response on discussion post CAREER GOALS: STRENGTHS AND CHALLENGES RELATED TO NURSING PRACTICE COMPETENCIES

As we begin this first semester of didactic and practicum there are many strengths and weaknesses that I possess that I look forward to enhancing.   As a Registered Nurse through years of experience and taking care of patients from birth to life I have developed my assessment skills to be able to recognize abnormalities and notify providers so they can order tests/procedures necessary to diagnose and I am to carry out the necessary portions of treatment plans within the scope of nursing practice.  As we transition from Registered Nurses to Advance Practice Registered Nurses (APRNs) it is imperative to recognize that it is now our responsibility to gather a comprehensive history, thorough physical assessment, order the correct tests, preform the correct procedures, and evaluate these treatments plans to determine their effectiveness.  We are also accountable for billing for services so that the patient does not get billed incorrectly for their visits. 

           One of the biggest aspects of transitioning into an APRN role that I am hesitant about is billing for the appropriate services. I understand that whether you work in an inpatient or outpatient setting there are usually billing coordinators that examine patient charts to ensure that the patient is not getting over or under billed for services they received.  Although I do have minimal experience in my current work setting, a high-risk labor and delivery unit with an obstetrical emergency department, with capturing charges and ensuring patients are being billed appropriately for services received it will still be quite different.  According to Eramo (2019), a portion of appropriate billing is not only selecting the correct E/M codes but also documenting the appropriate aspects of care given including patient history, physical exam, and medical decision making along with time spent educating the patient and coordinating care.    A strength that I am looking forward to enhancing is physical assessment. Lopes-Júnior (2021) discusses how APRNs, through didactic, research, and clinical experience, are proficient at in depth assessment techniques to detect medical conditions.  It is also discussed how APRNs possess the autonomy to make clinical decisions, diagnose these conditions, implement/evaluate treatment plans and coordinate resources for patients (Lopes-Júnior, 2019).  With all of the forementioned aspects of patient care APRNs also have to understand and be mindful of what is within their scope of practice.  In the state of North Carolina where I reside, APRNs are required to work with a supervising physician who are required to review certain aspects of APRNs work including prescribing certain medications, ordering tests, and treatment plans (North Carolina Board of Nursing, n.d.).  Mark & Patel (2019) discuss the pros and cons of APRNs being able to practice within their full scope of practice and the benefits to patient care including increased autonomy along with increased access to care especially within underserved populations. Not being able to practice to fullest scope and learning to understand what APRNs within the state of N.C. can do is a weakness that I am looking forward to strengthening through didactic education and my practicum experience.     

     Although a lot of the more in-depth assessments, procedures, testing and billing procedures will be new to me I am confident in my resilience and ability to learn new aspects of patient care.  Primary care is an important part of health maintenance, disease prevention, and management of chronic health conditions.  I am looking forward to growing as a healthcare professional by strengthening my assessment skills and comprehensive history gathering skills along with learning how to order appropriate diagnostic tests, complete procedures, and ensure that my patients are receiving correct billing along with efficient care.