NUR 801

Section 2, Lansing




A-126 Life Sciences or 133 W Fee Hall
Email: bgiven@pilot.msu.edu
Phone: 517-432-4326 or 517-355-6526
Fax: 517-353-4701

Email list:


New Links to Web Modules for Class Assignments



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This graduate seminar will provide the opportunity to explore the role of the advanced practice nurse and the concepts of primary care within a contemporary health care system. The content will included issues related to the role of the APN as well as health policies, legislative issues and reimbursement mechanisms relevant tot he APN practice.

This graduate seminar will provide the opportunity to explore the concepts and theories for role, role definitions, for the Advanced Nursing Practice (ANP). In order to apply this framework, areas of study will be on the major theme of the MSU ANP Program, that is, the Advanced Nursing Practice role and the role of primary care within the health care delivery system. We will examine the role characteristics of the ANP, with a special analysis of at least one role used in Advanced Nursing Practice.

Seminars on primary health care system will be used to analyze concepts, characteristics and the goal of primary care. With the advent of changing social demands, cost containment will be the managed care approach to primary care that is discussed. There has been an increased focus on use of interdisciplinary collaborative function as a process of health care delivery. To provide primary care such that is accessible "comprehensive, continuous, and "coordinated", a collaborative professional team effort is needed. Accountability for patient outcomes based on evidence from Advanced Nursing Practice will be discussed. Regulatory factors will be explored. Focus on practice guidelines, quality of care, and outcomes of care and limitations of the current, changing system will be discussed.

Throughout the course students are expected to develop and analyze strategies that could be used to implement the Advanced Nursing role within a primary health care system in which accountable collaborative practice occurs.

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A seminar format will be the method of instruction along with extensive use of the World Wide Web. Required readings and the use of the Web will provide the focus for class discussion and class preparation. Preparation for class will enhance discussion. Use of the Webs chat opportunities is an expectation of all students and documentation of use will occur. In addition, the written assignments and exams allow the student to integrate and synthesize content from Required Reading, Web activities and class discussions.

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Evaluation is based on scholarly papers and web activity and a final exam. A passing grade on all components is necessary to pass the course. A passing grade is 80%.

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The final exam will be worth 40% of the grade, will be a short answer essay examining the extent to which student understands course objectives. This will be given during finals week. Application of major concepts of the course will be the focus of the exam. The final exam will be December 17, 1998.

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The Web assignment paper will focus on a role of the nurse in Advanced Nursing Practice.

The assignment will be due October 8th.

Introduction of the concepts - review and find information using the Web on use of advanced practice nurses in primary health care. You may find information in health care plans, federal or state legislation, voluntary organizations, or from nursing specialty groups. Fine 5 sources that relate to one role characteristic of the APN role. (10 points)

Describe the role characteristic - define it, discuss the definition and characteristic (1-2 pages)

List 5 specific sources you used to define it -- 3 must be from the Web.

Implications for APN roles. How does the content review reflect "advanced practice"?

-- this is to be your ideas supported by what you have read. (10 points) Discuss from the novice to expert perspective. Relate all to the role you select.


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Student Name


Role Characteristics

(1-2 pages - 5 references) 10 points

Analysis of role and discussion from "Advanced Practice Perspective"

(2 -3 pages 2-3 references) 10 points

Total Points

(20 points possible)

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The purpose of this paper is to examine the role of primary care within a managed care environment and to examine the Advanced Practice Nurse role within that context. Select from interdisciplinary, access, continuity, comprehensive, accountable, or integrated.

The paper should be at least 13-15 pages excluding references and should be in keeping with APA format 4th Edition, using proper APA format for Web citations. May have up to 10 points off or be asked to resubmit with penalty if APA guidelines are not followed. Expect proper grammar and editing.

An outline should be turned in 3 weeks before the paper is due. i.e., An outline or draft of the paper must be turned in.

Papers will be evaluated using the following criteria.

Clear definition and description of the primary care characteristic selected. (see above) Documented literature must be included. It should be clear what this characteristic means and your literature must be primary not acute care. (35 points) Research articles must be included.

Discuss how managed care enables or interferes with the ability to deliver this component care. Be specific to your characteristic. Please use Web sites and resources to support. What are the barriers to implementing the advanced practice nursing role to deliver primary care within a managed care environment. (25 points)

What does the APN bring to the primary care environment to enable the ideal primary care characteristic to be delivered within a managed care environment. (Discuss at least 10 evidence based strengths or resources that nurses bring) (40 points)

Please use research based articles, including Nursing Research, to support your discussion.



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Students Name



Evidenced Based Description of a Selected Primary Care Characteristic (35 points)

(Define and Discuss Components)

Evidenced Based Barriers* that Interfere with Primary Care Delivery and

Implementing APN Role (Specific to Advanced Practice) (25 points)

3. Contributions of APN to the primary care characteristics -- must be at the advanced practice level with full discussion. Must be specific to the characteristic identified. Will need at least 15 with full discussion. (40 points)

Format or APN Problem** (-)

Total Points

*Must include data based research articles where the evidence based requirements exists.

**Papers will be returned ungraded if APA format is not followed and if not a scholarly paper.


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Compare and contrast the role characteristics of the APN with other primary care providers.

Analyze the APN role as related to accountability, responsibility and scope of practice.

Analyze quality and performance indicators appropriate to APN practice in primary care.

Examine the impact of the selected health policies, legislative issues and reimbursement mechanisms on primary care and the role of the APN.

Analyze the impact of the organizational and financial system resources on resource allocation in the delivery of primary care.

Evaluate components of the reimbursement system in primary care as it relates to APN practice.

Exit Behavior: Compare and contrast the role characteristics of the APN in relationship to other primary care providers.

Analyze dimensions of role characteristics and domains of practice needed to carry out the APN role.

Explore the role of the APN in comparison to other health care providers.

Analyze the process of professional socialization and resolution of role conflict necessary to implement the APN role.

Analyze dimensions of role characteristics utilizing domains of practice needed to carry out the advanced nursing practice role.

Analyze in detail selected roles and behavior to be realigned and expanded to implement an advanced nursing practice role in the delivery of primary health care.

Exit Behavior: Analyze the role primary health care system and current approaches to delivery of primary care. Consider the organizational and financial resources on resource allocation.

Define characteristics and goals of primary health care (include access cost containment, managed care, continuum of care outcomes, quality assurance).

Identify role and breadth of services of primary care within the overall health care delivery system.

Analyze potential areas for role stress (strain conflict) in nurse-physician relationships in the delivery of primary care.

Identify changes in professional nursing behavior and organizational structure and delivery pattern needed for delivery of effective primary care.

Identify strategies to facilitate the implementation of the advanced nursing practice role in primary care.

Examine the role of practice guidelines and care process within the delivery of primary care.

Analyze the relationship of the APN role relevant to resource allocation with primary care delivery.

Exit Behavior: Analyze the role of primary care within the health care system using managed care as a delivery approach.

Define characteristics and goals of managed care as a delivery model with in the overall care delivery system.

Describe the continuum of managed care models.

Examine the role of managed care within a primary care environment.

What are factors within managed care that enable or interfere with the implementation of the APN role.

Exit Behavior: Analyze the concepts and strategies necessary for effective collaborative interdisciplinary (collaborative) functioning within primary care.

Analyze the processes necessary for working together using a model as a theoretical base.

Compare and contrast how collaborative team functioning differs from an individual's professional functioning (both process and outcome).

Determine barriers and benefits of collaborative functioning on individual member (personal and professional), to team (group), and to client care. (Cost-benefit).

Analyze the concepts of conflict, trust, to develop strategies needed to function effectively within the collaborative model (overlapping responsibilities).

Identify strategies to facilitate the effectiveness of the Advanced Practice Role within a primary care collaborative model.

Exit Behavior: Analyze the legal and regulatory policies that influence the role, rights and responsibilities, accountability and scope of practice of the Advanced Nursing Practice role in primary care.

Define the advanced nursing practice role of the ANP from a legal perspective (scope of practice, authority, autonomy, and accountability).

