Family Nurse Practitioner

The difference between coaching and mentoring was clearly explained in the initial posts. Also, the initial posts offered creative ways coaching and mentoring can be used for new employees and patient care.

Question for Class:

* Most healthcare settings utilize a preceptor model to assist with orienting new employees. Which concept, coaching or mentoring, would be best utilized by a preceptor? Why?

Provide support for your response.
AND
Response to two posts. APA format. References less than three years old from peer review journals.
see post in Additional files

 

• Student 1 Roger

Understanding the difference between consultation and supervision has the potential to increase patient access to Advanced Practice Nurse (APN’s) expert nursing care. As stated by Harmic, Hanson, Tracy, and O’Grady (2014). Consultation helps to supplement the competence of the nurse to offer quality care by offering patients with essential resources to address their needs. The term consultation is used in many ways. It is sometimes used to describe direct care. For instance, the nurse practitioner is in consultation with the patient. Hence, consultation is used interchangeably depending on the intended purpose (Harmic, Hanson, Tracy, & O’Grady, 2014). The more precisely the word “consultation” is defined, the more likely consultation will be used for the intended purpose of improving patient care and promoting positive professional relationships that lead to true collaboration and optimal patient care. According to Harmic, Hanson, Tracy and O’ Grady (2014) Consultation is described as pursuing further information from a professional, colleague or family member with the aim of delivering optimal patient care and encouraging constructive professional interactions. The American Association of Colleges of Nursing (2013) highlights consultation as an important part of the master’s and the Doctor of Nursing Practice (DNP) programs. Therefore, consultation is the central competency of advanced practice nursing and precision for communication that is within or outside the profession.

Conversely, the term supervision is described by as “the action or process of watching and directing what someone does or how something is done.” Supervision essentially refers to oversight of junior associates and is related to authority. The other distinguishing aspect between consultation and supervision is that consultation requires the interaction to be mutual and non-hierarchical while supervision needs communication that is hierarchical in the arrangement.

Are Consultation and Collaboration synonymous?

Consultation and collaboration are closely related; however, the two ideas have distinctive implications both clinically and legally (Harmic, Hanson, Tracy, & O’Grady, 2014). The consultation typically involves collaboration in the growth of interdisciplinary connections between the two healthcare professionals. Consultation in advance practice nursing requires the building of relationships with healthcare professionals within nursing and across other disciplines. APN use consultation to acquire information that complements their practice or to offer their clinical knowledge to colleagues in a position role (Balzer-Riley, 2012).

Collaboration in healthcare is very vital in ensuring different professionals work together to make a patient well. Collaboration in healthcare is the best way to ensure the patient receives the best possible care (Coles et al., 2017). Advance practice nurses mostly collaborate with doctors, lab technician, and other co-workers. Just as it takes a village to raise a child, it takes a group of healthcare professionals to provide the best care to the patients. The main difference between consultation and collaboration is that in consultation a nurse seeks professional advice and insight from the consultant and he or she has the liberty of agreeing or disagreeing with the council (Balzer-Riley, 2012). Collaboration on the hand requires the contribution from all healthcare professionals towards achieving a common goal which is giving the best care to the patient. This group takes accountability of their choice and action as opposed to one individual.

Consultation competency in home health agencies

Consultation competency involves many principles.  Harmic, Hanson, Tracy, and O’Grady (2014) state consultation begins with the consultee, the interaction amongst the consultee and consultant is supportive. The consultant offers advice while the consultee chooses whether to apply or ignore the advice (Herrera-Bernal, Ramírez-Hernández & Ramírez-Montoya, 2016). The motivation of the consultation competency helps to enhance the patient outcome, patient care, healthcare system as well as professional growth. Home health agencies employ the services of APNs as healthcare providers to assess, diagnose and evaluate patients at their homes. The use of APNs in home health agencies have recorded improved patient satisfaction and better patient outcome. American Nurses Association (2015), states that collaborative approach is successful because of the cooperative nature of the supporting staffs and the patients. As noted by Herrera-Bernal, Ramírez-Hernández, and Ramírez-Montoya (2016),consultation and collaboration are complementary. The application of consultation competency by APNs helps to acquire patient-centered consultation from the home health agencies. This method gives enhanced patient care through a multidisciplinary collaborative approach.

