Trends and Issues in Nursing Practice
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Trends and Issues in Nursing Practice
The CMS Reimbursement Rules
The Centre for medicare and Medicaid Services-CMS reimbursement rules for never events is an initiative that is very vital in the patient care delivery. The shift in patient care delivery mode advocated by CMS will eventually improve the quality of service delivery to inpatients. This is due to the fact that the reimbursement rules state that there will be no-payment to additional treatment for conditions that are preventable (Cherry & Jacob, 2008).
These rules require more intense care from the medical professionals caring for inpatients as they would put the hospitals in debt due their carelessness as the CMS suggests. At the same time the patients are assured of proper conditions to enhance their recovery as hospitals are required to follow the recommended guidelines for reimbursement. Conditions such as objects left in after surgery and blood incompatibility complications now falls upon the concerned hospitals. These can be prevented if doctors and nurses do their job with utmost care and seriousness. Again, infections that inpatients acquire while in the hospitals due to poor environments for instance poor ventilation can highly be reduced, or even eliminated (Ellis & Hartley, 2012).
CMS rules if adopted and properly implemented by all stakeholders will create constructive relationships between medical care professionals and the inpatients as everyone will feel cared for and valued. The reimbursement will also help in addition of facilities for better working conditions for various specialists. Medical specialists have had much freedom when dealing with inpatients. They have also enjoyed legal protection from the decisions or actions they take concerning how they treat and care for patients. However, such freedoms and protections have been abused. Laxity in the practice has been experienced which have included equipment being left in the patient’s body after surgery, poor hygiene and sanitation among others which adversely affect the health of patients or may even put their lives in danger. Patients have been to pay for such cost which has been expensive. This also lowers the dignity of the patients and may make them to feel like they are not cared for. This rule will help reverse this trend and make medical professionals to take their work seriously. Hospitals’ management will also implement effective rules to ensure they do not incur these costs (Cowen & Moorhead, 2011).
Howard Donna (A Legislator in Texas who is also a Nurse)
Howard Donna a retired registered nurse serves in the Texas House of representatives representing D-48th, District. She has used her background in the nursing profession to advocate for changes in healthcare department. She pushed for the passing of a legislation that called for the protection of nurses who raise issues concerning workplace challenges such as lack of safety in inpatient care.
Howard lobbied for the increment of funding in 2009 for a program dubbed “Nursing Shortage Reduction”. Her effort saw the program awarded $7.3 million that was used to get more nurses thereby successfully leading to nurse graduates increasing by 1055.
Donna also works with other nurse legislators like Susan King to ensure nursing needs are addressed. They are again determined to convince other representatives to understand and appreciate nursing and healthcare matters (Cowen & Moorhead, 2011).
The Educational Preparation and Role(s) of the Clinical Nurse Leader (CNL)
The educational preparation of a CNL includes acquisition of a master’s degree majoring in nursing, and a certificate from the Commission on Nurse Certification (CNC) which is an important part of CNL Certification Examination. The roles of CNL designation include but not limited to ability to execute leadership and change, as well as enhance effective communication across different medical discipline. CNL is also expected to impart his/her knowledge on other medical staff, monitor and evaluate patient health conditions especially those who require specialized care. In addition, he/she must aspire to develop professionally and have refined skills to offer quality care to patients and also advice other nurses. Although CNLs are not sole caregivers to patients, they work as a team with nurses to achieve coordinated healthcare provision at all times. They assess patients who require very close personalized healthcare and may choose to relieve the nurse responsible depending on the condition of the patient. Their qualification calls for them to offer evidence-based practice and co-coordinate the care of patients. Hospitals that have implemented the roles of CNL have realized increased quality of medication care delivery (American nurses association, 2011). This has occurred in terms of better coordination between nurses and other specialists in the healthcare environment. Additionally, the holder of this post brings more skills in the care delivery setting due to the higher education attained. Consequently, patients requiring specialized care are assisted in a better way. A god example of such cases may include care required during and after acute treatment either in or after surgery, cardiological issues or even ambulatory care (Billings & Halstead, 2012).
Advocacy Strategies that can be used to create Change in Nursing
Some of the advocacy strategies that a nurse can use to effectively create a change at her workplace include; effective communication, both in written and speech form. Effective communication ensures that the message that needs to be passed across is clearly understood, for example, when advocating for a change in workplace safety. A nurse must detail the current issues and the suggested changes that she believes will best address them (Cherry & Jacob, 2008).
Formation of professional organizations or joining and participating in an already formed organization may also help as new ideas can be acquired. Through organizations, a nurse may find it easier to advocate for a change at her work place as her opinion will likely get enough support from like-minded professionals who better understand the workplace changes, for instance, nurse working conditions and patient healthcare requirement among others (American nurses association, 2011).

Cherry, B., & Jacob, S. R. (2008). Contemporary nursing: Issues, trends & management. St. Louis, Mo: Mosby/Elsevier.
American nurses association (01 June, 2011). Political advocacy, anyone? Retrieved from;
Billings, D. M. G., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty. St. Louis, Mo: Elsevier/Saunders.
Ellis, J. R., & Hartley, C. L. (2012). Nursing in today’s world: Trends, issues & management. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Cowen, P. S., & Moorhead, S. (2011). Current issues in nursing. St. Louis, Mo: Mosby Elsevier.

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