00:01
In today's video, we'll look at what changes
occur in terms of scope of practice, legal
things and ethics.
00:07
When you make the role transition from
registered nurse to advanced practice
registered nurse.
00:12
And I'll also share some tips that I think
will help make your transition to practice
maybe a little bit smoother.
00:18
Plus, we can talk about the question I get
asked most often from new Aprns
as they're switching roles, which is how
long exactly until I feel more
comfortable in this new role because this
whole transition, it's a
lot, which means we should probably get
started.
00:35
So when you are moving from the RN to Aprn
role, your scope of practice
is of course going to change.
00:42
As a nurse, you assess patients to see how
they're doing, and then you implement the
prescribed treatment plan as needed based on
those assessments.
00:51
And then you sound the alarm when things are
not going as expected.
00:55
But as an aprn, you add in the layer of
deciding what
is going to happen when the alarm is
sounded.
01:03
There's usually less implementation in the
aprn role, and
instead you spend your time assessing,
diagnosing and treating patients.
01:12
And that comes with a huge a huge
responsibility shift.
01:16
And if I'm being completely honest, I
totally underestimated that when I went
to NP school.
01:23
Like I knew I would be making diagnostic and
treatment plan decisions, but the
reality and the weight of that is definitely
something that hit different once I
started going in and being the final one to
decide what treatment plan to pursue and
what diagnosis a patient would carry with
them, maybe forever in their
chart. And if you haven't sat with that to
make sure you're comfortable with it,
I would encourage you to do so.
01:48
And if you think that it might be something
that would cause you some anxiety, which is
super, super common for this to cause
anxiety, start brainstorming
how you're going to manage that.
02:00
One thing that you could do now is start
asking your clinical
instructors or your clinical peers how they
handle some of
those feelings when they come up around
this.
02:11
It's common for the weight of that new
responsibility for it to
be a little bit difficult to navigate.
02:19
And by the way, you are gaining
responsibility in more
areas than just direct patient care.
02:26
You are much more responsible for your own
learning and keeping up
to date with evidence based guidelines.
02:33
You typically are also responsible for your
own little team
within your place of employment.
02:40
Often, as an aprn, you will have a medical
assistant working with you
and if you are lucky, you might have a nurse
as well.
02:47
And while you did delegate as a nurse, it
sound like a whole new
level. Now you can decide how you want your
visits to be set
up, what information the Ma will collect for
you at the beginning of the visit.
03:01
Based on the visit type, you'll be creating
protocols that will be Standard and
decide if the nurse working with you can
give standing meds.
03:09
If so, what are the protocols surrounding
that?
And you'll also need to figure out how to
work as a
cohesive unit, even when working through
things like conflict.
03:23
You'll also be an advocate for your team to
make sure that they're being treated fairly
at work, while also having a good
relationship with the
office admin.
03:34
It's honestly like it's a whole new little
dance to learn and you can do it.
03:39
It's just going to take a little bit of
practice now.
03:42
Again, starting now, it's probably a good
idea to when you're
in clinical, go and observe.
03:49
See does this team run well?
Does your preceptor have a good system with
the Ma they work with and the
other staff that's there, or is it a hot
mess?
You can honestly learn a whole lot from
both.
04:03
And seriously, just start taking notes so
that you can implement these things later
on down the line without having to try to
remember them
now already.
04:14
That was a lot and we barely started, but I
promise you it will be okay.
04:18
You will be okay. And there is there is good
news.
04:21
You already know the basics of a lot of
this.
04:25
You have already been assessing patients as
a nurse, so we just need to build on
that. You already have been around a lot of
diagnoses, so start
reading progress notes right now and
listening to rounds to hear how they
kind of weed out differentials, to get more
of the hang, of how those thought trains
actually work in real life.
04:46
And the best news of all is currently, you
probably do a
lot of patient education and patient
advocacy, and you're going to do a lot
of that as an aprn as well.
04:58
But you already do it as a nurse, so there's
not much.
05:00
Change there honestly, and that is hard to
learn.
05:03
So that's one huge thing that you don't even
have to worry about now.
05:07
Next, I want to talk about legal things to
consider when going from an
RN to an Aprn role.
