Discuss Nurse Practice Acts.Respond to the discussion #1 below using the following approach:Ask a probing question, substantiated with additional background information, evidence, or research.Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional research.

Hawai’i Nurse Practice Act

According to the Hawai’i Nurse Practice Act, the responsibilities of RNs include but are not limited to:

1. Providing comprehensive nursing assessments

2. Collaborating with interdisciplinary teams to provide patient-centered care

3. Developing a patient plan of care which includes nursing diagnoses, goals, interventions and recommendation

4. Implementing patient-centered care as directed by health care providers

5. Evaluating intervention responsiveness and plan of care effectiveness

6. Developing and implementing patient appropriate teaching plans

7. Delegating appropriately to implement plan of care

8. Providing and maintaining either direct or indirect, safe nursing care

9. Advocating for patient best interests

10. Managing, evaluating or supervising nursing care as appropriate

11. Teaching nursing theory and practice

12. Participating in the developing of health care policies and procedures

13. Clearly identifying themselves as an RN when providing patient care (National Council of State Boards of Nursing, 2012).

Responsibilities of APRN’s in the State of Hawai’i include but are not limited to the above responsibilities of an RN in addition to:

1. Performing advanced patient assessment

2. Ordering diagnostic procedures and interpreting them appropriately

3. Determining primary and differential patient diagnoses

4. Medication ordering, prescribing, dispensing and administering

5. Delegation of authority to appropriate personnel

6. Providing referrals to other disciplines as appropriate

7. Clearly identifying themselves as an APRN when providing patient care

8. Providing education and training (National Council of State Boards of Nursing, 2012).

APRN Responsibilities

According to the APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee (2008), APRN’s should be prepared to “assume responsibility and accountability for health promotion and/or maintenance as well as the assessment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologicinterventions” (p. 11).

In my practicum experience, the Nurse Practitioner I am working with assumes all of the above responsibilities. After each treatment, patients see her for assessment, diagnosis and management and problems. If a symptom exists which requires pharmacological interventions, she will write a prescription. If a non-pharmacological approach or referral is required, the APRN will either make a recommendation or refer to another provider. The Nurse Practitioner is very clear when she discusses symptoms related to radiation and symptoms that may be related to other treatment such as chemotherapy or dialysis. She will make recommendations for radiation-related symptoms and refer to the appropriate providers for other symptoms.

Skill Differences

The RN in my clinical radiation oncology practicum, greets patients, takes their vitals, assesses the patients for symptoms and coordinates follow-ups with other providers. The APRN then sees the patient for a more thorough assessment and makes recommendations for symptom management. The APRN collaborates with the radiation oncologist, radiology therapists, and RN to come up with a proposed plan of care for the patient. To summarize, the three major differences in my clinical setting are:

1. RN’s do initial assessment and APRN’s do advanced assessment

2. RN’s assess to determine symptoms; APRN’s prescribe if necessary based on those symptoms

3. RN’s discuss symptoms but do not diagnose; APRN’s diagnose symptoms and come up with differential diagnoses if applicable