Describe legal and regulatory barriers to implementing the APN within primary care role.

Identify the limitations of the APN role functioning according to the Nurse Practice Act and Michigan's Public Health Code.

Identify key legislative issues relevant to APN role functioning according to the Nurse Practice Act and Michigan's Public Health Code.

Exit Behavior: Analyze how practice guidelines (evidenced based) relate to performance indicators evaluation and patient outcome.

A. Analyze the distinction between practice guidelines and protocols.

B. Analyze appropriateness for use of practice -guidelines within primary care.

C. Examine the components and process needed to evaluate effectiveness of APN in primary care (value-added).

D. Analyze evidenced outcomes and performance indicators of primary care for which nurses in ANP should be responsible and accountable.

Exit Behavior: Analyze how the reimbursement system in primary care relates to APN practice and marketing the APN role.

Identify legal issues related to reimbursement for the APN.

Discuss how reimbursement effects practice issues.

Examine how the APN role can be marketed in the health care system. What is the value and what are reimbursement limitations.

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Class I: APN - Scope of Practice Roles

Class II: Role Characteristics and Domains

Class III, IV & V: Primary Care

Class VI: Role - Role Conflict

Class VII: Practice Guidelines

Class VIII - IX: Managed Care

Class X, XI: Interdisciplinary Collaborative Team

Class XII: Analyze quality outcomes and performance indicators appropriate to AP Role in Primary Care

Class XIV: Legal Rights and Responsibilities - Barriers and Regulation

Class XIV: Marketing and Reimbursement Issues for Advanced Practice

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Class I
Sept 3, 1998

Orientation - Advanced Nursing Practice

Barbara Given

Class II
Sept 10, 1998

Role Characteristics and Domains

Barbara Given

Class III
Sept 17, 1998

Primary Care

Barbara Given

Class IV
Sept 24, 1998

Primary Care

Barbara Given

Class V
Oct 1, 1998

Primary Care

Barbara Given

Class VI
Oct 8, 1998

Role of Advanced Practice Nursing
Wed Site Assignment Due

Web Class

Class VII
Oct 15, 1998

Practice Guidelines

Barbara Given

Class VIII
Oct 22, 1998

Draft of Paper Due
Managed Care

Barbara Given

Class IX
Oct 29, 1998

Managed Care

Web Class

Class X
Nov 5, 1998

Collaborative Team

Barbara Given

Class XI
Nov 12, 1998

Collaborative Team

Barbara Given

Class XII
Nov 19, 1998

Accountability in Practice -- Outcomes and Evaluations

Barbara Given

Class XIII
Nov 26, 1998


Class XIV
Dec 3, 1998

Barriers and Regulatory
Final Paper Due

Barbara Given

Class XV
Dec 10, 1998

Marketing the APN Role

Barbara Given

Class XVI
Dec 17, 1998


Barbara Given

E-mail Address bgiven@pilot.msu.edu

Office Hours: By Appointment

Fax: (517) 353-4701

You can leave a message with my secretary Faye at (517) 355-6523 or Cathy 517-432-4326.


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It is expected that you will review the texts that are required at the appropriate time. Separate listings are not always made



Book title, edition, year, publisher


Kongstvedt, P.R.

(1997). Essentials of Managed Health Care. (2nd Ed.). Aspen Publishers, Inc. Gaithersburg, Maryland.


Sheehy, C., & McCarthey, M.

(1998). Advanced Practice Nursing. F.A. Davis, Philadelphia.


*Benner, P.

(1984). From Novice to Expert. Reading, MA: Addison Wesley Publication Co.


*Hickey, J.V., Ouimette, R., Venegoni, S.A.

(1996). Advance Practice Nursing: Changing Roles and Clinical Applications. Lippincott.


Larson, C.E., & LaFasto, F.J.

(1989). Teamwork: What must go right/what can go wrong. Newbury Park, CA: Sage Publications.


*Donaldson, M.,
et al.

(1996). Primary Care: America's Health in a New Era, Washington, D.C. National Academy Press.

Class I

Bear, E. M.

(1995). Advanced practice nurses: How did we get here anyway? Advanced Practice Nursing, 1(1), 10-14.

Class I

*Busen, N. &
Engleman, S.

(1996). The CNS with Practitioner Preparation: An emerging role in Advanced Practice Nursing. Clinical Nurse Specialist, 10(3), 145-150.

Class I

*McCleod, R.P.

(1995). Nurse practitioners: Building on our past to meet future challenges. Advanced Practice Nursing Quarterly(1), 15-20.

Class I

Williams, C.A. & Valdiviesco, G.C.

(1994). Advanced practice models: A comparison of clinical nurse specialist and nurse practitioner activities. Clinical Nurse Specialist, 8(6), 311-318.

Class I


Advance Practice Nursing, Chapter 2.

Class I

*Sheehy, C., McCarthy M.

Chapters 1, 4, 13

Class II

American Academy of Nurse Practitioners Web page 1) Scope of Practice 2) Standards of Practice (visit Web page) 3) Position statement on Advanced Practice Role, Prescriptive Authority and "The NP in MCO."

Class II

*Davies, B., & Hughes, A.M.

(1995). Clarification of advanced nursing practice: Characteristics and competencies. Clinical Nurse Specialist, 9(3), 156-166.

Class II

Benner, P. (I)

Chapters 1, 2, 3, 4

Class II

*Fenton, M.V. & Brykczynski, K.A.

(1993). Qualitative distinctions and similarities in the practice of clinical nurse specialists and nurse practitioners. Journal of Professional Nursing, 9(6), 313-326.

Class II

Role Characteristics--See Appendix B.

Class II

*Berger, A.M., Eilers, J.G., Pattrin, L., Rolf-Fixley, M.

(1996). Advanced practice roles for nurses in tomorrow's healthcare systems. Clinical Nurse Specialist, 10(5), 250-255.

Class II

*Chase, L.K., Johnson, S.K., Laffoon, T.A., Jacobs, R.S., Johnson, M.E., et al.

(1996). CNS role: An experience in retitling and role clarification. Clinical Nurse Specialist, 10(1), 41-45.

Class II

Sheehy, C., & McCarthey, M.

Chapter 10.

Class II


Chapter 8

Class II

Redekopp, M.A.

(1997). Clinical nurse specialist role confusion: The need for identity. Clinical Nurse Specialist, 11(2), 87-91.

Class II

Strunk, B.L.

(1995). The clinical nurse specialist as change agent. Clinical Nurse Specialist, 9(3), 128-132.

Class III

*Donaldson, M., Yordy, K., Lohr, K.

(1996). America's Health in a new era, Institute of Medicine at Academy of Sciences Primary Care, 27-147, Washington D.C.

Class III


Chapter V-VIII

Class III

Benner, P., Tanner, C., Chesla, C.

(1997). The social fabric of nursing knowledge. AJN, 97(7), 16BBB-16DDD.

Class III

*Brykczynski, K.A.

(1989). Interpretive study describing the clinical judgment of nurse practitioners. Scholarly Inquiry for Nursing Practice: An International Journal, 3(2), 75-104.

Class IV

Managed Care

Class IV

Woodall, D.

Advanced Data National Ambulatory Medical Care Survey. 1996 Summary N#295, Dec 17, 1997.

Class IV

Sheehy, C., McCarthy, M.

Chapter 5

Class IV


Chapter 3.

Class IV

Addy, J.

(1996). Issues of access: What is going on in health care? Nursing Economics, 14(5), 299-302.

Class IV

Primary Care: Core Values

Class V

Mandelblatt, J., Traxler, M., Lakin, P., Thomas, L., Chauhan, P., Matseoane, S., & Kanetsky, P.

(1993). A nurse practitioner intervention to increase breast and cervical cancer screening for poor, elderly black women. Journal of General Internal Medicine, 8, 173-178.

Class V

Sawyers, J.

(1993). Define your role in ambulatory care: Clinical nurse specialist or nurse practitioner. Clinical Nurse Specialist, 7(1), 4-7.

