Identify and describe practice barriers for all four APNs roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner and clinical nurse specialist.

            Nurse practitioners significantly contribute to disease prevention, disease management and health promotion. APNs have faced barriers to practice at both the state and national perspective since the beginning. The four roles of the APN include the nurse midwife, nurse anesthetist, nurse practitioner and clinical nurse specialist. There are various rules and regulations based on the scope of practice. Advanced practice nurses face challenges including policy restrictions on practice, poor physician relationships, prescription privileges, licensure, payment and insurance company problems and restrictive practice settings. Each state varies when it comes to rules, regulations, practicing guidelines and prescribing privileges.

     The nurse practitioner in the state of Florida is permitted to perform medical diagnosis and treatment, prescribe medications, and operate with authorization of an established protocol supervision. The Florida law requires that NPs enter into a supervisory agreement with a physician to practice which allows the nurse practitioner to diagnose, dispense, prescribe, and administer medications (Weissing, 2019). Nurse practitioners in Florida can prescribe controlled substances that are scheduled II-IV. “An advanced registered nurse practitioner may prescribe or dispense a controlled substance as defined in s. 893.03 only if the advanced registered nurse practitioner has graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills” (Bushy, 2019, p.6). “The American Association of Nurse Practitioners (AANP) classifies state laws and regulations impacting APRN practice and identifies the practice environment within the state as full, restricted, or reduced” (Kleinpell et al., 2022, p.137).

     A certified nurse midwife has advanced education in both family practice and midwifery. A midwife provides care for women and newborns including gynecological and prenatal care. A barrier to practice for the nurse midwife is the lack of clarity regarding the nature and scope of practice of the nurse midwife. The Certified Registered Nurse Anesthetist is a licensed practitioner who administers anesthesia to a wide range of patients in collaboration with surgeons, anesthesiologists, and other healthcare providers. The CRNA does not prescribe medications or diagnose patients. A practice barrier the CRNA faces is being able to perform their duties with or without a supervising anesthesiologist. In the state of Florida, a physician’s supervision is required for a CRNA to practice.

     The clinical nurse specialists (CNS) focus on educating patients and their families on how to manage their symptoms and disease prevention through the most up-to-date evidence-based practice. The Clinical Nurse Specialist faces prescriptive barriers on the state and national level. In the state of Florida, the CNS works under established protocols and may plan for disease prevention and diagnose human responses to actual or potential health problems. The CNS has no prescribing authority in the state of Florida. On the national level it also varies, some states allow the CNS to have independent prescriptive authority, some have no prescriptive authority at all and other require a collaborative agreement with a physician.

Identify forms of competition on the state and national level that interfere with APNs ability to practice independently

     Nurse practitioners have various forms of competition at the state and national level. There are other medical professionals that deliver the same type of care to patients including physicians and physicians’ assistants (PA). A physician assistant is considered a mid-level provider, just like the nurse practitioner. Throughout the years, there has been an increase in the number of nurse practitioners. A major form of competition on the state and national level is over saturation. Outdated and restrictive regulations that are still in the scope of practice for the NP inhibit competition among health care providers and can limit access to healthcare services and decrease innovation in health care delivery (Moore et al., 2020). The American Medical Association has expressed concerns in letting APN’s practice independently and outside the supervision of a physician because they believe that physicians have more extensive and specialized training (JUCM,2020). Imposition of laws and regulations through state regulators of the medical board also cause competition for the NP (Peterson, 2017).

Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)

     In the state of Florida, where I plan on practicing, there are three branches that include the Executive, Legislative, and judicial branch. The governor, lieutenant governor, and cabinet are the lawmakers who serve on Florida’s executive branch. The executive branch’s purpose is to implement and enforce laws. In the state of Florida, the executive branch is currently run by governor, Ron DeSantis. The legislative branch consists of the Senate and the House of Representatives and are responsible for passing or carrying out laws for the state of Florida. Florida’s judicial branch is comprised of the supreme court, which is the highest court in Florida. The judicial branch interprets the laws. “The intent of the Legislature is that persons desiring to engage in any lawful profession regulated by the department shall be entitled to do so as a matter of right if otherwise qualified” (Toney-Butler, 2020, p. 38).

Discuss interest groups that exist at the state and national levels that influence APN policy.