References

American Association of Colleges of Nursing, & Peterson’s (Firm). (2013). Peterson’s nursing programs in 2014. Albany, NY: Peterson’s Publishing.

American Nurses Association. (2015). Nursing informatics: Scope and standards of practice.

Balzer-Riley, J. W. (2012). Communication in nursing. St. Louis, Missouri: Elsevier.

Buchan, J., Twigg, D., Dussault, G., Duffield, C., & Stone, P. W. (June 01, 2015). Policies to sustain the nursing workforce: an international perspective. International Nursing Review, 62, 2, 162-170.

Coles, E., Wells, M., Maxwell, M., Harris, F. M., Anderson, J., Gray, N. M., Milner, G., … MacGillivray, S. (January 01, 2017). The influence of contextual factors on healthcare quality improvement initiatives: what works, for whom and in what setting? Protocol for a realist review. Systematic Reviews, 6, 1.)

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013). Advanced practice nursing: An integrative approach. Elsevier Health Sciences.

Herrera-Bernal, J.-A., Ramírez-Hernández, D. C., & Ramírez-Montoya, M.-S. C. (January 01, 2016). Applied Competencies for Students by Using M-Learning Devices in Higher Education.

Robichaux, C. (2017). Ethical competence in nursing practice: Competencies, skills, decision-making.

 

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• Student 2

Consultation refers to one care provider asking another provider for insight or recommendations on a specific or particularly complex case (Hamric et al 2014).  For example, a Family Nurse Practitioner may consult with a Cardiologist on medication management for a patient who is not responding appropriately to pharmacotherapy treatment already tried.  The Nurse Practitioner can then treat the patient however they choose using the recommendations provided.  The Nurse Practitioner remains the primary care provider for the patient (Hamric et al 2014).  Supervision of clinical care is where one provider works underneath another provider while practicing patient care. In the State of Florida, at least one physician needs to be listed as the supervising physician in order for the nurse practitioner to practice care at a site (Florida Board of Nursing 2018). The Nurse Practitioner acts independently but can also work along with the physician to provide care for the patient, but the physician is primarily there to review the care being provided.

•           Consultation and collaboration are synonymous in that providers are working together to treat a patient but each one works a little differently. They both involve multiple care providers on the case in order to reach the same goal of providing the best outcome for the patient (Hamric et al 2014).  However, consultation is only looking for a recommendation from one provider to the other and collaboration is where the two providers work together throughout the treatment of the patient.  Think of consultation in a hospital setting where the consultant can “sign-off” the case once they have provided their amount of knowledge. With collaboration, two providers will work together through the end of the case. For example, collaboration can include a surgeon and an internal medicine doctor working together to treat a ruptured appendicitis that led to a systemic infection.  The two providers will remain on the case through its entirety. It is important for health care providers to collaborate effectively including communicating often and remaining organized on the set plan of care that was discussed with the patient (Hamric et al 2014).  This will promote a positive relationship with the patient and heal the patient quickly and more effectively.
•           The consultation competency is used heavily within the acute hospital setting.  At my current place of work, there is an internal medicine group (IMG) including physicians and nurse practitioners that treat the majority of the inpatient population.  The IMG team is responsible for leading the plan of care for the patient but frequently consult with other specialties pending which maladies the patient may have.  If a patient has new onset A Fib, a Cardiologist is consulted or if a patient develops a severe case of cellulitis, an infectious disease provider is consulted.  It is not uncommon to see a patient with up to four specialties consulted including cardiology, nephrology, pulmonology, etc. This practice does follow the graduate competency in that the frequent consultations maintain an ongoing consultee relationship (Hamric et al 2014).  It provides better patient outcomes in that the patient is receiving top care by all of the knowledge that is available
• (Hamric et al 2014).  Each area of expertise provides opportunity for the patient to reach the goal outcome quickly and effectively.
• Florida Board of Nursing (2018). Retrieved from floridanursing.gov
• Hamric, A. B., Hanson C. M., Tracy, M.F., & O’Grady, E.T, (2014). Advanced Practice Nursing: An Integrative Approach. St Louis, MO: Elsevier