2part question and response on change agent as an APN

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Part 1:TYPE – Reflective Practitioner

  • Based on your experiences and readings, analyze the roles, empowerment of patients, and values needed to be an effective nurse advocate and policy player.
  • Discuss the APN role as a change agent.
  • Provide an example of a time that you have acted as an advocate or a situation that you are familiar with that involved an APN acting as an advocate.Additionally, address how the APN role is implemented at an organizations, state, and national level.
  • The text discusses the limited evidence base for the credibility of advocacy, in your opinion does it work? Why or why not? Support your thoughts with evidence.

Students are expected to:

  1. For this discussion thread be sure that you address all 4 prompts. The third prompt has 2 parts so don’t miss discussing both aspects. When you use a source to support your discussion be sure to provide in-text and reference citations per APA style guidelines.
  2. an initial substantive response of 250 words
  3. Include in text-citations, APA format, use at least 2 peer review journals
  4. Post a response to each classmate. No more than 100 words include in-text citations and at least 1 reference APA style. Please be respectful.

Rebecca’s Response:

Nurse Advocate and Policy Makers

Nurse advocates are the liaisons between patients and doctors. They help patients understand their diagnosis and make the best decisions about their health. Another role that is included is patient safety. Patient safety depends on nurse advocacy. Nurses are considered the last barrier when it comes to errors in health care because of their proximity and continuity with patients; nurses are often the last opportunity to prevent an error. Nurses in all roles and at all levels of the organization have a duty to patient safety. To be effective in advocacy efforts, nurses need to understand the laws and regulations governing their practice, and with that they would be able to better sever and protect their patients (American Nurses Association, 2017).

APN Role as a Change Agent

Being a change agent is a major function for nurses. APNs have a large influence within their work environment and are able to help create necessary change. Since change agents need to convince others of the value of new approaches, they need to be able to embrace the new idea themselves. Since change can be a politically charged topic, effective change agents need to develop the following attributes: active listening skills, consistent communication, effective motivation, and helpfulness. The first and most important step in gathering support for change is communication. Change agents can increase staff participation by helping their unit understand the following: why is change necessary, who benefits, what does it require, what is a nurse’s role, and what are the positive and negative effects? If all of these ideas are taken into account, change can be accomplished smoothly (Colorado University, 2017).

Acted as an Advocator

I work in a busy Trauma Center in with Emergency Department. I came on shift and I had orders to discharge a patient that I had not seen yet. When I went to check on the patient I did not feel comfortable discharging her. I informed the Dr who wrote the discharge instructions and he told me “to just do what I say”. I advocated for my patient and went up the chain of command and refused to discharge her still. After about two hours of arguing with the doctor and refusing to discharge the patient, the patient coded and needed CPR and many other resuscitative measures. If I had done as the doctor asked the patient might have died at home.

How APN Roles are Implemented

APNs provide continuous, comprehensive care through disease management, health promotion, health education, and preventative health services. Organizations including the American Association of Nurse Practitioners, have taken a position on the scope of practice for nurse practitioners, stressing the unique level of accountability and responsibility they bear. The AANP describes NPs as being accountable by way of peer review, an evaluation of clinical outcomes of patients in their care and continued professional development. They have a unique responsibility to the needs of the public and the healthcare system and are looked upon as mentors, leaders and educators who participate in patient advocacy and the advancement of health policy (NurseJournal.org., 2018). While all state codes now recognize NPs are primary care providers, in many states, they do not enjoy the same rights as physicians. For example, in California, my home state, NPs must be supervised by physicians. And in some cases, physicians must sign NP charts to qualify for insurance reimbursement. NPs in California must also enter into a collaborative agreement with a physician or have direct physician supervision/delegation in order to prescribe drugs. Other states are much more progressive, giving NPs the latitude they need to practice autonomously. For example, in Colorado, NPs can prescribe medications without Board of Medicine or physician oversight). Nationally, APNs must hold a registered nurse license and be nationally certified and state licensed to practice as an NP (NurseJournal.org., 2018).

Credibility for Advocacy

Evidence based practice is an approach that helps people make well informed decisions about policies, programs and projects by putting the best available evidence from research at the heart of policy development and implementation. In order for a company or health care facility staff to listen and be willing to cooperate with any change base on EBP, the APN must have credibility. Credibility is more of a relational property than a static entity. The most productive credibility emerges from situational appropriate integration of expertise, goodwill, and trustworthiness (Horton, C., & Peterson, T., 2015). I believe all of these factors combined make for an effective way to implement change and create a better working environment.