Class V

Anderson, R. & Davidson, P.

(1996). Measuring access and trends. In R. Anderson, T. Rice, G. Kominski (eds.), Changing the U.S. Health Care System, 13-40. Jossey Bass: San Francisco.

Class VI

Fitzpatrick, E.

(1998). Analysis and Synthesis of the Role of the Advanced Practice Nurse, Clinical Specialist, 12(3), 106-107.

Class VI

Ward, C.

(1986). The meaning of role strain, Advances in Nursing Science, 8(2), 39-49. (good model).

Class VI

*Roberts. S.J., Tabloski,, P., & Bova C.

1997). Epigenesis of the nurse practitioner role revisited. Journal of Nursing Education, 36(2), 67-73.

Class VI

*Soehren, P., & Schumann, L.

(1994). Enhanced role opportunities available to the CNS/Nurse practitioner. Clinical Nurse Specialist, 8(3), 123-127.

Class VI

In Syllabus

Appendix A, C, G

Class VI

*Capan, P., Beard, M., & Mashburn, M.

(1993). Nurse-managed clinics provide access and improved health care. Nurse Practitioner, 18(5), 50-55.

Class VII

*Fleck, L &
Squier, H.

(1995). Facing the ethical challenges of managed care. Family Practice Management, October, 49-55.

Class VII

Worrall, G., Chaulk, P., Freake, D.

(1997). The effects of clinical practice guidelines on patient outcomes in primary care: A systematic review. Can Med Assoc J, 156(12), 1705-1712.

Class VII

*Goldon, W.E., Cleves, M.A., & Johnston, J.

(1995). Health care report cards: Validity of case definitions. Arch Family Medicine, 4, 976-980.

Class VIII

Moss, J., Steiner, K., Mahnke, K., Cohen, R.

(1998). A mode to managed capitated risks. Nursing Economics, 16(2), 65-68.

Class VIII

Vickery, D. & Lynch, W.

(1995). Demand management: Enabling patients to use medical care appropriately. JOEM, 37(5), 551-557.

Class VIII

Wurzback, M.

(1998). Managed Care: Moral conflicts for primary health nurses. Nursing Outlook, 45(2), 62-66.

Class IX

Davis, K.

The Managed Care Transition

Class IX

*Wagner, E.R.

(1996). Types of Managed Care organizations. In P.R. Kongstvedt (Ed.), Essentials of Managed Health Care, (pp.24-34). Gaithersburg, MD: Aspen.

Class IX

*MacLeod, P.K.

(1996). An overview of managed health care. In P.R. Kongstvedt (Ed.), Essentials of Managed Health Care (pp.1-9). Gaithersburg, MD: Aspen.

Class IX

Sheehy, C., McCarthy, M.

Chapter 9

Class IX

Lassen, A., Fosbinder, D., Minton, S., Robins, M.

(1997). Nurse/physician collaborative practice: Improving health care. Nurse Economics, 15(2), 87-91.

Class IX

Sheehy, C., &
McCarthey, M.

Chapter 3

Class X

*Barger, S.E.

(1997). Building healthier communities in a managed care environment: Opportunities for advanced practice nurses. Advanced Practice Nursing Quarterly, 2(4), 9-14.

Class X

*Buerhaus, P.

(1994). Economics of managed competition and consequences to nurses. Part II. Nursing Economics$, 12(2), 75-80.

Class X

American Nurses Association

(1995). Managed care: Challenges and opportunities for nurses. Nursing Facts.

Class X

*Dinman, S.

(1996). Credentialing in advanced practice nursing. Advanced Nursing Quarterly, 2(1), 13-29.

Class X

Helmlinger, C. & Milholland, K.

(1997). Telehealth discussions focus on licensure. American Journal of Nursing, 97(6), 61-62.

Class X

McAlpine, L.

(1997). Process and outcomes measures for the multidisciplinary collaborative projects of a critical care CNS. Clinical Nurse Specialist, 11(3), 134-138.

Class IX

*Coile, R.

(1995). Integration, capitation, and managed care: Transformation of nursing for 21st Century health care. Advanced Practice Nursing Quarterly, 1(2), 77-84.

Class XI

Dunevitz, B.

(1997). Collaboration--in a variety of ways--creates health care value. Nursing Economics, 15(4), 218-219.

Class XI


(1992, May). Collaboration between nurses and physicians: No longer a choice. Academic Medicine, 67(5), 295-303.

Class XI

Coeling, H., & Cukr, P.

(1997). What's happening: Don't underestimate your collaboration skills. Journal of the American Academy of Nursing, 9(11), 515-519.

Class XI

*Sprague-McRae, J.

(1996). The advanced practice nurse and physician relationship: Considerations for practice. Advanced Practice Nursing Quarterly, 2(1), pp. 33-40.

Class XII

Minarik, P.

(1997). Clinical nurse specialist recognition and prescriptive authority. Clinical Nurse Specialist, 11(2), 59.

Class XII

Kopser, K. G., Horn, P.B., Carpenter, A.D.

(1994). Successful collaboration within an integrative practice model. Clinical Nurse Specialist, 8(6), 330-333.

Class XII

*Stichler, J.F.

(1995). Professional interdependence: The art of collaboration. Advanced Practice Nursing Quarterly, 1(1), 53-61.

Class XII

*McEwen, M.

(1994). Promoting interdisciplinary collaboration. Nursing & Health Care, 15(6), 304-307.

Class XII

*Larson, C.E., & LaFasto, F.J.

Chapters IV, V, VI, VII and VIII.

Class XII

Donabedian, A.

(1984). Quality, cost, and cost containment. Nursing Outlook, 32(3), 139-143.

Class XII

Finefrock, W. & Havens, D.

(1997). Coverage and reimbursement for nurse practitioners. Journal of Pediatric Health Care, 11(3), 139-143.

Class XII

Micheels, T.A.

(1995). Linking quality and cost effectiveness: Case management by an advanced practice nurse. Clinical Nurse Specialist, 9(2), 107-111.

Class XII

Flanagan, L.

Family Physicians and Nurse Practitioners -- A Perfect Team

Class XII

*Larson, C.E., & LaFasto, F.J.

Chapter VII.

Class XIII

Suivillo, A., & Levine, A.

(1993). Strategies to limit CNS malpractice liability exposure. Clinical Nurse Specialist, 7(4), 215-220.

Class XIII

*Brooten, D., & Naylor, M.D.

(1995). Nurses effect on changing patient outcomes. Image, 27(2), 95-99.

Class XIII

Boykin, A. & Schoenhofer, S.

(1997). Reframing outcomes: Enhancing personhood. Advanced Practice Nurse Quarterly, 3(1), 60-65.

Class XIII

Girourard, R.

(1997). Medical group practice applications for HEDIS: Reality or myth? College of Review, 39-60.

Class XIII

Hedis Web Site

HEDIS and the Quality Report Card Movement.

Class XIII

Jones, K., Jennings, B., Moritz, P., Moss, M.

(1997). Policy issues associated with analyzing outcomes of care. Image: Journal of Nursing Scholarship, 29(3), 261-267.

Class XIII

Naylor, M., Munro, B., Brooten, D.

(1991). Measuring the effectiveness of nursing practice. Clinical Nurse Specialist, 5(4), 210-215.

Class XIII

Mirr, M.

(1995). Evaluating the effectiveness of advanced practice. In M. Snyder & M. Mirr (eds.). Advanced Practice Nursing, 153-164. Springer: New York.

Class XIII

*Ribnick, P. & Carrano, V.

(1995). Understanding the new era in healthcare accountability: Report cards. Journal of Nursing Care Quarterly, 10(1), 1-8.

Class XIII

McGlynn, E., & Brook, R.

(1996). Ensuring quality of care. In R. Anderson, T., Rice, G., Kominski (eds.), Changing the U.S. Health Care System, 142-179. Jossey Bass: San Francisco.

Class XIII

*Weiner, J.P., Parente, S.T., Garnick, D.W., Gowles, J., Lawthers, A.G., & Palemer, R.H.

