Eliminating Physician Oversight for APRNs in Texas

Eliminating Physician Oversight for APRNs in Texas The recent passage of the Affordable Care Act (ACA) and the effort to provide healthcare for every American is expected to create a large influx of citizens seeking primary care providers. The current demand for primary care services has already burdened most states with a projection of more than 16 million individuals gaining health coverage by 2016, with a projection in Texas of more than 4.2 million (Schiff, 2012). Advanced practice registered nurses (APRNs) possess the training, experience and expertise in providing primary care services and can be part of the solution in solving shortages, but face unnecessary restrictions in Texas. Advanced Practice Registered Nurses (APRNs) are nurses possessing masters, post-masters or doctoral level education. An APRN holds national certification and in Texas is licensed by the state Board of Nursing (BON) (CNAP, 2013). A wealth of evidence suggests that APRNs have the skills and expertise to perform many of the primary care services that physicians perform with an equal or higher patient satisfaction rate (Humphries, 2007). The Institute of Medicine (IOM) has criticized states laws that prevented APRNs from practicing to the full extent of their training (2011). Therefore, removing these restrictions, will permit APRNs in Texas is a practical solution to help meet this shortage. In addition, APRNs will also enhance health delivery efficiency and provide economic benefit as well for Texas by creating nearly 100,000 permanent jobs for the state of Texas (Perryman, 2013). Action needs to be taken to remove restrictions that are preventing or delaying APRNs from caring for Texans. As the population of Texas grows, this problem will only be compounded to a system that is already inadequate and overloaded. The laws and regulations concerning APRNs scope of practice varies by state, with 16 states permitting full practice authority, without physician oversight. This permits APRNs to practice to the full extent of their training. The remaining states (34) require some degree of physician oversight and involvement. States with only minimal restrictions have not reported any increased threat to patient safety (Texas Public Policy Foundation, 2013). Texas is one of the remaining states with a high level of oversight. Recent research indicates that APNs who live in states that allow full practice authority give more care (IOM, 2011). By removing these unnecessary restrictions, more NPs will be able to meet the healthcare needs of Texans. Texas Public Policy Foundation (2013) reports that of Texas’s 254 counties, only 23 have an adequate number of healthcare professionals to serve their populations. In addition almost 90% of rural Texas counties are considered partially or completely underserved. Twenty-five Texas counties have no physicians at all and it is estimated that 20% of Texans (3.3 million) do not have access to a primary care provider. As the provisions of our national healthcare law go into effect we can expect this to worsen with an anticipated shortage of 44,000 to 46,000 primary care providers nationally by 2025. The severe PCP shortage has also been affected by a shrinking medical school enrollment and a decrease in the number of students choosing primary care as a specialty (Texas Public Policy Foundation, 2013). Utilizing the expertise of APRNs as for primary care can lead to a more efficient delivery system that will provide significant savings. This would create almost 100,000 new permanent jobs by 2020, increase annual economic output (gross product) by $8 billion, and 16.1 billion in total expenditures within Texas (Perryman, 2013). In addition, this would stimulate the economy with yearly tax receipts of 483.9 million to the state of Texas and $233.2 million to local governments. These projections would be expected to rise each decade. Many studies over the last 40 years have indicated that APRNs are able to provide safe, high quality and low cost primary care to their patients (Perryman, 2013). Studies also indicate that patients report a similar if not better experience when they receive primary care from APRNs vs. physicians, and often at a lower cost (Brown Grimes, 1992). In a research study of Medicaid patients, the cost- effectiveness of utilizing APRNs was evident as patients re ceived the same high quality of care as physicians, while providing a discount of 8% from physician rates (Perryman, 2013). Failure to make the necessary changes to our healthcare delivery system in Texas will result in a worsening of the primary care shortage compounded by the provisions of the affordable healthcare law and the influx of newly insured individuals (Schiff, 2012). In addition to restrictions this places on accessibility to primary care services, there is a potential for a rise in the already inflated healthcare costs for services (Perryman, 2013). Changes in legislation are needed to address the removal of physician oversight restrictions on APRNs and to allow full practice authority in Texas. APRNs possess the training and experience to necessary to provide primary care services to Texas citizens and should be allowed to practice to the full extent of their education and training (IOM, 2011). This is vital and the best practical solution for addressing the healthcare needs of Texans. Political Environmental Scan Timing The Coalition of Nurses in Advanced Practice (CNAP) has been working to improve the recognition, reimbursement, and utilization of APRNs since 1991. Their efforts have accelerated legislative policies for this cause (CNAP, 2013). The most recent legislative action put into effect in November 2013 was SB 406 in which a collaborative agreement was made among APRNs and medical groups. This bill was unanimously passed by both the House and the Senate of the 83rd Texas legislature. The bill expanded the number of APRN’s/PA’s that a physician can supervise, eliminated any limit for medically underserved populations, reduced the number of face-to-face meeting with the physicians, and permitted these to be done via video web conferencing. In addition the new law lifts restrictions on prescriptive authority in regard to site–based restrictions and introduces a Prescriptive Authority Agreement (PAA) (Nelson, 2013). Further clarifications are still needed related to the SB 406, in particular on issues related to contracting problems with certain managed care organizations (CNAP, 2013). It is the ANA’s and CNAP’s position that removing barriers of APRN’s is a vital measure that must be taken to promote universal accessibility of healthcare especially in light of current healthcare reform goals (Hutto, 2013). The Texas legislature (84th) will meet again in regular session beginning January 2015 for 140 days. The CNAP continues to work on new legislative agenda