Growth in retail-based clinics after nurse practitioner scope of practice reform.

BACKGROUND: Retail clinics are largely staffed by nurse practitioners (NPs) and are a popular destination for nonemergent care. PURPOSE: We examined if there was a relationship between NP practice regulations and retail clinic growth after the passage of a scope of practice (SOP) reform bill in Pennsylvania. METHODS: General linear regression models were used to compare retail clinic openings in Pennsylvania, New Jersey, and Maryland between 2006 and 2013. DISCUSSION: From 2006 to 2008, Pennsylvania experienced a significant growth rate in net retail clinic openings per capita (p = .046), whereas New Jersey and Maryland experienced no significant increase (p = .109 and .053, respectively). From 2009 to 2013, Pennsylvania opened 0.20 clinics (p = .129), New Jersey opened 0.23 clinics (p = .086), and Maryland opened 0.34 clinics per capita per year (p = .017). CONCLUSIONS: Our study of three states with varying levels of SOP restraint reveals an association between relaxation of practice regulations and retail clinic growth.

Medicare and Medicaid Program: Conditions of Participation for Home Health Agencies. Final rule.

This final rule revises the conditions of participation (CoPs) that home health agencies (HHAs) must meet in order to participate in the Medicare and Medicaid programs. The requirements focus on the care delivered to patients by HHAs, reflect an interdisciplinary view of patient care, allow HHAs greater flexibility in meeting quality care standards, and eliminate unnecessary procedural requirements. These changes are an integral part of our overall effort to achieve broad- based, measurable improvements in the quality of care furnished through the Medicare and Medicaid programs, while at the same time eliminating unnecessary procedural burdens on providers.

Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.

BACKGROUND: One proposed strategy to expand primary care capacity is to use nurse practitioners (NPs) more effectively in health care delivery. However, the ability of NPs to provide care to the fullest extent of their education is moderated by state scope-of-practice (SOP) regulations. PURPOSE: The purpose of this study was to examine the impact of state SOP regulations on the following three key issues: (a) NP workforce, (b) access to care and health care utilization, and (c) health care costs. METHODS: Systematic review. RESULTS/DISCUSSION: States granting NPs greater SOP authority tend to exhibit an increase in the number and growth of NPs, greater care provision by NPs, and expanded health care utilization, especially among rural and vulnerable populations. Our review indicates that expanded NP practice regulation can impact health care delivery by increasing the number of NPs in combination with easing restrictions on their SOP. CONCLUSIONS: Findings show promise that removing restrictions on NP SOP regulations could be a viable and effective strategy to increase primary care capacity.

Professional regulation, public protection and nurse migration.

UNLABELLED: Nurse mobility, developments such as health tourism and the rapid expansion of health systems have increased the need for regulatory bodies to reach beyond their normal stakeholder groups so as to familiarize themselves with the legislation of other jurisdictions. PURPOSE: A systematic examination of a cross-section of nursing legislation, to ascertain the degree of consistency in the number of definitions specified as well as their underlying structure, was conducted to identify opportunities to strengthen public protection and reduce barriers to freedom of movement. METHOD: A purposeful sample of legislation, drawn to maximize differences, was subjected to documentary analysis to identify possible relationships between the variables of interest and the way terms and processes were defined in fourteen nurse practice acts. RESULTS: Potential relationships were identified between factors such as geographic region, legal tradition, administrative approach, regulatory model and economic status and the number and approaches used to specify definitions. A major weakness in the precision of definitions was discovered. DISCUSSION: Several international organizations have started to develop lexicons but all have weaknesses. By drawing upon these lexicons a more comprehensive and precise dictionary could be formulated to support the development of next-generation nurse practice acts. CONCLUSIONS: Current legislation lacks precision and, within the context of increased mobility of nurses, there is an urgent need to develop an authoritative source of definitions that can contribute to increasing public safety as well as reducing delays in the freedom of movement of nurses from one jurisdiction to another.

[Implementation of intersectional field 13: a survey of medical faculties in Germany]. / Implementierung des Querschnittsbereichs 13: Umfrage an den medizinischen Fakultäten in Deutschland.