American Nurses Association. (2017, November 22). Speak to be heard: Effective nurse advocacy. Retrieved September 16, 2018, from https://www.americannursetoday.com/speak-to-be-hea…

Colorado University. (2017, January 13). Nurses as Change Agents. Retrieved September 16, 2018, from https://degree.coloradomesa.edu/articles/nurses-as…

Horton, C., & Peterson, T. (2015). Credibility and advocacy in conservation science. Conservation Biology, 30(1), 23-32. Retrieved September 16, 2018.

NurseJournal.org. (2018). Role & Scope of Practice of a Family Nurse Practitioner. Retrieved September 16, 2018, from https://nursejournal.org/family-practice/role-scop…

Helen’s Response:

Nurse Advocate and Policy Player

Discussion includes advocacy for patients or advocacy for nurse practitioners (NPs). In both cases, the values that come to mind are the ethical principles of respect, beneficence and justice. Respect protects patients who are vulnerable and professionally honors other NPs (Cugini, 2015). Beneficence minimizes harm while maximizing benefits (Cugini, 2015). Justice treats all patients and professionals equally (Cugini, 2015). Advocacy for other NPs may take the shape of an NP working with the National Council of State Boards of Nursing, the local state board and lobbyists to effect changes in legislation so that NPs may possess full practice authority. Empowerment of patients may be as simple as including them in decision-making.

Change Agent:

Full practice authority for NPs will require building strategies for political support with a paradigm that will update legislation in a way that aligns with the values of the people who live in the state (Lugo, 2016). NPs are positioned to join professional organizations, enlist the support of senators and congressmen, and advocate as a change agent to the legislative body of the resident state. One way NPs are change agents is evidenced by the use of evidence-based practice. NPs are leaders identify problems in care and determine solutions to those problems (Blazek, 2015). Clinical decision making is driven by evidence and the use of critical thinking along with consideration of patient preference (Blazek, 2015). NPs develop clinical research questions, may conduct studies and disseminate findings or integrate findings into practice.

APN Role:

Organizations utilize the skills of APNs to meet community needs. The University Health Care Clinic in Lafayette hires NPs to see a variety of clients from family medicine to women’s health. The state of Louisiana has restricted practice laws so NPs must have a collaborative agreement with a physician. NPs do have prescriptive authority. Nationally, NPs are making strides to help the public in the public health arena. I worked with a child health NP in a public health clinic in North Carolina several years ago.

Example of Advocacy:

A patient was admitted to a hospital where I was acting as House Supervisor. The patient was 42, had a biopsy on his larynx and went into stridor. I called the attending that did not answer, took the patient’s v/s q 15 min., called nursing administration, and recruited the ER doc, who attempted and failed to intubate the patient. I called the attending again, finally got the attending, who came to the hospital and intubated the patient. The attending physician was an ENT.


Patient advocacy saves lives and promotes best practice with more positive outcomes for patients. The International Council of Nurses (ICN) sees advocacy as an essential portion of the contribution that nurses make to strong healthcare systems in alignment with the United Nations Sustainable Development Goals (ICN, 2016 as cited in Water, Ford, Spence, & Rasmussen, 2016). In this context, advocacy performed by NPs may help improve worldwide healthcare (Water et al., 2016).


Blazek, N. (2015). NPs important leaders for evidence-based practice, improving patient outcomes. Clinical Advisor. Retrieved from https://www.clinicaladvisor.com/napnap-2015-meetin…

Cugini, M. (2015). Successfully navigating the human subject’s approval process. Journal of Dental Hygiene, 18(1), 54-56. Doi: 10.1155/2016/6860240

Lugo, N.R. (2016). Full practice authority for advanced practice registered nurses is a gender issue. OJIN: The Online Journal of Issues in Nursing, 21(2), 1-11. Doi: 10.3912/OJIN.Vol21No02PPT54

Water, T., Ford, K., Spence, D., & Rasmussen, S. (2016). Patient advocacy by nurses-Past, present and future. Contemporary Nurse, 52(6), 696-709. Doi: 10.1080/10376178.2016.121235981

Part2:TYPE – Scholar Practitioner

Research and evidence based practice are integral to advanced practice nursing. Describe how you will demonstrate/utilize these to set yourself apart as an “excellent” APN.

