Business Plan Development

 
Elizabeth Jones, FNP-BC, has been an NP for 8 years. She has worked in the primary care setting, as well as the urgent care setting. She is considering relocating to a state that allows for unrestricted independent practice and opening her own primary care clinic. There are multiple benefits to owning an independent practice. However, owning a practice requires extensive knowledge and support. For an NP to establish independent practice, an appropriate plan must be developed.
For this Assignment, you will create a Business Plan for the potential future business.
Write a 2 page paper Business Plan that addresses the cost for establishing your own independent practice in your home state, including:
o Clinical site expenses
o Employee structure and expenses Supplies
o Utilities and other overhead expenses
o Malpractice insurance
o Continuing education expenses
o Accounting fees
o Services identified that you will provide (e.g., primary care services, drug screens, DOT exams)
o Projected monthly income necessary to support your independent practice

Leadership Implications

 
Discussion:
“The greatest leader is not necessarily the one who does the greatest things. He is the one that gets the people to do the greatest things.”
— Ronald Reagan
U.S. President (1981-1989)
Leadership is a critical role for advanced practice nurses. In order to be an effective leader, one must examine his or her role as an advanced practice nurse, and use his or her knowledge, and leadership skills to address issues related to his or her specialty area. There is a saying that one must know when to follow and when to lead. In order to be a good leader, you must also learn how to follow. As you transition from student to practicing NP, seek opportunities for mentor-ship to develop your leadership skills. Recognizing when to lead and when to follow is an interchangeable process that requires experience and preparation. The future for Americans in health care is unpredictable. This week it is important to focus on the complex and advanced leadership role that is needed to make effective change in a dynamic and demanding health care system.
This week you will focus on the importance of leadership in advanced practice nursing. You will have an opportunity to examine how you can execute positive social change in your state for salient advanced practice nursing issues.
State Practice Agreements
Write 1 page
This week you will have an opportunity to evaluate state practice agreements in your state ( of TEXAS ) and examine issues related to NP practice.
To prepare:
1. Review and Post a brief description of the REVIEW of practice agreements for NPs in your state of TEXAS.
2. dentify /name at least two physician collaboration issues in your state of Texas.
3. Explain what you think are the barriers to NPs practicing independently in your state mof TEXAS.
4. Finally, outline a plan for how you might address NP practice issues in your state.
5. Suggest additional actions you will  take.
6. Validate an idea with your own clinical experiences with the support of an additional literature search from a reputable source.

REFERENCES:

Required Readings

Buppert, C. (2015). The Employed Nurse Practitioner. In Nurse Practitioner’s Business Practice and Legal Guide (5th ed.). (323-336). Burlington, MA: Jones & Bartlett.
This chapter covers the rights of employed NPs, contract negotiation, interviewing, responsibilities of an NP employee, employer’s evaluation of the NP’s performance, malpractice insurance, and collaborative practice agreements.

Health Systems MGT (HCA 344)

 
The name of the book is (HOSPITALS)
**there are multiple choices questions and some essay questions**
QUESTION 1
In Article 2 (Scott et al), what aspects of nursing are LEAST satisfying to patients?
o Interactions based on physical and technical aspects of care only.
o Human understanding of patients’ (and relatives) illness experience.
o Technical & clinical skills competence for safe outcomes.
o Time spent listening and talking (caring behaviors).
QUESTION 2
As stated in Article 2 (Scott et al). inadequate patient-nurse staffing result in patient death.
o True
o False
QUESTION 3
Each of the following statements regarding the structure and function of the clinical laboratory are true EXCEPT:
o The clinical pathology division of the clinical laboratory is under the direction of a pathologist.
o The microbiology staff isolates and identifies microorganisms collected from patients.
o The clinical chemistry staff measures various analytes in plasma and serum (from Dr. Thorn – for your information “analytes” refer to metabolic panel items like the following: sodium, potassium, chloride, bicarbonate, blood nitrogen (BUN), creatinine, glucose, calcium).
o Staff in the phlebotomy section can collect blood samples from patient, as shared responsibility with the nursing staff.
o All of the statements above are TRUE.
QUESTION 4
You are a CEO of a 200-bed community hospital in a RURAL Kentucky region with a PHYSICIAN SHORTAGE. Given your concern for the well-being of your citizens, you are grateful for the increase of nurse practitioners and physician assistants who moved into your community. Even though these nurse practitioners and physician assistants will not have admitting privileges to your hospital, they can refer admissions to your hospitalists. You decide to write an editorial to the local newspaper about their community value.
Address the following points in your Editorial:
Dear Rural Community Citizens:
What is a nurse practitioner? What duties (medical care) can a APRN (Advanced Practice Nurse) conduct?
What is a physician assistant? What duties (medical care) describes the role of a PA?
Encourage the local citizens to support the role of nurse practitioners and physician assistants in their community.
Why you, as the CEO of a hospital, finds value to having not only medical doctors but also NPs and PAs providing health care in the community.
Sincerely,
CEO
QUESTION 5
Approximately 40 – 50% of all hospital employees work in the department of nursing.
o True
o False
 
