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

Independent Independent Advanced Nursing Advanced Nursing

PracticePracticeRosemary Goodyear Ed.D, Rosemary Goodyear Ed.D,

APRN-BC, FAANPAPRN-BC, FAANP

Chair INP/APN Network Chair INP/APN Network

China 1983China 1983

Independent Advanced Practice Independent Advanced Practice NursingNursing

What is advanced practice What is advanced practice nursing?nursing?

What is an Advanced Practice What is an Advanced Practice Nurse (APN)?Nurse (APN)?

What is independent practice What is independent practice (IP)?(IP)?

Independent PracticeIndependent Practice

IS A NURSING BUSINESSIS A NURSING BUSINESS

that works within the professional, that works within the professional, legal, socioeconomic, cultural and legal, socioeconomic, cultural and personal environmentspersonal environments

that addresses the patient/client’s that addresses the patient/client’s health needs for efficient, safe and health needs for efficient, safe and cost-effective carecost-effective care



that allows the nurse to demonstrate that allows the nurse to demonstrate excellence in nursing care and excellence in nursing care and provide job satisfactionprovide job satisfaction

that offers direct patient/client care, that offers direct patient/client care, education, research, administrative education, research, administrative and/or consultative services.and/or consultative services.



where the nurse is autonomous in where the nurse is autonomous in decision making in the practice decision making in the practice environmentenvironment

where the nurse is responsible and where the nurse is responsible and accountable for all outcomes in the accountable for all outcomes in the practice environmentpractice environment



where the nurse is an where the nurse is an entrepreneur – a risk taker!entrepreneur – a risk taker!

Why Pursue IP Now?Why Pursue IP Now?

BECAUSE--BECAUSE--Nursing knowledge is advancing Nursing knowledge is advancing

professional practiceprofessional practiceThe national health systems are The national health systems are

changing their attitudes towards changing their attitudes towards nursingnursing

Liberal global trade agreementsLiberal global trade agreements

Why Now?Why Now?

BECAUSE--BECAUSE--Transformation of laws and scope of Transformation of laws and scope of

nursing practicenursing practice

Patient populations are without Patient populations are without access to careaccess to care

Change in health needs of people are Change in health needs of people are not being addressednot being addressed

WHY NOW?WHY NOW?

BECAUSE--BECAUSE--Many of the conditions Many of the conditions

necessary for a successful necessary for a successful transition into independent transition into independent practice are present today!practice are present today!


Preparation for IPPreparation for IP

ReasonsReasonsResearch Research ReadinessReadinessReferencesReferencesResourcesResources

Reasons for Initiating IPReasons 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 Become an integral part of the health care system-care system-

Demonstrate quality professional Demonstrate quality professional practice-practice-

ReasonsReasons cont.cont.

TO HAVE NURSES--TO HAVE NURSES--Demonstrate reduced health care costDemonstrate reduced health care cost

Implement a scope of practice that Implement a scope of practice that reflects current nursing knowledgereflects current nursing knowledge

Demonstrate ethical practice and Demonstrate ethical practice and equality for nursesequality for nurses

Research before IPResearch before IP

Research ofResearch ofHealth Care SystemHealth Care System

Regulations/laws that govern Regulations/laws that govern nursingnursing

Literature of similar ventures Literature of similar ventures

ResearchResearch cont.cont.

Health Care SystemHealth Care System::Public or Private or mixedPublic or Private or mixedAre nurses currently working Are nurses currently working

independently within the independently within the system? system?

Does the system contract for Does the system contract for nursing services verses nursing services verses employment?employment?

Laws and Regulations for IPLaws and Regulations for IPSystem of regulationSystem of regulation

In place to register, monitor and protect In place to register, monitor and protect nursesnurses

Is the power to regulate nurses Is the power to regulate nurses within the profession or government?within the profession or government?

Who writes the scope of practice?Who writes the scope of practice?Are nurses registered to practice as Are nurses registered to practice as

generalist?generalist?

Literature Review for IPLiterature Review for IP

Through the library and internet Through the library and internet explore prior studies of APNsexplore prior studies of APNs

Information needed to submit a Information needed to submit a proposalproposal

Successes and barriers to Successes and barriers to independent practiceindependent practice

Readiness for IPReadiness for IP

ReadinessReadinessBusiness planBusiness planFiscal supportFiscal supportCollaborative supportCollaborative supportMarketing and publicityMarketing and publicityOperationsOperations

ReadinessReadiness

Business PlanBusiness PlanMission and goalsMission and goalsPhilosophy of Philosophy of

carecareServices Services Target marketTarget marketCompetitionCompetitionBusiness historyBusiness history

BenefitsBenefitsMarketing PlanMarketing PlanFacility Facility

advantagesadvantagesManagement teamManagement teamFinancial Financial

projectionsprojectionsBudgetBudget

ReadinessReadinessFiscal SupportFiscal Support

Grants – usually philanthropic Grants – usually philanthropic foundations; trust fundsfoundations; trust funds

InternalInternal Personal savingsPersonal savingsFriends/colleaguesFriends/colleagues

ExternalExternalLoans-debt or equityLoans-debt or equityVenture capitalVenture capital

ReadinessReadiness

Collaborative SupportCollaborative Support

Nursing colleagues and peersNursing colleagues and peersPhysician colleagues and peersPhysician colleagues and peersProfessional colleagues in legal Professional colleagues in legal

and business arenaand business arenaPersonal support – family, Personal support – family,

friendsfriends

Readiness – Readiness – Marketing and PublicityMarketing and Publicity

Know your productKnow your product Identify the market Identify the market

area area Identify the Identify the

competitioncompetition Know the customer Know the customer

needsneeds Establish a Establish a

marketing planmarketing plan

Networking with Networking with colleaguescolleagues

Word of mouthWord of mouth In-kind service in In-kind service in

the communitythe community Write for local paperWrite for local paper BrochuresBrochures Business cardsBusiness cards