(1995). Variation in office-based quality: A claims-based profile of care provided to Medicare with diabetes. JAMA, 273(19), 1503-1508.

Class XIII

*Wilson, I.B., & Clearly, P.D.

(1995). Linking clinical variables with health-related quality of life. JAMA, 273(1), 59-65.

Class XIII

Vezeau, T.

(1998). Quality of care and critical pathways: Brave New World. Outcomes Management for Nursing Practice, 2. 25-30.

Class XIII

Iwine, D., Sidani, S., & Hall, L.

(1998). Leaking outcomes to nurses roles in health care. Nursing Economics, 16(2), 58-87.

Class XIII

Keenan, G., & Aquillo, M.

Standardized nomenclatuus: Key to continuity of care, nursing accountability of nursing effective. Outcomes management for nursing practice, 2(2), 81-86.

Class XIII

Saks, N.

(1998). Developing an integrated model for outcomes management. Advanced Practice Nursing Quarterly 4(1), 33-39.

Class XIII

Spath, P.

(1998). Nursing performance measures go public. Outcomes Management for Nursing Practice, (2), 124-128.

Class XIII

Johnson, M., & Maas, M.

(1998). Implementing the nursing outcomes classification in practice setting. Outcomes Management for Nursing Practice 2(3), 99-104.

Class XIII

Consumer Bill of Rights.

Class XIII &


*Nichols, L.

(1992). Estimating costs of under using advanced practice nurses. Nursing Economics, 10, 14-19.

Class XIII & XIV

Iglehart, J.K.

(1996). The national committee for quality assurance. The New England Journal of Medcine, 335(13), 995-998.

Class XIII & XIV

McHorney, C.A., Ware, J.E., & Raczek, A.E.

(1993). The MOS 36 item short form health survey. Medical Care, 31(3), 247-263.

Class XIII & XIV

Ware, J.E., Jr., Kosinskin, M., & Keller, S.D.

(1996). SF-12: An even shorter health survey. Medical Outcomes Trust Bulletin 4(1), 2.

Class XIII & XIV

Ware, J.E., & Sherborne, C.D.

(1992). The MOS 36 item short form. Medical Care 30(6), 473-483.

Class XIV

Moore, K.

Billing for Nurse Practitioner Services: What you need to know.

Class XIV

Sheehy, C., &

McCarthy, M.

Chapters 6, 7, 8 & 12

Class XIV

Oncology Nursing Certification Corporation

(1997). Making your credentials work for you. (Pp. 1-9).

Class XIV

Rustia, J. & Bulet, J.

(1997). Managed care credentialing of advanced practice nurses. The Nurse Practitioner, 22(9), 90-103.

Class XIV

Buppert, C.

(June, 1998) Reimbursement for nurse practitioner services. The Nurse Practitioner, 23(1), 67-81.

Class XV

Schaffner, R., &Bohomey, J.

(1998). Demonstrating APN value in a capitated market. Nursing Economics, 16(2), 69-74.

Class XV

McCloskey, J., Bulechek, G., &Donahue, W.

(1998). Nursing Interventions Care to Speciality Practice.

Class XV

Ford, V., & Kish, C.

(1998). Family physician perception of nurse practitioners and physician assistants. The Nurse Practitioner, 10(4), 167-171.

Class XV

Weiss, M.

(1998). Case management as a tool for clinical integration. Advanced Practice Nursing Quarterly, 4(1), 9-15.

Class XV

Hill, M.

(1998). The development of care management systems to achieve clinical integration. Advanced Practice Nursing Quarterly, 4(1), 33-39.

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Managed Care | Health Care Professionals | Consumers/Patients | MSU | Government

New Links (Added 9/9/98)

Group Health Cooperative

Health Affairs: The Policy Journal of the Health Sphere

Government on the Internet

The Cochrane Collaboration

Clinical Performance and Quality Health Care: An Official Journal of the Society for Healthcare Epidemiology of America

Case Management Resource Guide

Cancer Online

American Society of Clinical Oncology

American Cancer Society

The American Academy of Nursing

The Gerontological Society of America


American Academy of Family Physicians

Managed Care Links

Associations | Journals | For Lay Persons | Professional Links


American Association of Retired Persons

ACP Managed Care Resources
The American College of Physicians managed care area offers an annotated bibliography of managed care publications, information on the ACP's public policy and advocate activities, along with other services and information.

American Association of Health Care Plans
This Home Web page for the recently combined Group Health Care and American Managed Care and Review Associations is accessed on two levels. Non-members can access information about the association, available services, a message from its President, membership information, and on-line registration. Individual members can access publications, conferences, an electronic bulletin, membership list, and a WEB directory to other sites.

American Medical Association
For both the professional and the consumer, this page offers a step-by-step explanation of how the AMA defines managed care. Has pages on financial incentives, disclosure provisions and utilization management.

Center for Health Care Strategies
This page contains links to other managed care sites as well as to the latest news on managed care. For the professional, the consumer, or the curious.

Families USA Managed Care Central
A list of managed care resources from this national, nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable and long-term health care.

Gerontological Society of America

Milliman & Robertson
Known internationally as Woodrow Milliman, this organization conducts managed Medicaid consulting for state agencies and HMOs. The site contains case studies, simulation products, research, seminars and presentations, and a list of services.

National Committee for Quality Assurance
Web site for a private, non-profit organization whose mission is "to provide information that enables purchasers and consumers of managed health care to distinguish among plans based on quality, thereby allowing them to make more informed health care purchasing decisions."

Nursing World
Section of the Web site produced by the American Nursing Association which is devoted to issues related to managed care.


Journal of the American Medical Association

Managed Care Strategies
The site offers visitors the opportunity to read past articles and issues of Managed Care Strategies. Conference information can also be obtained online.

Managed Care Magazine
Consumers can see things from the other side of the examining table at the Web site of this industry publication.

Medical News

New England Journal of Medicine
This renowned source of medical information is available on the Web with a search engine, information for authors, a list of upcoming meetings, customer services, classified ads and more.

The Gerontologist
Contains Internet resources on aging, including listservs, e-mail discussion groups and mailing lists.

For Lay Persons

Children's Managed Care
Topic areas inside this website include the following: "What's different about today's health insurance plans?", "What is a managed care plan?", "How does managed care save money?,"Why the change from traditional insurance to managed care?"

Health Scope
This ambitious site tries to help consumers make informed choices when it's time to pick a managed care plan.

Managed Care Overview
The Managed Care Overview site offers a comprehensive history and introduction to managed care. The site also includes an area where visitors can read "real life stories" of managed care or visit a "viewpoints" or "discussion" area.

National Health Law Program
Publisher of Health Advocate, the National Health Law Program provides answers to questions about Medicaid, managed care, federal funding for children's preventive care, government responsibility to proivide care, or how to understand your state or local health care system.

Reuters Health Information

USA today

Your Money & Your Life: America's Managed Care Revolution
A "workbook" that accompanied a PBS special on managed care, with a helpful overview on managed care, a glossary, facts, and viewpoints.

For Professionals

American Interactive Healthcare Professionals Survey
How health care professionals are using Internet resources.

The George Washington University
The George Washington University, an independent academic institution chartered by the Congress of the United States in 1821, dedicates itself to furthering human well-being. The University values a dynamic, student-focused community stimulated by cultural and intellectual diversity and built upon a foundation of integrity, creativity, and openness to the exploration of new ideas. The George Washington University, centered in the national and international crossroads of Washington, D.C., commits itself to excellence in the creation, dissemination, and application of knowledge.

The HMO Group
Contains information on improving managed care, from the HMO perspective.

Infinity Heart Institute
Handling half of all open heart surgeries performed in Wisconsin, the institute operates this site of resources for managed-care heart surgery. It offers links to numerous resources as well as databases and articles.

Managed Care Forum
The purpose of the AMSO web page is to provide a forum for the healthcare professional and consumers of healthcare to learn and expound about the ever-changing managed healthcare industry. Site includes areas dedicated to "managed care gossip and jokes," "managed care terms," "healthcare and legislation," etc.

