MSN560-Transitions in Practice

MSN560-Transitions in Practice

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Access, Cost, and Quality for APN’s

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MSN560-Transitions in Practice: The Role of the Advanced Practical Nurse





Access, Cost, and Quality for APN’s

                        Standards are care are well documented throughout the scope of practice among Advanced Practical Nurse (APRN’s) and cost-effective methods are documented to effectively provide optimal health care and reduce unnecessary health care costs.  “Nurse practitioners (NPs) are a proven response to the evolving trend towards wellness and preventive health care driven by consumer demand.  A solid body of evidence demonstrates that NPs have consistently proven to be cost-effective providers of high-quality care for almost 50 years. Examples of the NP cost-effectiveness research are described below” (AANP, 2013).  As health care provider we must always be conscious of cost-effective measures.  I have experienced several times where the physicians are not always aware of the cost of medication or procedure ordered and at times the patient or families are responsible for covering the costs even if their insurance covers a certain portion.

Quality Environments

The nursing work environment has been considered an important factor influencing the quality of nursing care.  Research by Cho and Han (2018) supports… Nurses working in a better practice environment are empowered to practice professionally, become deeply engaged in their job, have a lower level of burnout and intention to leave their current job positions, and have a higher level of job satisfaction and self-reported nursing quality. When considering that nurses are role models for patients which tend to adopt healthy lifestyles and health promoting behaviors of nurse can impact their own health and improve health care outcomes.  High turnover rates of staff have been recognized as a problem in many services industries including health care setting.  According to In U.S. hospitals, nursing turnover has been reported to range from 15 percent to 36 percent per year.  These turnover rates are much higher than those for other health care professionals, which are estimated to average 2.3 percent per year” (Stone et al., (2008).  Nursing leaders and management need to be aware of the job satisfaction of all employees on an ongoing basis, specially as low satisfaction can be lined to burnout, intention to leave, and every higher rates of job turnover or loss to the nursing profession.  It is well recognized and documented in the healthcare professional of burnout incidents and not attending to this situation creates and environment with probable below par health care provision.

Quality Initiatives

            The national effort that builds upon the existing work for the long term and post-acute profession by setting specific measurable targeted to further improve quality health care in skilled nursing center and assistive living best describes the efforts implemented to improve customer satisfaction, staff stability, prevent hospital readmissions and reduce the need for sedative or antipsychotics.  Working in a disciplinary team is an effective initiates to provide quality health care and setting priorities such as reducing hard in the delivery of care, ensuring that the family is engaged as partners in their care, promoting effective communication and coordination of care and making quality care more affordable for individuals and their families by developing and spreading new health care delivery methods.  Further quality initiates may include quality organization such as Institute for Healthcare Improvement, Centers for Medicare and Medicaid Services, The Joint Commission and National Quality Forum. Also, advocacy, education on quality, research and measurement.

Quality Improvements

Hospital have traditionally relied on leaders such as physicians to drive improvements in effective patient care.  Unfortunately, leaders such as physicians may not possess the clinical knowledge to advanced quality improvement and not have the influence to affect the change of a patients mind set of expected outcome at bedside compared to a APRN’s who’s experience was direct care with patients and communication with families.  Expectations for improvement in effective care performance may be linked to personnel performance evaluations, or incentives may be provided in the form of employee gain-sharing, through which employees are financially compensated when performance goals are met. Changing the goal from that of complying with a standard to providing “perfect care” for all patients has also been successful” (Cho & Kan, 2018).  Quality improvement methods are also effective in providing optimal healthcare to establish and improve the delivery of care.  The team’s first task is to establish an aim or goal for the improvement work. By setting this goal, you will be better able to clearly communicate your objectives to all the sectors in your organization that you might need to support or help implement the intervention.  Setting up weekly meetings and introducing literature or media to the meeting which helps illustrate an understanding of the expected goals and improvements.  Also, discussing the plan of care for each patient and expectation also expectations and tendencies for the overall progression of each individualized patients.

Outcome Measures

“Nurses have a social responsibility to evaluate the effect of nursing practice on patient outcomes in the areas of health promotion; injury and illness prevention; and alleviation of suffering. Quality assessment initiatives are hindered by the paucity of available data related to nursing processes and patient outcomes across these three domains of practice. Direct care nurses are integral to self regulation for the discipline as they are the best source of information about nursing practice and patient outcomes. Evidence supports the assumption that nurses do contribute to prevention of adverse events but there is insufficient evidence to explain how nurses contribute to these and/or other patient outcomes” (Jones, 2016).  “Studies have repeatedly found that the practice environment in which nurses work is a determining factor in nurse and patient outcomes. These studies find that the distinguishing attributes of Magnet hospitals are present in where nurses have high levels of job satisfaction and have low levels of burnout where the practice environment is poor, nurses working in hospitals with good work environments have the benefit of adequate staffing and patients in these hospitals have better outcomes” (Cheung et al. 2008).


There are many measures that can be implemented in the working environment that can provide quality health care while being conscious of health care costs.  Professional such as physician and APRN’s are the first to be aware of these initiate topics once providing care to a patient.  Being aware of implementing the quality initiates the overall quality measures will automatically revolved itself into the standards of quality and improvements required to provide and problem solve the many issues in the nursing working environment.



American Association of Nurse Practitioners (AANP). (2013). Nurse Practitioner Cost Effectiveness. Retrieved from to an external site.

Cho, H. & Han, K (2018). Associations Among Nursing Work Environment and Health-Promoting Behaviors of Nurses and Nursing Performance Quality: A Multilevel Modeling Approach. The Journal of Nursing Scholarship, 50(4), 403-410, DOI:10.1111/jnu.12390

Jones, T. (2016). Outcome Measurement in Nursing: Imperatives, Ideals, History, and Challenges. The Online Journal of Issues in Nursing. 21(2). Retrieved from

Stone, P.W., Hughes, R., Dailey, M. (2008). Creating a Safe and High-Quality Health Care Environment. Patient Safety and Quality. An Evidenced-Based Handbook for Nurse. Retrieved from

Cheung, R., Aiken, L.H., Clarke, S.P., Sloane, D.M. (2008). Nursing care and patient outcomes: international evidence. US National Library of Medicine National Institute of Health. Retrieved from

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