ReadinessReadinessOperationsOperations

LocationLocationMaterials and personnel necessary for Materials and personnel necessary for

operationsoperationsA management plan to include contracting, A management plan to include contracting,

price of services, billing systems as well price of services, billing systems as well as meeting the regulations for the as meeting the regulations for the business operationsbusiness operations

Personnel rights, responsibilities and Personnel rights, responsibilities and benefitsbenefits


ReferenceReference

Brown, S A and Grimes, D E (1995). Brown, S A and Grimes, D E (1995). A meta-analysis of nurse A meta-analysis of nurse practitioners and nurse midwives practitioners and nurse midwives in primary care. in primary care. Nursing ResearchNursing Research, , 44(6), 332-338.44(6), 332-338.

ReferenceReference

Sanders, E. M. and Kingma, M. (2003). Sanders, E. M. and Kingma, M. (2003). Handbook on Entrepreneurial Practice: Handbook on Entrepreneurial Practice: Nurses Creating Opportunities as Nurses Creating Opportunities as Entrepreneurs and IntrapreneursEntrepreneurs and Intrapreneurs 1111 International Council of NursesInternational Council of Nurses

Resources for IPResources for IP

ResourcesResourcesPersonal entrepreneurial zealPersonal entrepreneurial zealSystem of reimbursementSystem of reimbursementPhysical settingPhysical settingSupport systemsSupport systemsPatient populationPatient population

A Resource - Professional Nurse A Resource - Professional Nurse AssociationsAssociations

A comprehensive health system A comprehensive health system includes nurse entrepreneurial practiceincludes nurse entrepreneurial practice

The adoption of a scope of practice, The adoption of a scope of practice, standards and competencies for the standards and competencies for the APN is fundamental to protect the APN is fundamental to protect the nurse and publicnurse and public


The legitimation of advanced nursing The legitimation of advanced nursing practice must be written into law/rulespractice must be written into law/rules

Inform the public about the new Inform the public about the new advanced role of nursesadvanced role of nurses

Support entrepreneurial nurses in Support entrepreneurial nurses in policy manners such as equality of pay policy manners such as equality of pay or reimbursementor reimbursement


Educate the policy makers about APNs Educate the policy makers about APNs and the entrepreneurial projectsand the entrepreneurial projects

Encourage APNs into membership Encourage APNs into membership through supportive activities/programsthrough supportive activities/programs

Support advanced nursing through Support advanced nursing through periodic research of trends and needs periodic research of trends and needs of health careof health care


Types of Independent Practice may Types of Independent Practice may include:include:

Solo/Private PracticeSolo/Private PracticeCollaborative PracticeCollaborative PracticeGroup PracticeGroup Practice


Solo or Private PracticeSolo or Private PracticeA single professional nurse A single professional nurse

and staff operate and manage and staff operate and manage an office/clinic serving the an office/clinic serving the health needs of a patient health needs of a patient population.population.


Collaborative PracticeCollaborative PracticeOne or more independent One or more independent

health professionals work health professionals work together through contract or together through contract or consultation to provide consultation to provide services for their patient services for their patient populations.populations.


Group PracticeGroup PracticeA coalition of health care A coalition of health care

professionals form a professionals form a business to provide services business to provide services to a population of patients.to a population of patients.



What qualitiesWhat qualities must an APN must an APN have to practice have to practice independentlyindependently??

Independent Practice QualitiesIndependent Practice Qualities

EntrepreneurEntrepreneur – Self Assessment – Self Assessment ‘‘one who organizes and manages a one who organizes and manages a

business undertaking, assuming risk for business undertaking, assuming risk for the sake of profit’…the sake of profit’…

Decision-making and/or taking chargeDecision-making and/or taking chargeSelf discipline and self directionSelf discipline and self directionStaminaStaminaAble to communicate and negotiateAble to communicate and negotiate

Entrepreneurship Entrepreneurship cont.cont.

Do you enjoy competing in a Do you enjoy competing in a business environment?business environment?

Can you admit when you are wrong?Can you admit when you are wrong?Are you a self starter who can work Are you a self starter who can work

on your own?on your own?Do you trust people and do they trust Do you trust people and do they trust

you?you?Do you know how to quickly solve Do you know how to quickly solve

problems?problems?

Positive Positive EntrepreneurialEntrepreneurial QualitiesQualities

Like to be in control Like to be in control Are goal orientedAre goal orientedAble to manage by aims and goalsAble to manage by aims and goalsAble to analyze situations to Able to analyze situations to

minimize riskminimize riskCreative thinkersCreative thinkersCan admit they are wrongCan admit they are wrongBelieve in themselvesBelieve in themselves

Negative Negative EntrepreneurialEntrepreneurial QualitiesQualities

Lack management experienceLack management experienceLack understanding of financial Lack understanding of financial

planningplanningPoor location of facilitiesPoor location of facilitiesPoor fiscal managementPoor fiscal managementUnderestimates the personal timeUnderestimates the personal timeOver expands too quicklyOver expands too quicklyOver spends budgetOver spends budget

ConclusionConclusion 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 Do you want to move nursing into a partner role in

the delivery of care?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.

ConclusionConclusion

Answers to these questions can lead Answers to these questions can lead nursing and health care of the people nursing and health care of the people

forward. What is your answer?forward. What is your answer?

Thank youThank youRosemary GoodyearRosemary Goodyear

[email protected]

Hong Kong Harbor 1983Hong Kong Harbor 1983

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

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