  • Provide an example of an evidence based policy that you would like to implement in your practice. How will you implement it?
  • Provide the details of working through organization structures in obtaining feedback from your staff and organization on how to implement it.
  • Explore the AHRQ website and pick a quality care initiative that may impact quality client care in hospitals or areas of industry that deliver health care.
  • Read a few case studies in the “AHRQ’s Impact on Health Care” and pick 2. Compare and Contrast how the AHRQ research or evidence behind these case studies improves client care outcomes.

Students are expected to:

  1. Be sure that you construct a response to all 4 prompts. I believe using the ‘topic’ of each prompt as sort of a ‘subheading’ helps keep focus on what is being discussed and ensure none of the required discussions get over looked. Here are some helpful links for the assignment. https://www.ahrq.gov/https://www.ahrq.gov/news/newsroom/case-studies/index.htmlhttps://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html
  2. When you use a source to support your discussion be sure to provide in-text and reference citations per APA style guidelines.
  3. an initial substantive response of 250 words
  4. Include in text-citations, APA format, use at least 2 peer review journals
  5. Post a response to each classmate. No more than 100 words include in-text citations and at least 1 reference APA style. Please be respectful.

Rebecca’s Response:

Demonstration and Utilization

Nurse practitioners should take ownership and accountability for driving quality improvements and provide transformational leadership to encourage evidence-based practice changes. Evidence based practice and research are used by organizations nationwide to improve the quality, safety, effectiveness, and efficiency of health care (AHRQ, 2018). By using evidence-based practice it allows the APN to go beyond simply using results of a research study in an aspect of your nursing practice. It involves integrating the best available research evidence with the clinical expertise within your practice and also patient and family values to drive better clinical decision making. I personally will make sure that I not only stay up to date on all current research and EBP, but I will also go to many seminars and classes to make sure I am aware of all changes made. I think that this is so important because by being proactive in all new EBP and research, in the end, it makes you a better APN and aids in the treatment of all patients for the better.

Example of EBP Policy

One of the key principles in medicine today is evidence-based practice in nursing. This is the practice of medicine based on solid research, and it adheres to standards for high quality and safety, all while focusing on patients’ needs. An example of EBP that I would implement would be Oxygen Use in Patients with COPD. For patient health and safety, it is essential that nurses follow evidence-based practice in nursing when it comes to giving oxygen to patients with COPD. Despite the belief by some that providing oxygen to these patients can create serious issues such as hypercarbia, acidosis or even death, the evidence-based protocol is to provide oxygen to COPD patients. This practice can help prevent hypoxia and organ failure. Giving oxygen, which is the correct treatment based on the evidence, can enhance COPD patients’ quality of life and help them live longer (Arkansas State University, 2016). I see debates on this practice constantly between health care providers. I would implement this EBP by making sure all of my COPD patients were given the correct amount of oxygen depending on their illness and lab work.

Working through Organization Structures

The way a leader handles feedback tells a lot about their character and being able to learn from both positive and negative feedback is crucial for success. As well as being an important part of personal development, a strong feedback culture can also help companies and organizations to grow. According to the evidence, as soon as a leader implements a feedback culture that works, employee satisfaction goes up. By focusing more on the strengths of the specific individual, managers can improve employee engagement by nearly 30 times (Cleverism, 2018). There are the key steps a leader should take in order to encourage feedback. They include: Creating a regular system for feedback, making their environment feel secure and safe, establish a balance with change, implement the feedback culture as a normal case, have multiple feedback channels, have the right environment to enhance feedback, and foster both negative and positive feedback (Cleverism, 2018).

Quality Care Initiative

I have chosen the AHRQ Opioid Initiative. I work in an ER and I see the abuse of opioids daily. I think that this initiative will create a large impact within hospital settings.

The number of opioid overdoses has increased at a shocking pace. The misuse of opioids such as prescription pain medications and heroin has become widespread across the United States. The Department of Health and Human Services has recognized opioid use disorder as a national crisis, creating an initiative that targets three areas: Opioid prescribing practices, expanded use and distribution of Naloxone to treat overdose, and increased access to medication-assisted treatment for opioid use disorder (AHRQ, 2018).

Compare and Contrast

The two case studies that I chose were: Los Angeles County Health Center Uses CAHPS to Shorten Wait Times and Southern California Health Center Uses AHRQ Surveys for Patient Feedback and Improvements. For the first case study, Los Angeles County Health Center Uses CAHPS to Shorten Wait Times, the evidence behind this case was accumulated via a survey. The outcome of the survey showed that patients wouldn’t have much to complain about if the wait time met their expectations (AHRQ, 2018). This can be used to help facilities make improvements on their wait times and to help generate a more efficient way to see patients.

