In my opinion, the recommendations in the Institute of Medicine report (IOM) are crucial in advanced nursing practices. These recommendations are central in the pursuance of a reformed health care system. Expanding the scope of operation for advanced-practice nurses will create a framework that will facilitate a comprehensive application of the nursing education and training. This approach will eliminate various barriers that restrict certain procedures in the health care sector to a few professionals. I think that giving advance-practice nurses the authority to perform admission assessments and delegate on a patient’s health care program will eliminate various delays associate with the need to consult physicians on such matters. In my view, to derive optimal results from the education and training of advanced-practice nurses, concerned parties should provide them with the opportunity to influence health care practices. In this regard, various parties in the health care system should accommodate nurses in efforts to redesign and improve health care practices. In my observation, adopting approaches that include nurses in the improvement of the health care system will facilitate the integration of the roles of advanced-practice nurses in health care.

Due to the exposure to varying patient and care situations, nurses require a clearly defined residency program that ensures appropriate relation of the nursing education and training to real-life situations. I feel that it is crucial to expose nurses to a variety of working environments in order to promote appropriate levels of experience and competency in nursing practice. An appropriate residency program is crucial concerning effective service delivery within the health care system.

In my opinion, the stakeholders in the training of advanced-practice nurses should promote an education system that delivers the most positive effects on the nursing practice. I think that a baccalaureate-nursing program incorporates much of the content in nursing diploma and associate-degree programs. In addition, this program constitutes broader aspects of nursing such as nursing leadership and management, and physical and social sciences. The wide scope of a baccalaureate-nursing program depicts it as an appropriate approach in the promotion of effective health care. I feel that there is a close relationship between the education level for a nurse and his or her effectiveness in providing health care. Apart from adopting comprehensive learning programs, the stakeholders in nursing education and training should ensure the allocation of enough resources in nursing programs that focus on imparting high levels of competency in nursing practice. From my viewpoint, effective health care delivery in diverse populations and situations is crucial in the creation of a health care system that caters for the needs of patients in different settings.

In my observation, appropriate nursing education and training programs should include aspects of leadership and management, which are crucial concerning the participation of nurses in leadership and management across diverse levels of the health care system. The availability of leadership positions in both the public and private health care sectors will give nurses a chance to influence the advancement of health care. Thus, I think the stakeholders in health care should ensure the incorporation of nurses in management boards and other major leadership positions. Personally, I find the collection of data on various aspects of the roles of advanced-practice nursing crucial in the development and redesigning of policies and system that are central to the attainment of the objectives of the health care sector. Furthermore, this data is crucial in the modification of nursing education and training in order to meet the requirements of the health care system.

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M y strongest competency is the Health Delivery System competency. This competency focuses on effective health care delivery, which is the core objective in the health care sector. By combining various strategies, I have created a framework upon which I have achieved different roles in the health care system as a nurse practitioner. My career engages various aspects of management within the health-care setting. Thus, the possession of knowledge in organizational practices has helped to me to effectively execute various duties. This knowledge has enabled me to make appropriate decisions on various issues within the jurisdiction of a nurse practitioner. My skills in consensus building have enabled me to effectively undertake changes within the health care system. In additional the knowledge in organization practices has helped me to create synergy between organizational functions and the available resources to achieve effective health care delivery. My ability to work in consideration of the diversity of stakeholders in the health care sector has enabled me to promote a comprehensive health-care delivery system. The wide scope of operation provided by this competency has helped me to promote the effective redesign of the health care delivery to accommodate patients, health providers and other stakeholders.

My weakest competency is the Technology and Information Literacy competency, which largely focus on the integration of information technology in the pursuance of effective health care. The inability to obtain various systems that are crucial to the attainment of the Technology and Information Literacy competency has prevented me from achieving various health-care objectives related to this competency. Another challenge emanates from my lack of the technical expertise and knowledge in scientific health information analysis. These issues have prevented me from working within a framework that addresses the needs of patients. Insufficient knowledge concerning the design of health care information systems has considerably hindered my resolve to attain safe, quality and economically viable health care. To improve on the Technology and Information Literacy competency, I will undertake research on various information technology systems in the health care sector. This research will entail a comprehensive overview of the integration of information systems in health care to achieve various objectives. An evaluation of standards such as NIST, HIPAA and HITRUST CSF will be beneficial. In addition, I will expand my knowledge concerning the interpretation of various technical procedures such as CT scanner and X-rays.

Nurse practitioners play the crucial role of treating both the physical and mental aspects of patients. The education and training of nurse practitioners enables them to undertake a comprehensive evaluation of patients through physical examination and interpretation of diagnostic tests. In this regard, nurse practitioners can take appropriate actions concerning diagnosis and the provision of treatment through aspects such as medication prescription (Hudspeth, 2009). The scope of practice for nurse practitioners is not uniform because regulations relating to the profession are state-based. While the regulations in some states allow nurse practitioners to practice independently from physicians, other states require nurse practitioners to practice in consultation with a physician. The regulations concerning the practice of nurse practitioners also vary between states. Globally, variation in the scope of practice for nurse practitioners is minimal due to the attempts by the International Council of Nurses to harmonize the practice (Kleinpell et al., 2012).

Regulations on family nurse practitioners in California require them to collaborate with physicians as they practice. Thus, roles beyond the scope of a registered nurse are restricted to the decision of a family physician. In this regard, as a family nurse practitioner in Californian, one can only perform nursing functions that are described as essential in primary health care and thus do not require standardization. These procedures include physical and mental examination, disease prevention and restorative measures, withdrawal of blood and the initiation of emergency practices. However, to perform other procedures that California’s regulations describe as beyond the scope of a Registered Nurse, intervention by a physician is a requisite. Procedures such as suturing and biopsy require the physical presence of the physician. Furthermore, the intervention by other health care professionals may be necessary.

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