BACKGROUND: In 2013 palliative medicine (PM) will be integrated into the undergraduate curriculum as part of the mandatory education in German medical universities. The aim of this study is to determine the current state of implementation at German medical faculties (MF). METHODS: All German MFs were contacted using a written postal survey in June 2012. RESULTS: A total of 32 out of 36 MFs participated. Teaching staff consists of 15 or more lecturers in 8 MFs (30 %) and includes psychologists in 24 MFs (75 %) and also nurses in 18 MFs (56 %). Participating physicians are specialized in anesthesiology, internal medicine and general medicine. Teaching staff include palliative outpatient (20 MFs, 63 %) and consultation services (22 MFs, 69 %). Bedside teaching is provided in 15 MFs (47 %). Multiple choice tests are the major form of assessment (29 MFs, 84 %). The total number of teaching units in PM is between 12 and 43 and is usually provided at the end of medical school education. Nurses are employed in the education significantly more in MFs with a chair in PM. General practitioners were engaged only by faculties without a chair in PM. CONCLUSIONS: The implementation of the mandatory training in PM at MFs in Germany is inhomogeneous. Further steps include in particular the development of a competence-based curriculum and assessment.

Medicare program: conditions of participation (CoPs) for community mental health centers. Final rule.

This final rule establishes, for the first time, conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program. These CoPs focus on the care provided to the client, establish requirements for staff and provider operations, and encourage clients to participate in their care plan and treatment. The new CoPs enable CMS to survey CMHCs for compliance with health and safety requirements.

[Legal aspects of selling medical products by gynecologists]. / Aspekty prawne sprzedazy produktów leczniczych przez lekarza ginekologa.

Sales and distribution of medical products and drugs in Poland remains under strict regulations, especially legal regulation contained in the Medical and Dental Practitioners Act, that banned sales of medical products by doctors. It needs to be emphasized that currently doctors are allowed to sell drugs and medical products only in rigorously specified situations. Knowledge of current legal regulations concerning sales of medical products by gynecologists allows to conform with the law and to distribute drugs and medical products under special and predefined conditions.

Is there no alternative? Conscientious objection by medical students.

Recent survey data gathered from British medical students reveal widespread acceptance of conscientious objection in medicine, despite the existence of strict policies in the UK that discourage conscientious refusals by students to aspects of their medical training. This disconnect demonstrates a pressing need to thoughtfully examine policies that allow conscience objections by medical students; as it so happens, the USA is one country that has examples of such policies. After presenting some background on promulgated US conscience protections and reflecting on their significance for conscience objections by medical students, this paper observes that the dominant approach (following the American Medical Association's conscience clause) is to allow exempted students to instead be evaluated on the basis of alternative curricular activities to learn the associated underlying content. This paper then introduces and discusses an example in which male Muslim students who believe it is wrong to touch members of the opposite sex object to performing physical examinations on female subjects in their medical training. This sort of case, it is argued, causes difficulty for a conscience clause that resolves the dilemma by granting reasonable exemptions in the form of participation in alternative curricular activities: there are cases where one must perform the 'objectionable' activity itself in order to learn the necessary content and underlying principles.

Medical liability of the physician in training.

BACKGROUND: Lawsuits alleging medical negligence by postgraduate physicians in training (residents) arise from treatment received by aggrieved patients at teaching hospitals. A threshold question in determining liability is whether or not the standard of care has been violated. Courts have questioned whether the proper standard governing resident physician conduct should be that of a reasonably competent generalist physician, that of a specialty physician, or whether the standard should be some subjective determination that addresses the resident level of training. QUESTIONS/PURPOSES: We examined legal cases in which the standard of care for a physician in training has been questioned. Additionally, we address how resident conduct can extend liability to supervising physicians and employer hospitals. METHODS: Westlaw and LexisNexis, two major legal databases used by law professionals, were searched to identify existing case law and law review articles related to the standard of care that applies to physicians in training. Of 57 sources initially identified, 15 legal cases and 10 law review papers addressed the standard of care pertaining to physicians in training. These selected cases and papers form the basis of the present article. RESULTS: The standard by which the professional conduct of a physician in training is measured has varied; most recent legal cases have applied a specialty physician standard. Relevant court rulings have tried to strike a balance between patient interests versus the societal need to train physicians. CONCLUSIONS: Physician representation, nature of conduct, and extent of supervision of that conduct are relevant factors used by courts to determine liability. However, the recent standards are those of the physician who directly supervises the professional conduct of a resident in a given situation.

[Forensic psychologist's considerations about the new law regulation in cases of sexual crimes]. / Uwagi psychologa sadowego o nowych regulacjach prawnych w sprawach o tzw. przestepstwa seksualne.

