efficient, safe and cost-effective care that addresses the patient/client’s health needs for efficient, safe and cost-effective care

Independent Practice IS A NURSING BUSINESS IS A NURSING BUSINESS that allows the nurse to demonstrate excellence in nursing care and provide job satisfaction that allows the nurse to demonstrate excellence in nursing care and provide job satisfaction that offers direct patient/client care, education, research, administrative and/or consultative services. that offers direct patient/client care, education, research, administrative and/or consultative services.

Independent Practice IS A NURSING BUSINESS IS A NURSING BUSINESS where the nurse is autonomous in decision making in the practice environment where the nurse is autonomous in decision making in the practice environment where the nurse is responsible and accountable for all outcomes in the practice environment where the nurse is responsible and accountable for all outcomes in the practice environment

Independent Practice IS A NURSING BUSINESS IS A NURSING BUSINESS where the nurse is an entrepreneur – a risk taker! where the nurse is an entrepreneur – a risk taker!

Why Pursue IP Now? BECAUSE-- BECAUSE-- Nursing knowledge is advancing professional practice Nursing knowledge is advancing professional practice The national health systems are changing their attitudes towards nursing The national health systems are changing their attitudes towards nursing Liberal global trade agreements Liberal global trade agreements

Why Now? BECAUSE-- Transformation of laws and scope of nursing practice Transformation of laws and scope of nursing practice Patient populations are without access to care Patient populations are without access to care Change in health needs of people are not being addressed Change in health needs of people are not being addressed

WHY NOW? BECAUSE-- Many of the conditions necessary for a successful transition into independent practice are present today! Many of the conditions necessary for a successful transition into independent practice are present today!

China 1983

Preparation for IP Reasons Reasons Research Research Readiness Readiness References References Resources Resources

Reasons for Initiating IP TO HAVE NURSES -- TO HAVE NURSES -- Improve the quality of health care- Improve the quality of health care- Become an integral part of the health care system- Become an integral part of the health care system- Demonstrate quality professional practice- Demonstrate quality professional practice-

Reasons cont. TO HAVE NURSES-- TO HAVE NURSES-- Demonstrate reduced health care cost Demonstrate reduced health care cost Implement a scope of practice that reflects current nursing knowledge Implement a scope of practice that reflects current nursing knowledge Demonstrate ethical practice and equality for nurses Demonstrate ethical practice and equality for nurses

Research before IP Research of Research of Health Care System Health Care System Regulations/laws that govern nursing Regulations/laws that govern nursing Literature of similar ventures Literature of similar ventures

Research cont. Health Care System : Health Care System : Public or Private or mixed Public or Private or mixed Are nurses currently working independently within the system? Are nurses currently working independently within the system? Does the system contract for nursing services verses employment? Does the system contract for nursing services verses employment?

Laws and Regulations for IP System of regulation System of regulation In place to register, monitor and protect nurses In place to register, monitor and protect nurses Is the power to regulate nurses within the profession or government? Is the power to regulate nurses within the profession or government? Who writes the scope of practice? Who writes the scope of practice? Are nurses registered to practice as generalist? Are nurses registered to practice as generalist?

Literature Review for IP Through the library and internet explore prior studies of APNs Through the library and internet explore prior studies of APNs Information needed to submit a proposal Information needed to submit a proposal Successes and barriers to independent practice Successes and barriers to independent practice

Readiness for IP Readiness Readiness Business plan Business plan Fiscal support Fiscal support Collaborative support Collaborative support Marketing and publicity Marketing and publicity Operations Operations

Readiness Business Plan Business Plan Mission and goals Mission and goals Philosophy of care Philosophy of care Services Services Target market Target market Competition Competition Business history Business history Benefits Marketing Plan Facility advantages Management team Financial projections Budget

Readiness Fiscal Support Fiscal Support Grants – usually philanthropic foundations; trust funds Grants – usually philanthropic foundations; trust funds Internal Internal Personal savings Personal savings Friends/colleagues Friends/colleagues External External Loans-debt or equity Loans-debt or equity Venture capital Venture capital

Readiness Collaborative Support Collaborative Support Nursing colleagues and peers Nursing colleagues and peers Physician colleagues and peers Physician colleagues and peers Professional colleagues in legal and business arena Professional colleagues in legal and business arena Personal support – family, friends Personal support – family, friends

Readiness – Marketing and Publicity Know your product Know your product Identify the market area Identify the market area Identify the competition Identify the competition Know the customer needs Know the customer needs Establish a marketing plan Establish a marketing plan Networking with colleagues Networking with colleagues Word of mouth Word of mouth In-kind service in the community In-kind service in the community Write for local paper Write for local paper Brochures Brochures Business cards Business cards

Readiness Operations Operations Location Location Materials and personnel necessary for operations Materials and personnel necessary for operations A management plan to include contracting, price of services, billing systems as well as meeting the regulations for the business operations A management plan to include contracting, price of services, billing systems as well as meeting the regulations for the business operations Personnel rights, responsibilities and benefits Personnel rights, responsibilities and benefits