Managed Care Mall
A Web site which states that its purpose is "to bring together all the associations, case management meetings and conferences, general information, publications, conversations, providers and communications sought out by the case manager of the future."

Managed Care On-line
Site is dedicated to offering "managed information for the managed care community." Visitors have access to areas including "news menu" and "reports menu," while subscribers have access to the entire site.

Managed Care Resources (Infinity Heart Institute)
Sorted into three categories (Resources, Databases, and Articles), this site provides an incredible list of links to managed care-related information.

Marketing and Enrollment in Medicaid Managed Care
A guide to marketing and enrollment, including potential problems and solutions. This is a fact sheet from Families USA.

MedConnect Managed Care Forum
Here you can find a crash course on managed care. And for those already familiar with it and just wanting to know more, you will find articles, literature reviews, news, opinions, resources and message board. This site also offers a search engine -- very thorough.

MedQuest is a set of programs developed by HCFA that can be used to build custom clinical databases. This is free software that may be downloaded, modified, and distributed according to the user's needs.

Medscape Managed Care
Medscape's managed care area offers links to selected articles, briefs, and news reviews, along with related reference and patient information.

Mental Health Net
Contains dozens of links on the state of mental health managed care, as well as a link to its own page on managed care and administration.

Pew Charitable Trusts
This list of Pew Trusts for Medicaid and managed care is on the site operated by the Center for Health Care Strategies, but also contains a link to the Pew Trusts home page.


Links for Health Care Professionals

Alzheimer Web
Operated at the University of Melbourne, Australia, this site offers job information, links to laboratories and research sites, disease information and literature references.

American Heart Association
This Web site offers statistics, recounts of scientific sessions and councils, links to other sites, and general cancer information. Contains no direct information on managed care, but sometimes contains items on the subject as news breaks.

Creative Health Care Management
Site published by a group that promotes a decentralized structure to induce independence and interdependence, autonomy, responsibility, and acceptance.

Health A to Z
A search engine for health and medicine, with many other categories besides managed care. Offers ratings on other managed care Web sites as well as articles and other links.

Health Care Liability Alliance
Web site of a national advocacy coalition of health care associations representing "physicians, hospitals, blood banks, liability insurers, health device manufacturers, health care insurers, business, producers of medicines and the biotechnology industry."

Healthgate Continuing Medical Education
CME online via HealthGate is described as a comprehensive, high quality, low-cost way to stay informed about the latest topics in medicine while earning the Continuing Medical Education credits you need. We are dedicated to providing self-directed CME offerings, from ACCME accredited institutions, which are easily accessible and available at your convenience.

Interdisciplinary Task Force
Contains a summary of the findings of an independent expert panel established to develop recommendations for colorectal cancer screening and surveillance.

Institute on Health and Aging
General information on this program in the University of California at San Francisco's School of Nursing.

Journal of Family Practice
Contains the latest news and dozens of links for primary care physicians. This journal is operated by the Department of Family Practice at Michigan State University.

Karolinska Institute Library: Digestive System Diseases
A database on digestive system diseases targeted specifically at the health care professional.

Medical Economics
This useful page devoted to managed care has links to other resources as well as lists of managed-care publications such as newsletters and magazines.

The Medicine Index
A virtual library of international resources for biomedicine available by e-mail, in Usenet groups, via Gopher or other information servers, and as interactive databases. From A to Z.

National Digestive Disease Information Clearinghouse
A database that provides titles, abstracts, and availability information on digestive diseases information and health education materials. The value of this database is that it lists a wealth of health promotion and education materials that are not indexed elsewhere.

National Mental Health Services
Contains a managed care page with links on the latest news and research about mental health managed care. Site also has a search engine, announcements, publications and databases. Also has links to the committee's other programs such as the Children's Campaign.

Oncolink at the University of Pennsylvania
A highly useful search engine in which the user can look for issues concerning managed care. Operated by the University of Pennsylvania's Cancer Center, this site also offers a virtual classroom, frequently asked questions, and a link to the Abramson Family Cancer Research Institute.

The Urban Institute
The Urban Institute is a nonprofit policy research organization established in Washington, D.C., in 1968. The staff investigates the social and economic problems confronting the nation and government policies and public and private programs designed to alleviate them. The Institute's objectives are to sharpen thinking about society's problems and efforts to solve them, improve government decisions and their implementation, and increase citizens' awareness about important public choices. A variety of health care issues are addressed on the site.

Virtual Hospital
Operated by the University of Iowa's radiology department, this site offers a search engine bound to turn up numerous articles on managed care. Also offers information for patients and families as well as health care providers.



Aging Research Center
The "layman's" guide to aging research. Contains theories on aging, a conference calendar, references for recent books and papers, research tools and links to other laboratories involved in aging research.

The Alzheimer's Association
With resources including news, caregiver resources and a reading list on Alzheimer's topics, this is one of the most comprehensive Web sites about the disease. Also contains information on public policy, conferences and events, and research.

Cancer Prevention Park
The Cancer Prevention Park Web site is concerned with four cancer prevention areas: nutrition, specifically fruits, vegetables and fat content in foods; physical activity; sun exposure; and exposure to tobacco and secondary smoke. You will find commonly asked questions on the topics answered by experts as well as personal stories told by people who have made changes in their lives.

This site, developed by the Department of Health and Human Services (HHS), contains consumer health information resources produced by the Federal Government and its many partners. Topics include AIDS and HIV infection, mental health, women's health, heart disease, breast cancer, infectious diseases, aging, etc.

A corporation devoted to improving patient care, biomedical research and education by utilizing the latest advances in technology. Content areas include Nursing, Behavioral Health, Drug Information, and Patient and Medical Education.

The Healthweb site offers links to such healthcare related areas as: Diabetes, Genetics, Health Administration and Policy, Minority Health, and Public Health.

Virtual Library


MSU Links

College of Human Medicine
The College has become nationally and internationally known as a leader in university-based community-integrated medical education. In addition to excelling in clinical education, the College excels in research and development. An M.D./Ph.D. program also invites promising scholars to combine basic science research with clinical training.

College of Nursing
The College of Nursing's objective is to ensure quality education for its students, with a solid foundation of science and nursing theory, skill and clinical experience. The college is also mentoring its students in the leadership skills needed to advocate for the patient, the scholarship needed to document outcomes and provide evidenced based practice, and the compassion to see the individual in the midst of the system.

College of Osteopathic Medicine
For more than a quarter of a century, MSUCOM has been a leader in the osteopathic profession. The first new osteopathic educational institution in 50 years, MSUCOM paved the way for the creation of several new osteopathic colleges. Today, there are 19 colleges of osteopathic medicine in the United States. In the osteopathic profession, its consortium of hospitals has been a national role model for changes to the Medicaid and Medicare systems.

Department of Family Practice
The Department of Family Practice functions as a collaborative network with the following purposes: Training physicians who will provide competent, compassionate, cost-effective primary care; providing patient care in settings characterized by excellence and innovation; conducting community-based research; advancing knowledge relevant to primary care and medical education; advocating the ideals of family medicine to students, residents, and the community; and serving the people.

Family Care Research Program
The Family Care Research Program is a collaborative, interdisciplinary effort of faculty from the Michigan State University Colleges of Nursing and Human Medicine and the Department of Family Practice. The primary focuses of the FCRP projects are to gain increased knowledge about how patients and families face the burden of providing care in a transforming health care system; to better understand how families learn to care; and to disseminate this knowledge and influence health care reform and policy.

Michigan State University Extension
This web site covers a variety of MSU Extension educational programs and community-based issues such as natural resources, community and economic development, families and children. It also has sections about information resources, county and regional offices, events, staff resources, special projects and area of expertise teams. MSU Extension is committed to "helping people improve their lives through an educational process that applies knowledge to critical needs, issues, and opportunities."


Government Links

Administration on Aging
This web site, operated by the Department of Health and Human Services, is devoted to resources on aging and caring for older persons. It offers information for practitioners, students, researchers, and older persons and their families. Also contains statistics, news and lists of other Internet resources.