QUESTION 6
You are a graduate of the masters in HCA at WKU. You have held a mid-level management position in a hospital setting for the past 5 years. You are now interviewing for the position of Chief Operating Officer (COO) at a 120-bed Lifepoint-owned Hospital in Gallatin, Tennessee. One of several departments that will be under your responsibility, should you be selected, is the Department of Physical Therapy. The Director of the PT Department who recently received his doctorate degree in physical therapy from WKU will report directly to you.
How will you respond to the following questions posed by the Director of Human Resources during your JOB interview?
Question 1: tell me about your working knowledge of the role of physical therapists and physical therapy assistants and the services they provide in a hospital setting.
Question 2: Our PT department currently employs 10 FTEs (full time equivalents), in order to justify keeping this level of staffing going forward, describe how patient outcomes are affected by PT services.
QUESTION 7
Technology typically found on today’s patient care units include:
o Computerized axial tomography (CAT) scan, bar code-assisted patient identification, bedside computer terminals.
o Physician dictation station, hazardous waste incineration, telemonitoring equipment.
o Delivery robot, magnetic resonance imaging (MRI), interactive patient education systems.
o Bar code-assisted medication administration (BCMA), computerized medication dispensing machines, computers dedicated for physician use.
QUESTION 8
Which area within the Diagnostic Imaging Department uses radiopharmaceuticals to diagnose and treat disease?
o Radiation therapy (RT)
o Nuclear medicine (NM)
o Isotope tomography (IT)
o Radioactive fluoroscopy (RF)
QUESTION 9
Which diagnostic imaging modality provides the physician with a two-dimentional image?
o Chest radiography (x-ray)
o Computed tomography (CT) scans
o Magnetic resonance imaging (MRI)
o Ultrasound (US)
QUESTION 10
Diversity is a complex issue that reaches beyond rare, religion, and gender. For example, diversity also includes how to blend the work styles of three generations of hospital employees – Boomers, Gen X, Millennials. Healthcare leaders, like you will be someday, must demonstrate a commitment to building a DIVERSE workforce and developing an INCLUSIVE environment in which all personnel are respected, valued and engaged. Now to the essay questions:
a. Define the term “cultural competence” and its four components.
b. What is the “business case for diversity”? Said another way, when an healthcare organization embraces diversity and inclusion principles, how does it benefit the organization’s effectiveness?
c. The concept of inclusion, in concert with diversity and cultural competence, helps improve services in hospitals. Inclusion is:
QUESTION 11
__________ describes a specialty, ancillary service that uses high-energy ionizing radiation to destroy cancerous cells.
o Radiation Therapy.
o Radiation Oncology.
o Therapeutic radiology.
o All of the above.
Question 12
The most common size of patient-care or nursing unit is between:
o   8-10 beds per unit.
o   20 to 40 beds per unit.
o   60 to 70 beds per units.
o   >100 beds per centralized unit.
Question 13
Radiologic technologist are key personnel who perform diagnostic imaging examinations. As health care administrator, you will expect the following from this staff rule:
o   Cost-effective diagnostic imaging services
o   High-quality, accurate diagnostic images
o   Required education, certifications, and licensures
o   All of the above
QUESTION 14
This chapter informs you that hospitals significantly declined in number in the last several decades and that they are now better at controlling ALOS
a. Define the term ALOS
b. According to this author. What trend resulted in the significant decrease in hospital ALOS in the 1990s?
c. Find Table 2-2 in Chapter 2 page 15. State the ALOS trend for AHA-Registered Hospitals in the United States between 1980 to 2008
d. GO on-line to the internet to find the most current United States ALOS you can find Tell me what ALOS you found in what year AND compare it to the 5.5 days 2008 in Table 2-2
QUESTION 15
Clinical laboratories must be granted a certificate of compliance with CLIA (Clinical Laboratory Improvements Act) and it must be renewed every 2 years. CLIA 1988 was implemented by US Congress in 1988 as a measure to:
o   Prevent misdiagnosis of patients through misread or mixed up lab results.
o   Defined testing categories according to their level of complexity and which lab personnel could perform them.
o   Both A and B.
o   None of the above.
QUESTION 16
A patient may enter a hospital in a planned or unplanned manner. A planned entry into the hospital occurs when a physician with admitting privileges refers the patient to that hospital through the admissions office. Remember as a non-clinical healthcare manager you could head up the admissions department. Unplanned patient admissions through the emergency department occur every day e.g. from heart attacks or motor vehicle accidents. The emergency department of a hospital, and how it well it operates, will influence the success of the hospital. For example, if physicians and patients trust the services provided in Hospital A’s ER, it becomes a HUGE source of admissions for hospital A. When beds are full, hospitals are financially healthy. But, if Hospital A’s ER is inefficient – long wait times or patients are misdiagnosed then physicians and patients will go to Hospital B. Hospital B’s admission rates improve and it achieves financial and patient outcome successes.