05:14
And most importantly, you need to know where
you can work, what type of patients you can
see, and what you can actually do for them.
05:22
As a nurse, you can work in whatever setting
that nurses can work in and with
pretty much any patient.
05:29
And that is not is not the case.
05:33
As an aprn, your care is very specific to
patient and
setting based on your certification and your
training.
05:41
And it's not black and white.
05:44
It's not black and white at all.
05:45
And it's something that you will need to
look up based on your own state laws.
05:49
And you need to personally reflect on what
training you have had,
even if the patient is technically in the
right population and in the right
setting for your certification.
06:01
I would personally ask myself if I were to
care for this person
with this diagnosis, could I, in court,
confidently defend my
ability to have cared for them by listing
all of the ways that I was then trained to do
so? And if the answer is no, you need to
solve that by either getting more training
or not working with that patient population
or diagnosis.
06:24
And please do not rely on your future
employer to know what
is in or out of your scope of practice,
because many employers are not
sure exactly the types of patients that you
can and can't see.
06:39
So it's your job to research that and to let
them know if they're
trying to have you practice outside of your
scope, which you should never,
ever, ever, even if they ask really nicely,
do, because you are
now very responsibly, legally for actions
that you take with
your patients. Like, yes, you were
responsible for those things as a nurse as
well. But there was also some shared
responsibility for many of those roles.
07:06
Malpractice insurance.
07:08
Yeah, you may have had it as a nurse, but
you absolutely need to have it as an
aprn and you want it with tail coverage.
07:16
That means that you have coverage for events
that occurred while you were at the practice,
and will continue to have coverage for that,
even if you are no longer
working there. It is crazy expensive, but
you need it and it can
often be negotiated into your employer
contract.
07:33
Those are the basics.
07:36
Now, what is even more fun than talking
about legal things?
Ethics, which I actually spent far more time
pondering as a nurse
practitioner than I ever expected.
07:48
First, the easy ethical stuff.
07:51
Remember how we discussed you having way
more responsibility for things like your
own learning?
That's really an ethical thing.
08:00
Your patients deserve to have the most up to
date and evidence based guidelines that
apply directly to them, and that takes a lot
of work on your end to keep
up with that type of thing.
08:11
You you, yes, need to get CEUs for your
license, but the driving
force behind you keeping up with learning is
now patient safety
because you decide what policies need to
change based on what knowledge
you obtain from journals and other resources
that you use to keep up with,
like your current practice.
08:32
Now, will you personally be combing through
journals trying to find the latest and best
evidence? Probably not.
08:38
There are services and associations like
ones published by your specialty, that will
do that for you and give you like a nice
little summary of the topic.
08:46
But you do need to actively go out and seek
and learn that
information. What database and journals
should you use for this?
This is an excellent thing.
08:56
Again, to ask your preceptors while you're
in clinical.
08:59
Ask them how they keep up to date with
information.
09:03
There's amazing apps and podcasts and
websites and journals, etc.
09:07
that can be really good learning tools, many
of which you can honestly use while you're
doing things like commuting.
09:14
I would just write all of them down now,
even if you don't start utilizing them at
this point, and that list will be a
phenomenal resource for you in your
future, in your aprn practice.
09:25
But what happens when your patient can't
afford or
access the evidence based care that you so
dutifully researched for
them? This is an ethical dilemma that we
can't solve today, but
it's one to start thinking about.
09:41
Start learning about resources in your
community to help you meet those gaps that
are left in our health care system.
09:48
But I do have some general advice for making
your transition from
RN to Aprn a little bit smoother.
09:57
And the biggest tip that I can possibly.
09:59
Offer you is to take your time finding your
first job.
10:04
Work your nursing job that you have until
you find a really good
aprn job.
10:10
Because the biggest thing that's going to
determine how your role transition to
practice is actually going to go is who you
are taking that journey with.
10:18
You want to work with people who want to work
with you, who don't mind all of your
questions because you are going to have a
lot of them.
10:26
You want colleagues and office admin who
understand that you're
going to be really slow in the beginning,
but who also realize that you do
have value and deserve respect from day one.
