Appendix A Course Signature Assignment NP PRACTICE PLAN

 Appendix A

Course Signature Assignment



Week 6


The course signature assignment is a scholarly inquiry into assembling essential elements of a new DNP

graduate to initiate practice or add/change specialty. This is a generic assignment; students will individualize it according to their selected specialty requirements, opportunities, and aspirations.


The NP Practice Plan will be a scholarly exercise and in a narrative APA format with headings and subheadings as needed. Students may include other relevant appendices detailing lists, collaborative relationships, etc. specific to your entry into your new practice.


Using the NP Practice Plan worksheet outline below as a checklist, tailor it to include what fits for you, within provided outline/contents of organization. Apply the items elaborated in the list provided as they are consistent with the student aspiration, this means that all items do not necessarily need to be included in a student specific plan.


If items are not pertinent to your specific practice, simply provide a sound justification in the area specified under the topic and specify as such in the body of the paper (e.g., in the section requiring cost elaboration of career move entailing relocation here follows an example: Providers are provided housing; although relocation is needed for the position, housing costs are therefore not included and the relocation bill is also satisfied by the recruiter or simply – No relocation necessary).


Using your education plan, also include a target date for completion of each item listed.  Some may be completed during this exercise and others might have to wait until after you complete your program (or at least the clinical portion of your program to be eligible to apply for a national certification exam within 6 months before your graduation date).  After a correctly APA formatted title page, use the Outline criteria as the headings for your paper but do not submit the outline itself.


This project is an individual one and must accurately represent the specialty and DNP role expectations. The assignment is to be submitted to turnitin and then posted to Live Text at

Please use the Live Text website to upload the assignment to the course faculty using this convention to

name your assignment:  Last name_First initial_NPPP_month-day-year

(EX: Last name_first initial_NPPP_8-5-11).


Worksheet/Outline for the NP Practice Plan assignment: (DO NOT INCLUDE THIS – USE AS GUIDE)


Student Name:

Date Completed:

Are you a BSN/PM/Post-Doc student?



 Item Applicable? Target Date: (Month/Yr) OR


Personal Philosophy, Mission and Vision Statements:


Include population foci and role; does it match the Musco School of Nursing’s?


Practice Venue:


State your ideal vision for practice to include your population, mission, vision and scope of practice within your ideals.  Discuss if you will have an independent practice (if allowed in your state) or with a group, etc.

Begin with your first year after graduation or specialty completion.


What type of Community do you want to serve:

·       Describe community of practice setting e.g.; rural, suburban, urban, poverty level, population mix, crime statistics etc.

·       Place here whatever defines the needs of your practice and what you must do to be prepared to meet the community needs through this practice.


National Specialty Certification:


Identify the certifying body and requirements (including costs) to sit for the exam.  If there is more than one option, please identify them both and talk about which one you will take and why.


Also provide the link to the application website(s)’ url(s).




State Nurse Practice Act:


Identify your State Board of Nursing (or the state that you intend to practice in) requirements (including costs) for application for advance practice licensure or to add an additional specialty.

Include any special considerations for prescriptive authority (e.g., the CA BRN requires that each applicant take a Schedule II medication course) and how you will meet those requirements (e.g., CANP provides a CA BRN approved course included in their membership fee).

Include any other State Requirements for practice:

(e.g.; Practice Protocol, Collaborative Practice Contract and provide an example of these.


Also provide the link to the application website(s)’ url(s).



Federal Regulations:


Provide a summary of the federal application requirements (including costs) for each of the following as needed in your practice:

·        National Provider Identifier (NPI)

·        Prescribing Authority: Drug Enforcement Agency (DEA) and Controlled

·        Dangerous Substance (CDS) numbers.

·        MAT identifier


Also provide the link to the application website(s)’ urls.




Outline requirements and where to obtain coverage:

A)   General:

·        Professional liability

·        Health/Life Insurance

·        Umbrella policy

·        “Tail” insurance

B)    Individual Malpractice Insurance:

·        Additional coverage for self

Also provide the insurance companies’ website(s)’ urls.





Local practice opportunities:

List possible opportunities in your selected region or city, state appropriate to specialty, degree, role, locale etc.

Also provide the job search website(s)’ urls

Environment for practice:

If you have identified where you want to practice, consider your personal and professional practice needs and if the selected environment supports your practice and security for the following:

•   Safety, lit parking lots, escorts if needed, security

·     Is it organized?


·      Clean rest rooms, access to meals/meal prep, conference rooms, play area for children, exam rooms, waiting area, laboratory, utility room, offices, storage, and quiet room.


•   Will you need to take call?

•   How flexible are they with your work schedule and hours?

·     How flexible are they with vacation, sick leave, maternity leave


•   Do you have to supply your own coverage if you are out?

•   Who makes those decisions?  Is it an office manager? Medical director? Supervising physician?

·     Other?


Specific requirements to step into NP position:

Consider these aspects of initial career launch. e.g.;

·        Is a relocation or separate apartment needed?