China 1983

Reference Brown, S A and Grimes, D E (1995). A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing Research, 44(6), Brown, S A and Grimes, D E (1995). A meta-analysis of nurse practitioners and nurse midwives in primary care. Nursing Research, 44(6),

Reference Sanders, E. M. and Kingma, M. (2003). Handbook on Entrepreneurial Practice: Nurses Creating Opportunities as Entrepreneurs and Intrapreneurs 11 International Council of Nurses Sanders, E. M. and Kingma, M. (2003). Handbook on Entrepreneurial Practice: Nurses Creating Opportunities as Entrepreneurs and Intrapreneurs 11 International Council of Nurses

Resources for IP Resources Resources Personal entrepreneurial zeal Personal entrepreneurial zeal System of reimbursement System of reimbursement Physical setting Physical setting Support systems Support systems Patient population Patient population

A Resource - Professional Nurse Associations A comprehensive health system includes nurse entrepreneurial practice A comprehensive health system includes nurse entrepreneurial practice The adoption of a scope of practice, standards and competencies for the APN is fundamental to protect the nurse and public The adoption of a scope of practice, standards and competencies for the APN is fundamental to protect the nurse and public

A Resource - Professional Nurse Associations The legitimation of advanced nursing practice must be written into law/rules The legitimation of advanced nursing practice must be written into law/rules Inform the public about the new advanced role of nurses Inform the public about the new advanced role of nurses Support entrepreneurial nurses in policy manners such as equality of pay or reimbursement Support entrepreneurial nurses in policy manners such as equality of pay or reimbursement

A Resource - Professional Nurse Associations Educate the policy makers about APNs and the entrepreneurial projects Educate the policy makers about APNs and the entrepreneurial projects Encourage APNs into membership through supportive activities/programs Encourage APNs into membership through supportive activities/programs Support advanced nursing through periodic research of trends and needs of health care Support advanced nursing through periodic research of trends and needs of health care

Independent Practice Types of Independent Practice may include: Types of Independent Practice may include: Solo/Private Practice Solo/Private Practice Collaborative Practice Collaborative Practice Group Practice Group Practice

Independent Practice Solo or Private Practice Solo or Private Practice A single professional nurse and staff operate and manage an office/clinic serving the health needs of a patient population. A single professional nurse and staff operate and manage an office/clinic serving the health needs of a patient population.

Independent Practice Collaborative Practice Collaborative Practice One or more independent health professionals work together through contract or consultation to provide services for their patient populations. One or more independent health professionals work together through contract or consultation to provide services for their patient populations.

Independent Practice Group Practice Group Practice A coalition of health care professionals form a business to provide services to a population of patients. A coalition of health care professionals form a business to provide services to a population of patients.

China 1983

Independent Practice What qualities must an APN have to practice independently?

Independent Practice Qualities Entrepreneur – Self Assessment Entrepreneur – Self Assessment ‘one who organizes and manages a business undertaking, assuming risk for the sake of profit’… ‘one who organizes and manages a business undertaking, assuming risk for the sake of profit’… Decision-making and/or taking charge Decision-making and/or taking charge Self discipline and self direction Self discipline and self direction Stamina Stamina Able to communicate and negotiate Able to communicate and negotiate

Entrepreneurship cont. Do you enjoy competing in a business environment? Do you enjoy competing in a business environment? Can you admit when you are wrong? Can you admit when you are wrong? Are you a self starter who can work on your own? Are you a self starter who can work on your own? Do you trust people and do they trust you? Do you trust people and do they trust you? Do you know how to quickly solve problems? Do you know how to quickly solve problems?

Positive Entrepreneurial Qualities Like to be in control Like to be in control Are goal oriented Are goal oriented Able to manage by aims and goals Able to manage by aims and goals Able to analyze situations to minimize risk Able to analyze situations to minimize risk Creative thinkers Creative thinkers Can admit they are wrong Can admit they are wrong Believe in themselves Believe in themselves

Negative Entrepreneurial Qualities Lack management experience Lack management experience Lack understanding of financial planning Lack understanding of financial planning Poor location of facilities Poor location of facilities Poor fiscal management Poor fiscal management Underestimates the personal time Underestimates the personal time Over expands too quickly Over expands too quickly Over spends budget Over spends budget

Conclusion The future is bright to move nursing forward Where is nursing in your nation? Where is nursing in your nation? Do you want to move nursing into a partner role in the delivery of care? Do you want to move nursing into a partner role in the delivery of care? Do you have the qualities of an entrepreneur? Do you have the qualities of an entrepreneur? Nurses can be more independent and in control of their practice and patient care when there is regulatory and professional support.

Conclusion Answers to these questions can lead nursing and health care of the people forward. What is your answer? Thank you Rosemary Goodyear

Hong Kong Harbor 1983