10:41
And when negotiating your job, I want you to
advocate for a ramp up
schedule for your onboarding so that you
aren't starting seeing 20 patients
a day. Instead, you see one patient per hour
while you're learning things like
the charting system, and you're looking up
every single thing constantly throughout the
day. And then slowly appointment times
decrease as you get
faster and more comfortable, because you
will get faster and more
comfortable. It just takes time, and you can
jump start this
whole process of getting comfortable by
asking your employer for a list of like
the 10 to 15 most common diagnoses and
reasons for
presentation that they see at your office,
and then you can prepare
HPI questions, assessment findings,
differentials, diagnostic workups,
and treatment plans for all of those before
you ever see patients,
which will give you a huge confidence boost
for those visits when they do happen.
11:41
And also it gives you something to do with
all of that nervous energy you have
before your job starts.
11:48
And if you want to save even more time later
on, create some basic
templates for charting.
11:54
For those commonly seen diagnoses.
11:56
Type them up in a document and paste them
into a template as soon as you have access to
it. Or you can do it as you reach the
patient.
12:04
Encounters. In practice, charting takes up a
ton
of valuable time, and templates are a great
way to help combat that issue a little
bit. Also, ask if your institution has any
templates that are
pre-made. I would still edit them and make
them your own, but it's a
huge time saver if they have already started
them.
12:27
Communicate often with your office
supervisor.
12:31
They may have resources that you don't even
know about unless you
ask. They can also help troubleshoot your
schedule.
12:39
Sometimes, even if they can't give you
longer appointment times or
give you more admin time, they can help
block it so that you don't have more than
three new patient visits a day, so that your
last appointments of the day will
be simple quick follow ups or acute sick
visits, which are usually much quicker
and less complicated than other follow ups.
13:01
All of these things can help improve your
workflow and decrease
overwhelm, which is so, so important.
13:10
Remember, asking for help is okay and they
can't offer help if they
don't even know that you're struggling to
get your assessment skills up to speed.
13:19
You have great basics from your nursing
life, as we discussed, but
there are a lot of new assessment skills to
learn and the best way is
to just do it a bunch.
13:30
Whatever you are struggling with assessing,
assess a lot of
normal ones. The abnormal will then become
much clearer.
13:38
And of course, when in doubt, use the buddy
system and pull someone in whenever you
aren't sure of what a finding is.
13:45
It's very normal.
13:46
It's very okay.
13:48
And last but not least, the answer to the
ever popular
question how long will it take to feel
comfortable after transitioning your
practice from an RN to an Aprn?
For most people, 2 to 3 years.
14:03
That varies by person, obviously, but that's
the general timeline I've seen
in myself and many of my peers the first six
months of
being an aprn just complete overwhelm.
14:16
But remember, it was like that when you
became a nurse too, and you probably just
forgot and you did that.
14:22
So you can do this and it does really get
better every day.
14:26
And then around like one year, you're
usually no longer scared to go to work,
and you can do quite a few diagnostic and
treatment workups and plans on
autopilot, but are definitely still looking
up a great number of things
throughout the day as more patient
encounters come in and you're looking up
symptoms and meds and stuff, and then by two
years you're kind of
coming up for air, you can start to be
curious again and learn things other
than what you're looking up for, your
patient encounters that day that are on your
schedule because you might.
14:59
Don't be looking up 1 or 2 things a day at
that point.
15:02
So you just have a lot more brain space,
which really feels it feels glorious.
15:07
And then at three years, it it really takes
a lot to faze you at
this point and make you nervous.
15:14
You just feel a lot more confident.
15:16
And you're often used as a resource for
other people in the office, which is super,
super cool.
15:23
This whole thing, it's a long process, but
you will get there and it's okay to
not love it. It doesn't mean you made the
wrong career choice if you completely hated
it first. That's okay.
15:34
It's a ton to learn and that can be really
not fun.
15:38
You probably hated being a nurse for a
little while when you were new.
15:41
And now look at you. You went back to school
for nursing, like, of all things, your
nursing career.
15:46
It's a great foundation for your future as
an aprn.
15:50
There's a lot of changes that come with that
transition to practice as we discussed, but
you can do it.
15:56
I hope this gave you a little bit of insight
into what that practice transition will look
like, and give you some tips for navigating
it.
16:03
You got this.