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Nurses implemention

up your state’s health department; what trends do you see relating to health in the school
system? How do you feel nurses are implementing this within the school systems in your
own communities? How do they evaluate outcomes?


One of the issues that has of being of interest within the Maryland Health Department is
that there has been a growing trend in the number of nurses not who do not meet the set
standards of practicing as independent practitioners due to their education qualifications. In the
recent years, the needs of patients have been described as a spectrum that broadens by the day.
The education received by most of these nurses does not qualify or prepare them to serve as the
first point of contact when it comes to providing healthcare services to patients. Organized
medicine has always stated education as the main factor in discrediting nurses who seek to
provide independent care.
Corresponding studies have shown that most nurses are only able to provide quality
healthcare services in treatment and management in only limited cases. Despite studies done by
the Office of Technology Assessment (OTA) showing nurse practitioners and physicians have
equal quality of care in a range of comparable services; physicians have had a monopoly in the
providing of health care services since they act as independent practitioners. (Aktan, 2015, pg
This issue narrows down to the school system. This has seen national and international
reports being published as part of a comprehensive health care reform. For example, one that was

published by the Institute of Medicine describing strategies that can be used to enhance the role
of nurses in healthcare. It has been cited that in many settings such as the state of Maryland,
there are a number of outdated regulations and policies that may provide a barrier in the process
of ensuring that the role of nurse practitioners is strengthened. This has led to nurses, whether at
an individual or organizational level, to come up with a number of strategies that can be
implemented within the school system as a means of ensuring that the role of nurses as
independent practitioners is strengthened.
The American Association of Nurses has come up with recommendations of ensuring that
all advanced nurses practice nurses masters-level programs will be developed to a doctorate of
nursing practice by 2015 and this doctorate will encompass a restructuring of traditional health
professionals’ education to include an emphasis on issues such as evidence-based practice and
quality improvement. (In Cherry & In Jacob, 2014, pg 107) With this restructuring of school
systems, nurses are expected to gain a number of more enhanced skills that will enable them
practice as independent practitioners.
There has also been a technological upgrade in most school systems. Practices such as
surgery require an individual with advanced knowledge in technological equipment used in the
surgery practice. The technology can therefore familiarize them with surgical technology. (In
Cherry & In Jacob, 2014, pg 109) With this knowledge it is expected that nurses will now be
able to perform some roles on their own which they were not able to perform due to
technological barriers.
Over the years, physicians and specialists have always been entrusted to provide health
care services in situations regarded as being complicated at the expense of nurses. This has been

attributed to the fact that nurse practitioners lack vast knowledge in quality and safety issues. A
number of efforts have been put forward by the Quality and Safety Education for Nurses (QSEN)
to integrate quality and safety education in the school systems. One such effort has been through
the introduction of a national initiative, Institute for Healthcare Improvement (IHI), which
oversees the integration of both quality and safety education in school systems. (In Cherry & In
Jacob, 2014, pg 112) The quality and safety education is meant to provide students with skills
which will ensure that they are able to provide relevant healthcare services to patients in more
complex environments.
Some policies used in the school systems have also played a role in this issue. For
example, in the process of social professional socialization and role transitioning, it is a policy in
most schools’ systems that licensed practice nurses (LPNs) are subordinate to registered nurses
(RNs) and that their ideas are of a lesser magnitude when It comes to the implementation of
strategies and concepts in the practicum setting. Such a policy greatly helps in the lowering of
self-confidence in most of these nurses; even years after graduating and practicing as nurses.
This has been confirmed through a number of studies conducted. Such policies have such a
negative impact due to the psychological effect that is left in the nursing students that they
cannot practice independently. In some schools, the RNs have started implementing strategies
such as incorporating LPNs’ ideas in their practice as a means of ensuring that there is a sense of
appreciation in the LPNs
The outcomes of these strategies have been evaluated through a number of ways. For
example, the formation of the Institute for Healthcare Improvement (IHI) to assess the
integration of quality and safety education in school systems. Surveys have also been conducted
in a number of health facilities where nurses are allowed to practice independently so as to assess

whether or not these implemented strategies are effective in promoting the role of nurses acting
as independent practitioners. Lastly, there has also been an assessment of patients who have
received healthcare services from independent nurse practitioners so as to establish their
standards of health provided by the nurses as independent practitioners. (Committee on the
Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of
Medicine, Robert Wood Johnson Foundation, & Institute of Medicine, 2011, pg 55)


Aktan, N. M. (2015). Fast facts for the new nurse practitioner: What you really need to
know in a nutshell.
Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing,
at the Institute of Medicine., Robert Wood Johnson Foundation., & Institute of Medicine (U.S.).
(2011). The future of nursing: Leading change, advancing health. Washington, D.C: National
Academies Press.
In Cherry, B., & In Jacob, S. R. (2014). Contemporary nursing: Issues, trends, &

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