The article comments, from the perspective of a forensic psychologist, the changes which have been recently provided to the law regulations on sexual crime and the treatment of the sexual crime perpetrators. It appears that the new law regulations follow the right path, because they create the conditions for holistic and complex solutions in the sexual crime treatment matter. Unfortunately they are still rather incomplete and inconsistent. Their practical implementation is difficult because of the very demanding qualification criteria to the psychotherapy of sexual crime perpetrators, the existence of law criteria to the therapy, the narrow frame of the therapy goals and unclear rules of therapy constraint. Moreover, in Poland there is a lack of complex therapy models of sexual perpetrators, we have little experience in this kind of therapy and there is a deficiency of qualified specialists. Finally the relationship between the treatment of this kind of criminals in prison conditions and ambulatory therapy conditions isn't very clearly precise. On the other hand, a lot of improvements have been provided, such as: continuing the treatment after leaving prison, not only pharmacological treatment but also psychotherapy, the system of prevention. Despite of the strong attempts to promote the special role of pharmacological treatment of sexual crime perpetrators (,,chemical castration"), the new solutions promote a complex and interdisciplinary approach to this problem. In this article, the author described the current Polish experience in the therapy of sexual crime perpetrators and listed several rules of preparing the forensic-psychological expertise according to the described problem in context of new legal regulations.

[The competencies of health professionals and the ministerial policies]. / As competências profissionais em saúde e as políticas ministeriais.

In Brazil, nursing professionals are trained based on the perspective of professional competencies. The objective of this exploratory, descriptive study was to identify the critical-emancipator potential of the competency, as described by the Brazilian Ministries of Education and of Health. The sources used for data collection were the regulating documents of technical professional education of the referred Ministries regarding the years 1996 and 2006. Results showed that, for the Ministry of Education, the guiding principles of professional education are the demands of the working market; the idea of competency is supported on the constructivist perspective, highlighting personal features over their social dimension. For the Ministry of Health, professional education is an instrument of citizenship, guided by the political health care paradigm of the national public health system, referred to as the Unique Health System; the idea of competency is founded on the critical-emancipatory perspective. In conclusion, the two Ministries, despite having regulations regarding professional education, are contradictory in terms of their conceptual foundations.

Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective.

Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed.

Roundtable discussion: "no one can condemn you to a C-section!".

The stories in this Roundtable Discussion are related by two women whose babies were born recently in Canadian hospitals. Each woman had undergone a cesarean delivery for her first child, and whereas Sophia delivered her second baby by vaginal birth after a cesarean (VBAC), Marie was unable to find a practitioner or hospital that would allow her to have a VBAC for her second birth. The women describe how they feel about their choices and experiences. Their two accounts and the issues that they raise are discussed in commentaries by a family physician, midwife, doula, and obstetrician.

Can mental health nurses diagnose in Australia?

The naming of health related conditions has been the traditional province of the medical profession. Occasional concessions have been made in specific narrow domains, such as psychology or speech-related pathology, but diagnosis typically has been seen as medical practitioner business. "Ownership" of language is worthy of critical discussion. The answer to why the tradition has persisted, and nurses have invested lots of energy within the established rules of who can say what, may well be found through the lens of psycholinguistics. Nurses can name states of health and ill health using the currently accepted nomenclature. The authors argue that there is an unconditional "yes," to the question of can nurses diagnose, as long as they are not holding themselves out to be a medical practitioner by doing so. Additionally it is argued that advanced practice nurses must diagnose in order to fulfill their role as advanced practice clinicians.

Vision, grit, and collaboration: how the Wisconsin Center for Nursing achieved both sustainable funding and established itself as a state health care workforce leader.

In 2001, a dedicated group of nurses from across Wisconsin came together to discuss how to create a state center of expertise on key nursing workforce issues. The result was the establishment of the Wisconsin Center for Nursing (WCN) in 2005. Since that time, through its statewide Board of Directors, WCN has clarified and targeted specific state workforce needs and identified gaps that exist in addressing those needs. During its five-year existence, WCN has received funding from a variety of sources, and volunteers have spent hundreds of hours working on behalf of the organization. Finding a sustainable base of funding for WCN has been a priority in order to ensure that the organization can hire permanent staff and invest in ongoing initiatives. In 2009, WCN was involved in developing a strategy that resolved both the issue of sustainability and the need to collect and analyze data on the nursing profession. A bill was passed by the Wisconsin legislature that required RNs and LPNs to complete a comprehensive survey every two years when they renew their state licenses. In addition, the legislature raised the licensure fee for RNs and LPNs and dedicated a portion to WCN to assist in the analysis of the newly-collected nursing workforce data and to develop a state-wide plan addressing the future of the Wisconsin nursing workforce. This article will include the history of the WCN and the details of its journey toward sustainability including accomplishments and lessons learned.