Interview With an Advanced Practice Nurse Practitioner and Mistakes

Interview With an Advanced Practice Nurse/Nurse Practitioner and Mistakes

The objective of this study is to answer the following questions as an interview with an experienced Advanced Practice Nurse in regards to their transition from novice to expert practitioner:

(1) What was your experience like transitioning from novice APN (Advanced Practice Nurse) to expert practitioner?

The transition from novice to Advanced Practice Nurse (APN) is a critical time for the nurse and it is a time that is quite unnerving. The experience has moments of feeling powerful and powerless and is a challenging experience but an exciting time in the career progression of the nursing professional.

(2) What helped in your transition?

Having a mentor was of great assistance during the transition in that she acted as a sounding board and a fountain of wisdom.

(3) What did not help in your transition?

My own expectations of myself were the least helpful because I am a perfectionist and perfect does not exist.

(4) What advice should be given to new APNs in their transition?

First, I would advise the new APN to relax more because those who have really applied themselves to their studies will do well. Secondly, I would highly advise that they make proper use of their mentor who is there for them in the form of support and advice.

Part Two

The objective of part two of this study is to examine the legal aspects of being an Advanced Practice Nurse in regards to regulation of practice as well as the aspect of making mistakes and will include the synopses of legal cases against APNs who have actually made a mistake. The number of tasks that nurses undertake is reported to have increased due to various factors "ranging from resource issues such as the need to reduce junior doctors' hours to the fact that nurses are being entrusted with wider responsibility as recognition of their role as independent practitioners." (Tingle, nd, p.69) Included in nursing activities are such as "s electrocardiography, de-brillation after a heart attack, veri-cation of death (not in cases of unexpected death), taking blood samples, and performing male catheterization (Eaton 1993). There are nurse-led minor injuries units (MIUs) where nurses carry out a variety of activities, which can include suturing, X-ray, plaster, and refer (Carlisle 1995). There are also nurse endoscopists (United Kingdom Central Council 2000)." (Tingle, nd, p. 70) Croke (2003) relates that more nurses "are being named defendants in malpractice lawsuits, according to the National Practitioner Data Bank (NPDB)." (p.1) It is reported that between the years 1998 to 2001 "the number of The trend shows no signs of stopping, despite efforts by nursing educators to inform nurses and student nurses of their legal and professional responsibilities and limitations. A charge of negligence against a nurse can arise from almost any action or failure to act that result in patient injury-most often, an unintentional failure to adhere to a standard of clinical practice -- and may lead to a malpractice lawsuit." (Croke, 2003, p.1) Factors that are reported to contribute to the increases in the number of malpractice cases against nurses are reported to include those stated as follows:

(1) Delegation. As a result of cost-containment efforts in hospitals and HMOs, nurses are delegating more of their tasks to unlicensed assistive personnel. Delegation of some of these tasks may be considered negligence according to a given facility's standards of care or a state's nurse practice act.

(2) Early discharge. Patients are being discharged from hospitals at earlier stages of recovery and with conditions requiring more acute and intensive nursing care. 5 Nurses may be sued for not providing care or not making referrals appropriate to the patient's condition.

(3) The nursing shortage and hospital downsizing have contributed to greater workloads for nurses, increasing the likelihood of error.

(4) Advances in technology require nurses to have knowledge of a variety of technologies' capabilities, limitations, and safety features.

(5) Increased autonomy and responsibility of hospital nurses in the exercise of advanced nursing skills have also brought about greater risk of error and liability.

(6) Better-informed consumers are more likely to be aware of malpractice issues and to recognize insufficient or inappropriate care.

(7) Expanded legal definitions of liability have held all professionals to higher standards of accountability. For example, because of the expanded scope of practice of advanced practice nurses, courts have held them to a medical standard of care. (Croke, 2003, p.1) Reported as the nursing negligence issues that were the reasons for settlements or verdicts in favor of patients were those stated as follows:

(1) failure to communicate adequate information to the physician;

(2) inadequate patient assessment,

(3) nursing interventions, or nursing care;

(4) medication errors;

(5) inadequate infection control; and (6) unsafe or improper use of equipment. (Croke, 2003, p.1)

A study involving 250 cases that were analyzed show findings the following types of negligence to be the most frequently reported cases.

Figure 1

Source: Croke (2003)

As shown in the figure above "the greatest frequency of reported cases of negligence occurred" in the following settings:

(1) acute care hospitals (60%).

(2) The rest occurred in long-term care facilities (nursing homes and rehabilitation and transitional care units) (18%);

(3) psychiatric facilities (8%);

(4) home health agencies (2%);

(5) independent practice care settings of physicians (2%); and (6) advanced practice nurses, which include nurse practitioners, nurse midwives, and nurse anesthetists (9%). (Croke, 2003, p.1)