     Interest groups are individuals, organizations or institutions that attempt to influence public policy and are essential to regulate the NP’s scope of practice (Brom et al., 2018). Interest groups play a major role in influencing the regulation of NPs’ scope of practice and work together to initiate change. There are several interest groups on both the state and national level that influence APN policy. In the state of Florida, the Florida Association of Nurse Practitioners is major interest group and nationally the American Associates of Nurse Practitioners (AANP) is a major interest group. The Florida Association of Nurse Practitioners promotes patient-centered healthcare and increases knowledge on health care policy for the nurse practitioner’s practice. The objective of the FLANP is to utilize strong lobbying and grassroot efforts in combination with medica to inform and educate the public on issues in Florida’s health care system and how Nurse Practitioners can change these problems if outdated laws are changed (FLANP,2020). The American Association of Nurse Practitioners provide support to nurse practitioners nationwide, educational opportunities, scholarly journals, and other forms of support to benefit the NP.

Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government and interest groups.

     There are multiple methods that can influence change in healthcare policy. Participating and allowing your voice to be heard is one of the most powerful ways to produce change in my opinion. The only way to be heard is by speaking up and becoming involved. An important step in influencing change is understanding the policy process. It is essential for the NP to be knowledgeable about the policy process and knowing who the policy makers are. Reviewing proposed health care legislations is important to help promote best practices and determine changes to see if they will be beneficial or not. Interest groups heavily influence the regulation of NP’s scope of practice are one of the key methods to influence change (Brom et al., 2018).

instructions- write 1 full one page response with two references. adds importance, depth, and meaningfulness to the discussion. Grammar, syntax, spelling, and punctuation are accurate.  

Research on disruption of the Supply Chain and Transportation industry due to COVID-19, deliberate recovery post COVID-19 with assistance from federal government implementing new policies, funding, and lessons learned to avoid another disaster. 

 How Government policies and regulations have affected the supply chain and transportation industry in a positive way?

 What is the impact of political instability on global sourcing? 

 Did the supply chain and transportation fully recovered from the gridlock caused by COVID-19?

Discussion 1)

Everything you need to know about the Fourth Industrial RevolutionWhen telephones were first invented, it took almost 75 years for 100 million people to gain access to one. In 2016, it took less than one month to hook that same amount of people to the gaming app, “Pokémon Go”. This is what analysts are calling the Fourth Industrial Revolution and it is blurring the lines between the physical, digital and biological spheres. Technologies like artificial intelligence and autonomous vehicles are merging with humans’ physical lives. Key Points

• A combination of new artificial technologies are changing the way we live, work and interact 
• Digital technology is so intertwined with many of our businesses, as well as our social and economic lives, that trying to separate “tech” and “non-tech” is becoming increasingly redundant
• Studies show that technologies like artificial intelligence will eliminate some jobs, while creating demand for new jobs and skills  

Discussion Questions

1. What can companies do to innovate as we enter into the Fourth Industrial Revolution?
2. Do you believe that workers and their jobs are at risk with the new industrial revolution? Why or why not?

Everything you need to know about the fourth industrial revolution. From CNBC: https://www.cnbc.com/2019/01/16/fourth-industrial-revolution-explained-davos-2019.html

Prior to engaging in this discussion, review the following video resource (link to video above), which is a pre-requisite for participation. Can You Afford to Retire? PBS Frontline. This video is 55 minutes in total. The discussion questions included in this module may be answered by limiting viewing to the first 34:16 of the video, however, all 55 minutes are pertinent to this discussion. This PBS video documents the transition from Defined Benefit to Defined Contribution plans and explores the effects on workers’ preparation for retirement. Experts report that, on average, only workers earning more than $90,000 per year tend to have retirement balances that grow significantly beyond the level of contributions for reasons discussed in the video. 

