Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post

——You don't have to post this in APA format necessarily, it's just giving feedback to the student .

Theresa Dinard

     Here, in the state of Florida, one of the main barriers was the clause that nurse practitioners must work on the sponsorship of a physician or within close proximity of a physician. That has been relaxed by legislation that says only nurse can work in most sectors of healthcare, without oversight of a physician, this allows APRNs autonomy in a medspa, primary care clinics and/or even telemedicine when working independently and as an entrepreneur.

    Since June of 2020, Florida operates under “Full practice”policy, which allows nurses that have proof of at least 3000 clinical hours of experience and graduate level pharmacology and differential diagnosis courses, the privilege to operate autonomously in primary care, med spas and even telemedicine under this regulation. This is considered to be the gold standard as APRNs are now able to register as an Autonomous Advanced Practice Registered Nurse and practice to the full extent of their role (Fla. BON, 2023) 

     With just just three short years ago, APRNs had to work under the supervision or sponsorship of a physician that was either either working in the practice or had a vested interest in a clinic where the APRN is practicing. Some states may also hold a prescriptive regulation or the APRN whereas they can only order certain schedules and medications. In some instances there may be pushback from physicians who do not co-sign the concept of nurse practitioners and or having the privileges that they are allowed believing that they are not trained like physicians. In some communities nurse practitioners may not be a choice of patients to be examined by and may just prefer their doctor instead.

     For midwives in Florida, some of the barriers include the need to have a supervisory agreement with a Florida licensed physician for post graduate supervisory hours A lack of recognition as primary care providers on Medicaid and Medicare and private insurance company provider panels and other restrictions. (Hastings, et al, 2018)

     CRNAs have barriers such a lack of fair reimbursement by third-party, payers,  stating that they are not trained on the same skill level as physicians and failure of some of the other surgical groups or colleagues to recognize CRNAs as board certified to administer anesthesia. (Toney, 2023)

     Rep. Cary Pigman (R-Sebring) and Sen. Jeff Brandes (R-St. Petersburg) joined members of the interest groups for APRNs the Florida Association of Nurse Anesthetists (https://www.fana.org/)and the Florida Nurse Practitioner Network (https://fnpn.enpnetwork.com/) in making new legislation that forwards, the causes nurse practitioners and pushes for more independence for them as well.

References 

Toney-Butler TJ, Martin RL. Florida Nurse Practice Act Laws and Rules. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 

Hastings-Tolsma M, Foster SW, Brucker MC, Nodine P, Burpo R, Camune B, Griggs J, Callahan TJ. Nature and scope of certified nurse-midwifery practice: A workforce study. J Clin Nurs. 2018 Nov;27(21-22):4000-4017. doi: 10.1111/jocn.14489. Epub 2018 Jun 20. PMID: 29679403; PMCID: PMC7992184.

Adeyanju Bello

11/10/23, 2:49 PM NEW

The nurse and the patient must be aware of the interactions between medications and nutrients. The nurse must be able to ensure that the correct dose is given and that no negative interactions occur when showing the drug or explaining how to take it. The patient must comprehend and follow instructions correctly.

Fentanyl is a drug that interacts with nutrition. Fentanyl is used to treat “breakthrough” pain by altering the brain's and nervous system's response to pain. Grapefruit and grapefruit juice should be avoided because they increase the amount of medicine in the body, which can lead to an overabundance of fentanyl.

Warfarin is a blood thinner that prevents blood clots from forming or developing in the blood or blood arteries. Warfarin interacts with foods when you eat a constant amount of vitamin K. Broccoli, spinach, and kale are green, leafy vegetables that can make the drug less effective.

Linezolid is another medication that interacts with nutrition. This drug treats infections (such as pneumonia) and prevents bacteria from growing. If the patient is taking linezolid, tyramine-containing meals should be avoided. Cheese, excessive chocolate, caffeine, yogurt, raisins, bananas, sour cream, and sausage are all examples. The interaction can cause blood pressure to rise dangerously.

The interactions should be explained during client education so that the patient understands the importance of following the medication directions. An important point to remember about fentanyl medication is that increasing the dosage can increase the risk of overdosing and severe side effects (respiratory failure). The takeaway for warfarin is that the vitamin K level must be monitored and consistent for the medication to work correctly—finally, the importance of avoiding tyramine-containing foods while on linezolid should be thoroughly explained.

The Centers for Medicare & Medicaid Services (CMS) formed its no-pay policy based on the growing work of National Quality Forum (NQF) of “never events.” Meaning, CMS will no longer pay for certain conditions that result from what might be termed poor practice or events that should never have occurred while a patient was under the care of a healthcare professional.

• Discuss specific examples of “never events” and their impact in your workplace.
• What issues are you considering for your clinical project and why?

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.