Agency for Health Care Policy and Research
This site contains reams of valuable information for researchers, including grant announcements and notices, research training assistance, and research findings on primary care, women's and children's health, and other health services research projects. Also has clinical information, consumer health links, data and surveys, as well as a search engine.

Center for Health Care Strategies
This site provides information on improving health care delivery for those living with chronic illnesses and on the relationship between managed care and Medicaid and children's health. Users have access to a searchable report on Medicaid managed care contract language, the organization's quarterly newsletter, and other reports, links, and information on Medicaid managed care.

Centers for Disease Control and Prevention
Contains items about the CDC, news, health information for domestic consumers and for travelers, publications and products, data and statistics, training and employment information, and funding information.

Commonwealth Foundation

Department of Health and Human Services
Contains news and public affairs items, a search engine, answers to basic questions about HHS, a link to Healthfinder, and more.

A search engine for government Web sites.

Foundation for Accountability Health Care Financing Administration
Effectively purchasing health care on behalf of some 74 million people, this is the site of the agency that oversees the Medicaid, Medicare and Child Health insurance programs. It offers news, legislative information and meeting schedules. It also includes such things as the Medicare Handbook.

Kaiser Permanente

Michigan Department of Community Health
News, general information and links to topics on aging, mental health and child health care.

Michigan Government Directory 89th Legislature 1997-1998
This site, developed by Gongwer News Service Inc., allows you to either jump to the home page of a government entity by clicking on the links below or send an E-mail by clicking on the names of individuals.

Michigan Legislature
Information about bills, resolutions, committee schedules and other proceedings in the Michigan Senate and House of Representatives.

National Academy for State Health Policy (NASHP)

National Association of State Budget Officers
This Web site provides data on state budget expenditures, including Temporary Assistance to Needy Families (TANF) and Medicaid. The site allows access to the executive summaries of two comprehensive spending reports: The Fiscal Survey of States and the 1996 State Expenditure Report. Also online are Medicare information briefs and weekly updates on federal legislative activity.

National Association of State Medicaid Directors
This web site gives users the full text of legislative memos, recent testimony by members of the association, and issue briefs dealing with Medicaid policy. Also included is detailed, state-specific information on active and pending 1915(b) and 1115 waivers. The site also has a comprehensive guide to the Medicaid, managed care, and child health-related provisions of the recently passed Balanced Budget Agreement.

National Cancer Institute
Contains links to advisory boards and groups such as the President's Cancer Panel, the Board of Scientific Advisors, the NCI Initial Review Group, as well as links to other cancer-related sites. Also has news, legislative updates and consumer information.

National Institutes of Health
This site has an overview and introduction to NIH with an employee directory and contains news, a calendar of events, press releases, special reports, and employment information. Also included is a selection of NIH health resources such as CancerNet, Clinical Alerts, the Women's Health Initiative and the NIH information index. There are also items about research grants and contracts, scientific resources, and links to institutes and offices.

National Institute on Aging
This site for one of the National Institutes of Health will give you research information, tell you how to order public information, provide links to other health-care sites, and give you updates on congressional legislation regarding aging.

National Institute of Mental Health
Look at this Web site for information on diagnosis and treatment of mental disorders, publications order forms, news and events, research training and career development, small business programs, and research activities.

National Institute for Nursing Research
Contains news, legislative information including hearings testimony, links to nursing schools and information about research programs, scientific advances and diversity programs.

National Library of Medicine
You will find a cornucopia of resources -- and not just about managed care -- at this web site. Aside from the latest news, there are links to many of the library's publications, including MEDLINE, a bibliographic database for medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.

Office of Disease Prevention and Health Promotion

Robert Wood Johnson Foundation

Social Security Administration
Includes information on things such as benefits, recent legislation, statistical reports and raw data sets.

Thomas Legislative Information on the Internet
Contains updates on floor and committee activities of the House and Senate, vote tallies, a search engine for specific legislation, and an archive of historical documents. This site is run by the Library of Congress.

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Overview of Primary Care

Primary care is distinguishable from secondary and tertiary care, which are based on referral rather than initial contact.

Primary care is that care the patient receives when he first approaches the health care system or formally participates in the "process of medical care." The second dimension of this primary care definition is the responsibility for the continuum of care--that is, the promotion and maintenance of health, evaluation, management of symptoms and appropriate referrals. Implied in this definition is that services by the health care professional include decision-making and accountability for promoting wellness, preventing illness, and maintaining and restoring health.

There are four major tasks to be accomplished by primary care. Primary care must:

1. Serve as the point of entry, screening and referral point for the rest of the personal health care system.

2. Provide a full range of basic services necessary to preserve health, prevent disease and care for common illnesses and disabilities of client populations and provide services necessary to ensure utilization of these services.

3. Provide the stabilizing human support needed by patients and their families in times of health-related crises.

4. Assume responsibility for the continuing management and coordination of personal health care services throughout the entire health care process (whether patient is ambulatory or bedridden, home or in community setting; whether receiving care at secondary or tertiary level).

Although these tasks may be accomplished at secondary and tertiary levels, it is at the primary level needs ultimate responsibility and accountability must.

Longitudinal responsibility for the client, now deemed continually regardless of the presence or absence of disease, is as an essential element in primary care. They point out that primary care is oriented to outreach and follow-up as well as toward helping the client define those conditions by which involvement with professional services and continuation of care are appropriate. At the primary level, care may be relinquished in part at times, but not terminated. Care at this level is not limited to the course of a single episode of illness but implies an ongoing, longitudinal responsibility and accountability. When other health resources are involved, the primary care health care providers the coordinating and integrating role.


The nature and scope of nursing practice as it relates to primary care needs is based upon a holistic approach to Man. As such, it is devoted to understanding human beings and the way in which individuals respond to health care problems. The delivery of primary nursing care has a foundation in the psychosocial and spiritual services as well as the medical, physical, and biological sciences. Nursing practice needs to develop as much excitement about the study of the normal conditions and situations as that which exists for the abnormal and illness health status. Primary care includes helping people at all points along the health-illness continuum. Inherent in the normal health status is health maintenance, health promotion, education, anticipatory guidance, and preventive care. Nursing requires sufficient evidence to justify what actually promotes or contributes to improve health status. A creative approach to maximize the health status of clients should serve as a challenge to the Advanced Practice Nurse.

Nurses prepared for primary health care roles are able to function as family health care generalists. The Advanced Practice Nurse delivering primary care places emphasis on wellness, or promoting the client's and families' abilities to cope with illness, to adjust and adapt to disability and incapacitating illness, and support and enhance the client's own strengths and assets.

The Advanced Practice Nurse prepared for primary health care roles is able to provide prenatal, post-natal, and well-child care; family planning; guidance regarding nutrition and preventing infectious disease; assistance in coping with illness, and adapting to disability and the normal effects on aging; and supervision of therapy and physical and psychosocial comfort throughout the entire developmental cycle. The Advanced Practice Nurse can provide support to assist and guide clients and families to manage their own care to cope with crisis. The Advanced Practice Nurse is also concerned with educational services, how information is transmitted, how the client internalized this information to promote health maintenance at an optimal level to promote client capabilities to assume responsibilities for self-care. In the final analysis, the Advanced Practice Nurse should reach out to clients from a variety of social, economic, ethnic, racial and environmental backgrounds. These clients may have different expectations of health care; they may not recognize the existence of health problems; they may fail to participate actively in the health care system, and may consequently not seek care. Primary care is practiced whenever patients are assisted in preventing physical and emotional illness, in acquiring those behaviors which lead to productive parenting, in coping with illness and disability in ways that promote growth, in problem-solving, in identifying and considering alternatives and actions related to health, and finally, in mobilizing their resources in order to live and die in harmony with self and others.