Social Change Agents

 

State Practice Agreements

Social Change Agents

 
STATE PRACTICE AGREEMENT
Social change Agents
“We’ve been called disruptive innovators,” Ford said. “And I think ‘disruptive innovators’ is great – we just need more of them.”
— Heidesch, T. (2008)
As NPs, we are obligated to promote our profession. A component of promoting the profession is proactively being engaged with our communities and identifying areas where change is needed. An example of this would be identifying a community issue, such as an increase in the rate of obesity in a middle-school population and discovering that soda machines are present in the schools. Identifying a problem and being a positive change agent is an essential component of the NP role. Understanding the lawmaking process and how to initiate a local or state change empowers the NP to impart Social Change.
This week you will focus on the importance of leadership in advanced practice nursing. You will have an opportunity to examine how you can execute positive social change in your state for salient advanced practice nursing issues.
Consider the following:
During NP clinical practicum experiences, we identify, as nurses, many health care issues that need to be addressed at the local, state, or national level. Addressing the need for change in health care policy is now an intricate part of your role as a social change agent.
For this Discussion, you will identify a change needed in your community and what your nursing legacy for positive social change will be.
To prepare:
· 1. Consider the health care issues and deficits you have recognized in your professional practice.
· 2. Identify a change needed in your community in health care policy and discuss how you could impart change during your career as an NP.) (A change needed in my community is Obesity ).
· 3. Consider your future as a NP and what your nursing legacy will be. How will you impart Social Change?
1. Post a change needed in your community and an explanation for how you will begin to implement that change.
2. Then, share with your colleagues a brief explanation of what your nursing legacy will be:(My nursing legacy  will be (Being an advocate for health promotion through disease screenings and illness prevention)
3.  How will you impart Social Change. 
4.  Provide  at least one suggestion for a colleague in your class on how they could implement this change and for their nursing legacy.
REFERENCES: Required Readings
Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Sudbury, MA: Bartlett & Jones Learning.
· Chapter 12, “Lawmaking and Health Policy” (pp. 421-433)
This chapter covers the legal process, the judicial system and health policy. Additionally, law and rules that affect NPs, how to initiate a change in law and the process involved from beginning until law or rule is finalized.
Christensen, C. M., Bohmer, R. M. J., & Kenagy, J. (2000). Will disruptive innovations cure health care? Harvard Business Review, 78(5), 102-112, 199.
Note: Retrieved from the Walden Library databases.
National Conference of State Legislatures (n.d.). Glossary of Legislative Terms. Retrieved from http://www.ncsl.org/research/about-state-legislatures/glossary-of-legislative-terms.aspx