According to the U.S. Bureau of Labor Statistics (BLS), about 40% of individuals ages 55 and older were working or actively looking for work in 2019. That number, known as the labor force participation rate for persons in this age bracket, is expected to increase fastest among the oldest segments of the population, including those ages 65 to 75 and older, through 2024. In contrast, labor force participation rates for most other age groups in the labor force are expected to remain stable (Toossi and Torpey, 2017). Since the early 1990s, the Labor Force Participation Rate for workers 55 and over has been steadily rising (BLS, 2019). The Centers for Disease Control and Prevention (CDC) finds that current life expectancy in the United States is 78.6 years (NVSS Fact Sheet, Centers for Disease Control, 2017) and the social security retirement age in the United States is between ages 62 and 67 (Benefits Planner, Social Security Administration). We may conclude from these statistics that many older individuals continue to work beyond an age when they could retire with full social security benefits.

The tendency for more older workers to actively participate in the labor force is related to factors affecting both younger and older workers. Younger workers are typically relatively unprepared to begin saving for retirement, yet experts encourage workers to begin to save early. Younger workers are offered self-managed retirement accounts at a point when they are usually not prepared to manage them. As workers age, given education and income, they remain poor managers of retirement options, when compared to professional managers once employed by firms to manage employee retirement funds.

Growing numbers of older Americans remain in the work force because they lack retirement savings. This situation faced by older workers results from a shift to self-managed retirement plans. It is likely that workers will increasingly remain employed longer. Older and younger workers now routinely manage their own retirement accounts. Individuals are less knowledgeable in managing retirement savings than professional financial managers assigned by firms to manage employee retirement accounts to ensure a defined level of benefits to employees after their retirement from the firm. Older workers continuing to work later in life is related to corporate financial management practices. Across many decades, corporations have led employers in turning away from offering defined retirement benefits to workers who retire after many years of service. Defined contribution plans are cheaper for firms to fund and administer. As of 2019, only 51% of private sector employees and only 4% of private industry workers had access to a defined contribution plan (BLS, 2019).

Nearly half of all working-age families have zero retirement account savings (Morrisey, 2016). One of the important sources of these savings is from retirement benefits offered by an employer. In a recent report on retirement issues, the Government Accountability Office (GAO) noted that federal retirement-related programs including the Social Security Program face financial uncertainty. At the same time:

“… employer-sponsored plan(s) have experienced a shift from traditional defined benefit (DB) plans that generally provide set monthly payments for life, to defined contribution (DC) account-based plans, like 401(k)s. DC plans provide greater portability of savings that can be better suited to the needs of a more mobile workforce, but also require individuals to assume more responsibility for planning and managing their savings. While DC plans can provide meaningful retirement security for many, especially higher earners, lower earners appear more prone to having little or no savings in their DC accounts…and individuals’ savings…may be constrained by economic trends such as low real wage growth and growing out-of-pocket health care costs. Combined with increased longevity, these challenges can put individuals at greater risk of outliving their savings …” (GAO, 2019)

Census Bureau data shows that only 12% of adults in the U.S. have a bachelor’s level or higher education and 88% are high school graduates. The National Center for Educational Statistics (NCES, 2020) reports that only 12% of individuals completing bachelor’s degree programs graduate in business-related subjects offering familiarity with principles of finance. Per capita savings in the United States is negative. The average individual spends more than they save each year (BLS, 2019). The American Community Survey (also administered by the Census Bureau) found that median household income in the U.S. in 2018 was $61,937. In this discussion, we look at 22-year-old Nadja, who is typical of young householders under the age of 25. Young workers like Nadja have little practical financial knowledge and the lowest median household income, at $33,389 per year.

Case Study

 The PBS video at the beginning of this discussion explores factors influencing a worker’s ability to self-manage retirement accounts to achieve a satisfactory level of savings by the time s/he would otherwise be prepared to retire. This following case combines factors found statistically to contribute to an insufficient level of retirement savings. We connect Nadja, the character in our case, with the corporate trends resulting in most workers being given responsibility for managing their retirement saving. In this way, we combine personal and corporate financial concerns.

Nadja, age 22, is typical of many people transitioning into the labor force. Nadja may be relatively unprepared to begin planning for her retirement. She is young, and saving for retirement may seem less important than current needs. She has more education than most Americans, but statistically, she has only a 12% chance of having familiarity with financial principles. Her earnings are most likely low because she has just begun her career. The median income for all individuals holding a bachelor’s degree is roughly $60,000 (Torpey, 2018), and workers just entering the labor force are likely to earn less than the median. Half of workers with bachelor’s degrees will earn less than this amount, while half will earn more.