The scope of the Advanced Practice Nurse practice is differentiated by the area of expertise (family health gerontologist or gerontology) by the complexity of the development and situational crises of the clients for whom the service is provided. These crises might involve health maintenance for families or individual clients with several chronic diseases or might include therapeutic regime of individuals for whom physical illness is complicated by major psychological involvement or the normal effects of aging. Research is used to improve care and to develop the body of knowledge related to primary care by investigating problems and questions.

The Advanced Practice Nurse role includes the ability to recognize problems and ascertain who is the best resource to meet patient needs when the client needs to be referred. The Advanced Practice Nurse assists the client to determine his own health care goals, and to achieve continuity of care.

The nature of nursing in primary care includes direct care and management as well as the coordination of care. The coordination of care for client's with health problems of multiple and complex causation strongly suggests functioning interdependently with others. This role includes the ability to work collaboratively and in a consultive capacity with professionals of many disciplines and with agencies of many types.

As an end result, the Advanced Practice Nurse assists clients in understanding the need for the process of seeking health care and the services that are available. The Advanced Practice Nurse should assist individuals who are not in the health care delivery system to enter, and to help them define the situations under which entry would be acceptable and appropriate.

The Advanced Practice Nurse prepared to function in primary care should participate in assessing community needs and in surveillance of health problems. Advanced Practice Nurses should be involved in planning, organizing, administering and monitoring pertinent health services for the community. These must seek out individuals and groups in need, work with them to improve health status, and work with the community at large to bring about change in the delivery of health care. Ultimately, they are concerned with improving the quality of care of a population.

The uniqueness of the Advanced Practice Nurse lies in the eclecticism and the comprehensiveness with which she/he must synthesize and utilize theory and practice. This is nursing's greatest strength and greatest vulnerability since nursing practice is often seen to overlap with that of every other health care professional, especially in this expanded role. However, it is just this broad nature that is most needed in primary care.

The caring relationship established with the client is the central core of nursing and cannot be practiced without continuity. The basic pattern of caring in nursing is that of helping another to grow toward more complete health and self-care abilities and development. In providing primary care, nursing offers an aspect largely absent from care provided by other professionals--that is, client-centered or family-focused care. If one accepts the notion that a client's environment is an extremely important aspect of maintenance of health and recovery of adjustment to illness, primary care must be client-focused.

The Advanced Practice Nurse can deliver primary care, regardless of which setting or specific health status. It is the assumption of primary responsibility and continuing management of longitudinal care that defines primary health care services. The Advanced Practice Nurse can determine the scope to her/his own practice, accept the responsibility for primary health care and is accountable for decisions and actions to both the client and to society for her/his practice. The care nursing described includes accountability, first, to the patient. Accountability and responsibility are shared with physician colleagues as well as other health providers.

Depending upon the state in which the Advanced Practice Nurse practices, the nature and scope of nursing in primary care may or may not include making a differential diagnosis, prescribing therapeutic regimens based on the diagnosis or solving of complex patient problems. The process used by the Clinical Nurse Specialist does include recognizing deviations from the normal, labeling the deviation, and differentiating the clinical findings that require referral or the expertise of other disciplines.

The scope of the Advanced Practice Nurse in primary care should be viewed as fluid and evolutionary, and it is defined by the knowledge and skills needed to meet primary care needs. The scope of practice for the master's level clinician includes more sophistication and comprehensive approach in the management of client care. The Advanced Practice Nurse are capable of investigating and evaluating nursing interventions of others as well as providing direct care for selected clients.

This clinician prepared at the master's level must also be role model in primary care: maintaining and refining knowledge and skills, integrating the various components of primary care into specialty practice, and manipulating the organization of health care providers, utilizing the skills and expertise of each member.

The role of the Advanced Practice Nurse is entirely compatible with the specialists role in family-focused primary care as well as care of the elderly. The latter enriches the former as it is more fully integrating nursing knowledge and behaviors which emanate from the knowledge. The Advanced Practice Nurse must always consider the client, however, without losing sight of her/his role in leadership, teaching and research. The master's prepared Advanced Practice Nurse must be involved in developing and testing models of primary health practice along with the continuing evaluation of the quality of primary care practice.


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Advocate -- One who works to promote a transfer of responsibility to the client by creating a climate of mutuality in which the nurse assists the client in exercising his/her rights and in improving self-care abilities.

Case manager (Care Coordinator) -- One who facilitates the identification of health needs and development and implementation of a therapeutic plan of care for patient within the context of an interdisciplinary team. One who assures continuity and advocacy for the patient.

Clinician/Practitioner -- One who systematically collects subjective and objective data, interprets the data using advanced clinical judgment and formulates diagnosis based on sound theory. One who continuously updates, validates and revises plan of care based on patient needs. Provides direct primary care in a variety of health care settings.

Collaborator -- One who exchanges information and participates in client care or problem management with other members of the health care team to achieve joint responsibility and accountability for planning for decisions made regarding client, community and or system needs and outcomes.

Consultant -- One who utilizes the problem-solving process and provides advice or information related to his/her area of expertise to broaden the scope of health care planning for other health professionals and provides information regarding health care to lay groups.

Counselor -- One who provides stabilizing human support based on objective analysis of the situation and knowledge of problem-solving skills, facilitates individual to accept coping behaviors, improve self-care abilities based on clients capacity to accept counsel and express concerns.

Educator -- One who applies learning theories and selected learning methods to teach and assist clients or other appropriate groups in identifying and meeting primary health care needs. One who serves as an example/role model for others in the nursing profession.

Evaluator -- One who uses standards/guidelines/clinical pathways to appraise the quantity and quality of effectiveness of own care and others and one who develops and implements standards to guide practice and foster accountability for the quality of performance. Outcomes measures and used for assessing achievement.

Leader -- One who directs, facilitates, negotiates and supervises individuals or groups to meet common goals, one who systematically works to bring about positive changes in an individual or system. One who assumes responsibility for helping to direct the profession and impact policy. One who markets and facilitates the role of the APN.

Researcher -- One who pursues the systematic and scientific investigation of clinical problems and tests nursing theories. One who fosters a spirit of inquiry within the profession to advance nursing knowledge.

Change Agent -- One who utilizes a systematic and deliberative approach to collaborate and coordinate activities to bring about positive alterations in individual's health behaviors and/or in the health care system itself.


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APPENDIX C: Family Advanced Practice Nurse Job Description / Gerontological Advanced Practice Nurse Job Description


Family Nurse In Advanced Practice Job Description for Clinical Nursing Practice


1. Entering an individual or family of any age group into the health care system.

2. Establishment of a caseload of clients/families with selected health care problems and management programs within the scope of the FNAP's role.

3. Initial and ongoing total assessment of the client's health status. This assessment includes: a) a systematic health history with data obtained in the physiological, social, psychological, and spiritual spheres, b) a physical examination, and c) diagnostic testing.

4. Initiating and monitoring the treatment of patients with single acute and/or stabilized chronic illnesses or health problems which lie within the clinical nurse specialist's scope of practice. Such treatment(s) are based on accepted medical and/or nursing standards and protocols.

5. Collaboration with nursing, medical, or other staff for comprehensive interdisciplinary management of care or referral. Such collaboration includes initiating health care team conferences.

6. Assuming leadership and patient advocacy roles for coordinating and communicating patient problems and/or needs to appropriate health care team members.

7. Assessing individual's, families' and or community groups' learning needs for specific knowledge and skills required to maintain health and prevent illness.

8. Applying learning theories to teach individuals, families and/or groups health maintenance/illness prevention strategies.

9. Counseling individuals in relation to their health needs in the physiological, psychological, social, and spiritual spheres which fall within the clinical nurse specialist's scope of practice.

10. Providing continuity of care of residents/client/families through the care coordination, follow-up and communication with referring professional/ agencies.

11. Intervening in crisis situations, including taking action within the clinical nurse specialist's scope of competence or referring the client/ family to the appropriate health care provider/agency.

12. Documenting nursing practice.

13. Providing the highest quality nursing care through the utilization and/or conduction of research in nursing practice, standard setting, peer review, evaluation of care, and continuing professional education.