In the second case study, Southern California Health Center Uses AHRQ Surveys for Patient Feedback and Improvements, the study was done in order to learn about patient experiences in receiving health care. The results not only will help improve patient care, but also influence the financial incentives its medical providers can earn (AHRQ, 2018). This company can use the evidence they gather to better assist patients and improve their facility by creating better patient outcomes.


AHRQ. (2018, August 01). AHRQ Impact Case Studies | Agency for Healthcare Research & Quality. Retrieved September 16, 2018, from https://www.ahrq.gov/news/newsroom/case-studies/in…

Arkansas State University. (2016, December 20). Examples of Evidence-Based Practice in Nursing | A-State. Retrieved September 16, 2018, from https://degree.astate.edu/articles/nursing/example…

Cleverism. (2018, February 19). How To Implement A Feedback Culture In Your Company. Retrieved September 16, 2018, from https://www.cleverism.com/how-to-implement-feedbac…

AHRQ. (2018). AHRQ Opioid Initiative. Retrieved September 16, 2018, from https://integrationacademy.ahrq.gov/about/opioids-…

Helen’s Response:

Example of EBP and How to Implement

One project that I would like to see implemented is to limit the amount of time a patient has a urinary catheter. Urinary tract infections are considered the most common healthcare acquired infection (HAI) with the majority of them occurring after the placement of a urinary catheter (Meddings et al., 2014). HAIs increase costs in terms of human suffering, healthcare skills needed, and hospital reimbursement.

According to Spruce (2015), The Agency for Healthcare Research and Quality (AHRQ) recommends the following steps to implement EBP:

  • Choose a change agent who identities problems and challenges to implementation
  • Run a test of the project
  • Multidisciplinary teams are needed for implementing the project
  • The use of EBP guidelines for step by step tools is practical
  • Use electronic records to prompt clinical stop times
  • Educate the staff and the patient to change practice
  • Monitor outcomes of the change and communicate the outcomes to the entire team

Organizational Structure

The organization I work with has a posting board for ideas that leaders placed to disseminate ideas to improve patient care. We have weekly staff/leader huddle as a formed of shared governance to discuss change and how to implement change with leaders making sure that the change becomes policy. Leaders send out emails to the staff with the new policy attached.

Quality Care Initiative

HAIs are considered a leading threat to patient safety (AHRQ, 2018). The HAI program helps frontline clinicians to prevent HAIs by the improvement of the provision of care to patients (AHRQ, 2018). The AHRQ funds both the evidence based research and the implementation projects that assist clinical staff in the application of EBP to prevent HAIs (AHRQ, 2018). The tools used to fight HAIs are called comprehensive unit-based safety programs (CUSP).

AHRQ Impact on Health Care

In one study, a 151 bed hospital in Chicago reduced catheter associated infections (CAUTI) to zero with CUSP tools. The hospital reduced CAUTIs by 90% from 2014 to 2016 and to zero by 2017 (AHRQ, 2018). One of the physicians stated that they are prescribing fewer antibiotics which leads to fewer antibiotic resistant strains of bacteria (AHRQ, 2018). A second study demonstrates the reduction in patient falls by 25% in a Mississippi hospital. The estimated cost savings is $238,000 (AHRQ, 2018). The program emphasis is on accurately assessing the patient for fall risk level (AHRQ, 2018). This program epitomizes the prevention harm and patient safety.


Agency for Healthcare Research and Quality. (2018). AHRQ’s healthcare associated infections program.Retrieved from https://www.ahrq.gov/professionals/quality-patient…

Agency for Healthcare Research and Quality. (2018). Chicago hospital reduces catheter-related infections to zero with AHRQ’s CUSP tools. Retrieved from https://www.ahrq.gov/news/newsroom/case-studies/20…

Agency for Healthcare Research and Quality. (2018). Mississippi hospital reduces patient falls by 25 percent using AHRQ program. Retrieved from https://www.ahrq.gov/news/newsroom/case-studies/20…

Meddings, J., Rogers, M.A.M., Krein, S.L., Fakih, M.G., Olmsted, R.N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review

Spruce, L. (2015). Back to the basics: Implementing evidence-based practice. AORN, 101(1), 107-112. Doi: 10.1016/j.aorn.2014.08.009


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