INDEPENDENT PRACTICE ISSUES

Prepared by :Christian Raveina 1st year M.Sc.Nursing,MTIN, Changa.

INTRODUCTION :Self employed

nursesstill bound by all

nursing legislation and standards

face some unique challenges

KEY PRACTICES COMPONENTS TO CONSIDER THE SCOPE OF SERVICES : a nurse needs to clearly

identify that he or she is providing nursing services, the extent of those nursing services and under what conditions he or she will refer clients to other health care professionals.

must maintain the high standards of nursing and uphold the public trust that has been bestowed on the nursing profession

CONFLICT OF INTEREST primary obligation is

providing professional care to his or her clients

In a position of trust and cannot use their position to influence their clients for financial gain of non-financial benefit

CONFLICT OF INTEREST CONT… Avoid selling products

or services to clients they are treating

avoid conflict of interest situations in their practice, particularly when it comes to the endorsement and advertising of products.

ENDORSEMENT Endorsing or

promoting a product or services is closely linked to conflict of interest

Endorsement occurs when a nurse uses her credentials to lend credibility to a commercial product line or service.

ENDORSEMENT CONT… The endorsement of a

product or service without providing information about other options could mislead the public and compromise trust.

For example, a nurse in independent practice who provides foot care services should not sell any foot care products for her clients.

ADVERTISING There are limitations on how a

nurse can advertise his or her services.

Advertising may take various forms, such as business cards, listing in telephone directories, announcements in newspapers and periodicals, and promotional materials.

It can include information such as a description of services and nursing credentials, practice experience, fees, address and phone number.

PRACTICE GUIDELINE INDEPENDENT PRACTICE FEES The college does not

determine or approve specific service fees. According to Nursing Act 1991 and the accompanying regulations, the following activities related to fees are considered professional misconduct.

A). Submitting an account or change for services that the member knows is false or misleading.

PRACTICE GUIDELINE INDEPENDENT PRACTICE FEES CONT… B)Failing to fulfill the terms of an

agreement for professional services.

C). Charging a fee that is excessive in relation to the service for which it is charged and/or

D). Offering or giving a reduction for prompt payment of an account. Before setting fees, a nurse should research the fees of other nurses who have similar qualifications and experience and who provide comparable services.

INFORMED CONSENT Nurses in independent practice

are expected to obtain informed consent before performing any treatment.

For consent to be valid, it must relate directly to the treatment.

Treatment is defined as anything that is performed for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health related purposes, and includes a course or plan of treatment.

DOCUMENTATIONAn integral part

of service that a nurse provides is creating and maintaining accurate and complete health records and documentation.

DOCUMENTATION CONT… Health records are the

means by which information about the client is communicated to the health care team and how continuity of care is maintained.

They also demonstrate the nurse’s accountability and answer questions about the type of care provided

CONFIDENTIALITY Nurses in

independent practice are required to maintain the confidentiality of the client information and cannot communicate the information to another person unless the client or client’s representative gives consent or it is required by law.

OTHER ISSUES AND RESOURCES INCORPORATION Regulated

professionals may incorporate their independent practice under legislation.

BUSINESS OR LEGAL COUNCIL

Nurses may want to seek legal advice before starting an independent nursing practice.

LIABILITY PROTECTION The college

recommends that nurses in independent practice purchase liability protection to enable public redress if any problem occurs.

NETWORKING

Entrepreneurial support groups for self employed nurses offer assistance with peer feedback, idea and issue sharing, planning for vacation and sickness etc.

VARIOUS AREAS OF INDEPENDENT NURSE PRACTICE :

Adult nurse practitioner Family nurse practitioner Pediatric nurse practitioner Acute care nurse practitioner Geriatric nurse practitioner Psychiatric and mental health

nurse practitioner Midwifery or women’s health

nurse practitioner School health nurse

practitioner Family nurse practitioner

INDEPENDENT NURSE MIDWIFERY PRACTITIONER

INTRODUCTION : Activities of health care

providers who are experts in the women health care including prenatal care to expectant mothers, attending at birth and providing post partum care to mother and infant.

Practitioners of midwifery are known as midwives.

Independent midwifery practice enables registered nurse midwives to utilize their knowledge skills, judgment and authority in the provision of midwifery practice package and primary women’s health services while maintaining accountability for the management of patient care in accordance with midwifery standards laid down by the midwifery or nursing council of their country.