14. Coordinating and/or supervising other personnel as deemed necessary through clinic/agency/professional policy, clinical nurse specialist education and credentials, and legality issues.

15. Facilitating the process of care through understanding how the delivery system is organized and being able to use it effectively.



Gerontological Advanced Practice Nurse Job Description for Clinical Nursing Practice



1. Entering an individual in the older adult years into the health care system.

2. Establishment of a caseload of older adult clients covering a range of specified care and services appropriate to the needs of the gerontological client in primary care and within the scope of the GCNS.

3. Initial and ongoing total assessment of the gerontological client's health status. This assessment includes: a) a systematic health history with data obtained in the physiological, social, psychological, and spiritual spheres, b) a physical examination, and c) diagnostic testing.

4. Making decisions for planning, writing orders, evaluating and managing (gerontological) clients with single acute and/or stabilized chronic illnesses or health problems which lie within the clinical nurse specialist's scope of practice. Such management is based on accepted medical and/or nursing standards and protocols.

5. Collaboration with nursing, medical, or other staff for comprehensive interdisciplinary management of care or referral. Such collaboration includes initiating health care team conferences and other appropriate services.

6. Assuming leadership and patient advocacy roles for coordinating and communicating patient problems and/or needs to appropriate health care team members.

7. Assessing individual's, families' and/or community groups' learning needs for specific knowledge about the gerontological client and skills required to maintain health and prevent illness in the older population.

8. Applying learning theories appropriate to the older client to teach individuals, families and/or groups health maintenance/illness prevention strategies.

9. Counseling individuals in relation to their health needs in the physiological, psychological, social, and spiritual spheres which fall within the gerontological nurse specialist's scope of practice.

10. Providing continuity of care of residents/clients/families through the care coordination, follow-up and communication with referring professionals /agencies.

11. Intervening in crisis situations, including taking action within the clinical nurse specialist's scope of competence or referring the client/family to the appropriate health care provider/agency.

12. Documenting nursing practice.

13. Providing the highest quality nursing care through the utilization and/or conduction of research in nursing practice, standard setting, peer review, evaluation of care, and continuing professional education.

14. Education of family members in the needs of the older adults health care with provision of a wide range of supportive services as appropriate.

15. Coordinating and/or supervising other personnel as deemed necessary through clinic/agency/professional policy, clinical nurse specialist education and credentials, legality issues.

16. Facilitating the process of care through understanding how the delivery system is organized and being able to use it effectively.


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Orientation Toward Health - greater emphasis on prevention and wellness, and greater expectation for individual responsibility for healthy behaviors.

Population Perspective - new attention to risk factors affecting substantial segments of the community, including issues of access and the physical and social environment.

Intensive Use of Information- reliance on information systems to provide complete, easily assimilated patient information, as well as ready access to relevant information on current practice.

Focus on the Consumer - expectation and encouragement of patient partnerships in decisions related to treatment, facilitated by the availability of complete information on outcomes, and evaluated in part by patient satisfaction.

Knowledge of Treatment Outcomes - emphasis on the determination of the most effective treatment under different conditions and the dissemination of this information to those involved in treatment decisions.

Constrained Resources - a pervasive concern over increasing costs, coupled with expanded use of mechanisms to control or limit available expenditures.

Coordination of Services - increased integration of providers, with a concomitant emphasis on teams to improve efficiency and effectiveness across all settings.

Reconsideration of Human Values - careful assessment of the balance between the expanding capability of technology and the need for humane treatment.

Expectations of Accountability - growing scrutiny by a larger variety of payers, consumers, and regulators, coupled with more formally defined performance expectations.

Growing Interdependence - further integration of domestic issues of health, education, and public safety, combined with a growing awareness of the importance of U.S. health care in a global context.

Reprinted with permission of the Pew Health Professions Commission

National Organization of Nurse Practitioner Faculties. (1995). Advanced Nursing Practice: Curriculum Guidelines and Program Standards for Nurse Practitioner Education (2nd ed.). Washington, D.C.: Author.



Care for the Community's Health - Understand the determinants of health and work with others in the community to integrate a range of activities that promote, protect, and improve the health of the community. Appreciate the growing diversity of the population, and understand health status and health care needs in the context of different cultural values.

Provide Contemporary Clinical Care - Acquire and retain up-to-date clinical skills and apply them to meet the public's health care needs.

Participate in the Emerging System and Accommodate Expanded Accountability - Function in new health care settings and interdisciplinary team arrangements designed to meet the primary health care needs of the public, and emphasize high-quality, cost-effective, integrated services. Respond to increasing levels of public, governmental, and third-party participation in, and scrutiny of, the shape and direction of the health care system.

Ensure Cost-Effective Care and Use Technology Appropriately - Establish cost and quality objectives for the health care process and understand and apply increasingly complex and often costly technology appropriately.

Practice Prevention and Promote Healthy Lifestyles - Emphasize primary and secondary preventive strategies for all people and help individuals, families, and communities maintain and promote healthy behaviors.

Involve Patients and Families in the Decision-Making Process - Expect patients and their families to participate actively, both in decisions regarding their personal health care, and in evaluating its quality and acceptability.

Manage Information and Continue to Learn - Manage and continuously use scientific, technological, and patient information to maintain professional competence and relevance throughout practice life.

Reprinted with permission of the Pew Health Professions Commission

National Organization of Nurse Practitioner Faculties. (1995). Advanced Nursing Practice: Curriculum Guidelines and Program Standards for Nurse Practitioner Education (2nd ed.). Washington, D.C.: Author.

Pew Competencies Needed for Health Professionals in 2005 and Role Characteristics

Ability to care for community health:

Practice primary care/prevention:

Promote healthy life styles:

Involve clients and families in decision-making:

Accommodate expanded accountability:


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APPENDIX G -- Nurse Practitioner Collaborative Agreements and Prescription Protocol (Example)


The undersigned nurse practitioner and physician agree to the following collaborative agreement for provision of health care services to clients.

The health care services provided by the nurse practitioner will include: Health maintenance, management of acute episodic illness and stable chronic illness, within the scope of advanced nursing practice.

And agree that education, experience, standards, protocols (oral and/or written), books and other references will be used to define the scope of advanced nursing practice, consultation and/or referral criteria.

Both parties mutually agree to this document per our signatures.

As collaborating physician, agrees to:

A. Be available for consultation on-site or by telephone during office hours, and when the nurse practitioner is covering for phone calls.

B. Delegate prescriptive privileges via mutually developed protocols.

C. Review records and co-sign when appropriate (i.e., when a prescription is written by the nurse practitioner).

As collaborating practitioner, agrees to:

A. Follow mutually agreed upon protocols.

B. Prescribe, as delegated, using the protocols agreed to, and consult when needed, for those medications not covered by protocols.

C. Document consultations and referrals in the progress notes.

Both parties agree to ongoing development of this relationship and mutually review goals and objectives, protocols, and practice concerns formally and/or informally at least annually.

Each party is responsible and accountable for performing to a full and appropriate extent his/her role and function in accord with he collaborative practice agreement, the individual's professional level of knowledge and expertise, and within their separate and distinct scope of practice as defined by the Michigan Public Health Code.

Agreed to on this date By And .



The nurse practitioner may prescribe medications in accordance with the laws of the State of Michigan. The prescribing is under the supervision and delegation of the authorizing physician.

The nurse practitioner may prescribe by signing her name and credentials to the prescription. The authorizing physician's name must also appear on the prescription. Verbal prescriptions, when telephoned to a pharmacy, include the same information.

Medications within the categories on the attached list may be prescribed by the nurse practitioner without physician consultation.

For controlled substances (schedule 2,3,4, and 5 drugs) the authorizing physician must be consulted and the prescription authorized and co-signed. The physician may specify other medications that also require physician consultation.

Medications for chronic problems may be renewed by the nurse practitioner after the patient has been stabilized by the physician.

The physician retains responsibility for and must review and co-sign records when the nurse practitioner writes a prescription. It is the responsibility of the nurse practitioner to have the physician review the chart, if appropriate.





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