·        What are the projected costs in time and resources (“ball parking” this set of costs is sufficient)


Quality Assurance Plan:

•   Identify what you feel must be measured to practice safely

•   Does the practice manage QA in a manner agreeable to your philosophy?

IF considering your own private practice:


·     Consultants (lawyer, etc. if starting a private practice)


•  Skills needed to document to apply for hospital privileges

•  Additional certifications, training or education needed for owning your own practice and understanding the billing

·     Additional staffing needs (receptionist, billing specialist, other providers, etc.)


•  Will you need to speak a foreign language or have a translator for your desired position



Local Professional Resources:

Create a list reflecting local to broader contacts which may include the following:

·       Local list-serves of specialty referral sources

·       Local List for consultation contacts – who will you call for advice?

·       Local organizations of specialty/role

·       Major and essential professional organizations/ membership in specialty

·       Membership fees/benefits


Also provide specialty and organization website(s)’ urls

Provide url’s for at least one national and one local organization



State what you will require in your practice (self /private or group:

Software, such as :

•   Billing software/printer

•   EHR; compatible with Medicare/Medicaid systems

•   E-Prescribing

•   Data entry forms

•   HIPAA compliance programs

•   Email/patient and referral options

•   Transcription services

•   Apps for your mobile device such as Guidelines for your practice

·        Other


Hardware, such as:

·        Desktop computers or

·        iPad or other mobile device

·        On-line printer

·        Credit card Processor

·        Other


Templates or charting forms:

Review current or practice needs and forms essential to practice. Ask if these are present, if not, be ready to locate/create forms, state where they are found or retrieved to provide structure and continuity to encounters (e.g., a PMHNP will need a template for a Diagnostic Evaluation on hand, AIMS and other scales, etc.)

Other forms (per eChart or paper):

•   Intake (name, address, telephone, insurance company, phone number, birth date etc.)

•   History & Physical

•   Evaluation/consultation

•   Tracking of healthcare maintenance/screening

•   Patient Instructions forms

•   Common screening forms

•   CHDP or other routine physical form templates

•   Other


Create a list identifying texts, books and on-line, virtual resources that are indispensable for your specialty and any other “must have” materials needed nearby for day to day practice.  Are they available to you?

·        ePocrates

·        NEI app

·        Up-to-Date

·        DSM-V

·        Professional library access

·        Other per specialty




•   Does position or your practice require/support evidence-based research? Do you plan to include this in practice?

•   Is there access to a medical library for references?

Cost of Rx for Patient:

·     Provide at least 3 website(s)’ urls for medication costs (e.g., Costco, Target, Walmart, Good Rx) for cost comparison for commonly used drugs






Standard of care:

State your plan for annual updating of your skills (e.g., consult specific evidence-based texts, attendance at a minimum, one conference annually in addition to state Board of Nursing continuing education (CEU) mandated or other procedure protocols (if any).

·       What conferences will you attend (costs)


·       What journals will you subscribe to (costs)?


Also provide conference and journal website(s)’ urls


Policy engagement:

•   Outline your plan to remain current, compliant and engaged in emerging legislative policies, actions, and debates impacting practice

•   Identify the state representatives that are responsible for

your physical practice area and give their contact

Information – addresses, phone numbers

·        List any current legislative issue that may impact your current of near future practice as an APRN


Also provide legislative website(s)’ urls for at least one national nursing organization’s PAC page and the information pages for your representative(s)

Plan of Action:

·       Provide three first year of practice goals in a desired action plan with timeline of completion as identified above (e.g., date of program completion, date for passing national certification exam, date for completion of APRN licensure in your practice state, etc.)


·       Identify required professional and personal “life” changes that include projected cost(s)


·       How will you sell yourself to a new employer – create a personal cover letter in writing for employers, insurance companies, other providers for marketing purposes





Grading Rubric NP Practice Plan

















35 points



Plan is complete and  succinctly presented;

logical justification for not applicable

Plan is mostly complete with some missing items or illogical justification(s) for not applicable Plan is somewhat complete with several missing items or illogical justification(s) for not applicable Plan is incomplete with most items missing or inappropriate justifications(s) for not applicable Majority of plan items and not applicable justification(s) are missing


Website url(s)





20 points (80/300)


Plan reflects evidence-based references and resources.  Website url(s) are appropriate for NP practice and specialty Plan reflects mostly evidence-based references and resources.  Most website url(s) are appropriate for NP practice and specialty Plan reflects some evidence-based references and resources.  Some website url(s) are appropriate for NP practice and specialty Plan reflects inappropriate or non-evidence-based references and resources.  Website url(s) are inappropriate for NP practice and specialty Plan is missing evidence-based references and resources or website url(s) appropriate for NP practice and specialty
APA Formatting, correct English grammar and punctuation


20 points


Perfect APA format with correct English grammar and punctuation. APA format with some errors; overall correct English grammar and punctuation. APA format with some errors; overall correct English grammar and punctuation. References outdated, numerous APA and/or writing errors. Disregard for APA format. English grammar and punctuation.
        Total = 300 points