Independent should not interpreted to mean alone, as there are clinical situations when any prudent practitioner would seek the assistance of other qualified.

MIDWIFERY PRACTICE PACKAGE FOR INDEPENDENT PRACTICE : 1. Access to a midwife 24 hours

a day, 7 days a week.2. Two midwives available

alternatively and provide women centered antenatal, intrapartum and postnatal midwifery care.

3. Antenatal care in privacy.4. Continuity of care throughout

labour.5. Postnatal care up to 6 weeks.6. Knowledgeable breast

feeding support.

STANDARDS REQUIRED FOR THE PRACTICE OF MIDWIFERY :

Midwifery practice as conducted by midwife is the independent management of women’s health care, focusing particularly on pregnancy, child birth the postpartum period care of newborn, family planning and gynecological needs of women.

Midwives provide consultation, management, collaborative management or referral as indicated according to standards of midwifery practice.

In India as such standards of midwifery practice act are not developed to do independent midwifery practices which are one of the essential requirements. American college of nursing midwives has defined eight standards of practice.

STANDARD- I : Midwifery care is provided

by qualified practitioners. Midwifery should be

registered. Shows evidence of

continuing competency as required by certification agency by council.

It is in compliance with the legal requirements of the jurisdiction where the midwifery practice occurs.

STANDARD- II : Midwifery care occurs in a

safe environment within the context of the family, community and a system of health care.

Demonstrate a safe mechanism for obtaining medical consultation, collaboration and referral.

Uses community services as needed.

•Demonstrates knowledge of the medical, psychological, economical, cultural and family factors that affect care.•Demonstrates appropriate techniques for emergency management including arrangements for emergency transportation.•Promotes involvement of support persons in the practice settings.

STANDARD- III : The midwives practices in

accordance with the philosophy and the code of ethics of the professional body provides clients with a description of the scope of midwifery services and information regarding the client’s rights and responsibilities.

Provides clients with information regarding services when requested or when care required is not within the midwife’s scope of practice.Provides client with information regarding health care decisions and the state of science regarding these choices to allow for informed decision making.

STANDARD- IV : Midwifery care is comprised

of knowledge, skills and judgment that foster the delivery of safe satisfying and culturally competent care.

The midwife collects and assesses client care data, develops and implement individualized plan of management and evaluates outcome of care.

Demonstrates the clinical skills and judgments described in the basic midwifery practice.Practices in accordance with standards.Practices in accordance with service or practice guidelines that meet the requirements of the particular institution or practice settings.

STANDARD- V : Midwifery care is based upon

knowledge, skills and judgment which are reflected in written practice guidelines.

Midwife describes the parameters of services for independent and collaborative midwifery management and transfer of care when needed.

Establish practice guidelines for each specialty area which may include, but is not care of the child bearing family and newborn care.

Includes the following information in each specialty area :

Client selection criteria. Parameters and methods

for assessing health status. Parameters for risk

assessment. Parameters for consultation,

collaboration and referral. Appropriate interventions

including treatment, medications and or devices.

STANDARD- VI : Midwifery care is documented in

a format that is accessible and competent.

The midwife uses records that facilitate communications and institutions.

Provides prompt and complete documentation of evaluation, course of management and outcome of care.

Promotes documentation system that provides for confidentiality and transmissibility of health records.

Maintain confidentiality in verbal and written communications.

STANDARD- VII : Midwifery care is evaluated

according to an established programme for quality management that includes a plan to identify and resolve problems.

The midwife participates in programme of quality management for the evaluation of practice within the setting in which it occurs.

Provides for a systemic collection of practice data as a part of a programme of quality, management.

Seeks consultation to review problems, including peer review of care.

Acts to resolve problems identified.

STANDARD- VIII : Midwifery practice may be

extended beyond the set competencies to incorporate new procedure that improve care for women and their fames.

The midwife identifies the need for new procedure taking into consideration consumer demand, standards for safe practice and availability of other qualified personnel.

Ensures that there are no institutional state or council statures, regulations or laws that would constrain the midwife from incorporation of the procedure into practice.

Reports the incorporation of this procedure to the authority. In respect to provide standardized practice independently, the nurse midwife has to meet required education, experience, advanced skills and competency.