Unlike 88% of the population, however, Nadja graduated and received a bachelor’s degree. According to the National Center for Educational Statistics, only 12% of individuals earning a bachelor’s degree choose to major in business-related subjects (NCES, 2020). As a recent college graduate, Nadja has accepted her first professional position. Without a great deal of life experience, she is confused with the process of “on-boarding” by her new employer. Like 51% of all private sector employees, she has been offered a Defined Contribution Plan as part of her employment benefits package. Nadja is concerned about the retirement plan and is unsure what role it will play in her preparation for retirement. Nadja does not have a high income, and meeting her basic needs is already a challenge on her moderate wage. She saw her father and grandfather work beyond the age when she knew they were eligible for Social Security benefits, with questionable health and an unquestionable desire to retire to a more leisurely life. Nadja has been told by family members that retirement planning is important.  As this is Nadja’s first full-time position, she feels it is too early to contribute to a retirement plan when retirement is decades away. Her earnings are also limited in relation to basic financial needs, such as housing and transportation. She wonders whether she should contribute to the retirement plan or wait until later in life to begin saving for retirement.

In this discussion, you will take on the role of a relative or trusted friend with knowledge of the importance of retirement planning. You will assist Nadja in determining whether to contribute to a retirement plan offered by her employer. Taking into account trends in financial management that you learned about in this module, you will consider how typical Nadja’s situation is and what issues she and many other employees may face as they age. You are concerned that trends in financial management have caused firms to offer defined contribution versus defined benefits plans most frequently, placing the burden of financial planning on the individual, rather than on the employer.

 

Case Questions

Initial Post

Section 1: The Statistical Question of Worker Preparation for Financial Management Responsibilities 

Considering material in the required reading and the PBS Frontline video, “Can You Afford to Retire?”, reflect on a typical worker’s age and preparation for a decision to contribute to a retirement plan, including choosing investment options. Discuss at least two reasons why it is statistically unlikely that Nadja will reach her retirement goals.

[Hint: You might consider statistics regarding educational preparation of the American population and the likelihood that individuals are familiar with investment planning tools and concepts. You might also think about which varieties of individuals are best prepared to meet these goals and the techniques used to build retirement savings to a high value, as discussed in the video, “Can You Afford to Retire?.”]

Section 2: The Work of the Professional Financial Manager

Even if you are not a professional financial manager, you employ financial management tools and concepts in your personal life. Remembering that the functions of a financial manager are to manage cash and credit, issue and repurchase financial securities; decide how to allocate capital for new and existing projects (capital budgeting), and manage financial risk; comment on the similarities between corporate and personal financial management that you learned about in this module and discussion.

Scenario: Your school administrator has asked you to create a weekly article for parents with the topic being children’s literature. The article will be featured on the school website. The purpose of the article is to educate parents on the importance of quality children’s literature in the development of their young reader. The administrator intends for you to write a new article each week in which you will share current ideas and information about children’s literature, along with recommendations of books and authors for parents to explore at home with their children.

This assignment requires a description of five children’s literature awards and a book summary for two books which have won or been honored by awards.

Research the following children’s literature awards:

• Newbery Award
• Caldecott Award
• Coretta Scott King Award
• Pura Belpre Award
• Horn Book Award

Begin the assignment with an introduction of yourself and the purpose of the weekly articles.

Write a 50-word or more description of each of the awards. Include: 

• history of the award (how did it come about, how did it get its name, when was the first award, etc)
• criteria for receiving the award (what criteria are used to determine if a book is worthy of the award)
• types of books/authors/illustrators for which the award is given
• any other pertinent information

Select and read one book awarded or honored by two of the awards (two books total).

Write a 200-word or more description of each book to include the following:

• The title of the book, author’s name, and illustrator, if any
• Summary of the book (A summary includes characters, setting, quick synopsis of plot or story line) 
• Reasons why the book is deserving of the award based on the award’s criteria (how are the criteria evident within the book’s story line)
• Genre of the book and characteristics of the book that place it within the genre (Genre and characteristics can be found in the textbook and genre explanation for this week.)

Include: The Award Winning Books assignment must include a title page, introduction (which introduces yourself and the purpose of the article), conclusion, citations for references, and reference page. APA guidelines must be followed.

Submit your assignment.