during the interim. Since the last legislative session addressed these issues, it is unlikely this topic will be a priority for the 84th session. General elections are slated for November 2014, so the exact makeup of the next legislature is unknown, however, the Republican party has had a stronghold on both the Executive branch as well as the Legislative branch for the last decade and is likely to continue (UT Austin, 2009). Relationships/Reputation Political relationships have been formed between nursing organizations like the CNAP and Texas legislators and include lobbyists who discuss these important issues. This coalition of advanced nursing organizations includes all statewide APN organizations. Their focus is to expand prescriptive authority, ensure clinical privileging, increasing third party reimbursement, improve the recognition of APN’s, and keep APN’s informed on laws and regulations (CNAP, The major stakeholders are the organizations and groups that have a vested interest in the issue. APRN’s will most definitely benefit from the elimination of oversight since it will allow them to practice to their full potential. Hospitals, insurers and managed care facilities will also benefit from cost savings and improved quality of patient-centered care. In addition, the taxpayers and the State of Texas will benefit from the decreased healthcare costs and increased economic output (Perryman, 2012). The stakeholders with opposing viewpoints include the AMA, Texas Medical Association (TMA), Texas Academy of Family Physicians, American Society of Anesthesiologists, and American Academy of Pediatricians. These groups will most likely continue to resist changes that they feel infringe on their scope of practice and will be reluctant to agree to the removal of barriers that restrict APRNs from practicing to their full potential (CNAP, 2013). Resources Much research has been done to support this issue and according to the CNAP, there is no evidence that patient outcomes in states that mandate physician delegation are better than in states where APRNs are allowed to practice independently (CNAP, 2013). In a review of literature by Brady (2000), comparisons were made regarding the performance of nurse practitioners and physicians on three key patient outcome measures: patient satisfaction, health status, and service utilization. Researchers investigated the primary care given by NPs using the traditional medical model and found no difference in effectiveness or quality when compared to that of physicians (Brady, 2000). To support advancement of this issue, several other organizations are also lobbying for these proposed changes. These include organizations like the ANA and the Veterans Administration (VA), who are pushing for policy changes. The VA has in fact revised its nursing handbook, allowing APRNs to practice as independent practitioners throughout the Veteran’s Health Administration system, even in states where laws require physician oversight (ANA, 2014). The ANA has supported this change within the VA system, since the change is congruent with the 2010 Institute of Medicine’s recommendation that nurses should practice to the full extent of their education and training (ANA, 2014). On the state level, the TNA supports the elimination of MD oversight of APRNs as well. According to the TNA, removal of practice barriers for APRNs will alleviate the shortage of primary care providers, especially in rural areas (TNA, 2014). Communication Several media platforms can be utilized to creating public awareness of an APRN’s role and as a viable option for primary care. These can be used to increase public awareness and gain support for the removal of the practice restrictions currently in place in Texas. An increased public awareness can also assist the policy process by creating grass-roots approaches to this issue. The use of PSA’s via social media sites can encourage the general public to send emails, letters, and support for candidates, nursing organizations and action committees that work to advance the nursing agenda. A media strategy has been proposed to include the following communication tools: 1) a PSA using a PowerPoint delivered via popular media sites like YouTube that can provide public information regarding the need for immediate changes to this health policy issue and can encourage support, 2) a social media approach utilizing a Facebook page for the same intent, and 3) a pamphlet/flyer to be distributed to Texas US Senators and Members of the House, outlining the key talking points and urging support for the policy changes and future legislation on the issue. (See Appendix A for links) Included in each of the different media strategies, key aspects will be addressed using these talking points: What is the role, education and training of an APRN? What is the impact of the ACA on the existing shortage of primary care providers in Texas? How will allowing full practice authority for APRNs benefit Texas? The recent passage of the Affordable Care Act (ACA) is expected to create a large influx of citizens seeking primary care providers. The current demand for primary services has already burdened most states with a projection of more than 16 million individuals gaining health coverage by 2016, with projections in Texas of more than 4.2 million. Advanced practice nurses (APRN) possess the training, experience, and expertise in providing primary care services. The Institute of Medicine has urged states, like Texas, to change laws that place unnecessary restrictions on APRNs, as part of a solution to these shortages. Removing these restrictions will allow APRNs to be more fully utilized in Texas to serve the healthcare needs of Texans. As the population of Texas grows, the efficiency of a healthcare system that is already inadequate and overloaded will worsen. Reports indicate that of Texas’s 254 counties, only 23 have an adequate number of healthcare professionals to serve their populations. Nearly 90% of rural Texas counties are considered partially or completely underserved. Furthermore, 20% of Texans (3.3 million) do not have access to a primary care provider. As the provisions of our national healthcare law go into effect we can expect this to worsen with an anticipated shortage of 44,000 to 46,000 primary care providers by 2025. The severe physician shortage has also been affected by a shrinking medical school enrollment and fewer opting for a primary care specialty. APRNs can enhance health delivery efficiency and provide economic benefit by creating nearly 100,000 permanent jobs by 2020, increase annual economic output (gross product) by $8 billion, and 16.1 billion in total expenditures within Texas. This would also stimulate the economy with yearly tax receipts of 483.9 million to the state of Texas and $233.2 million to local governments by 2020, with projections continuing to rise every decade. A large number of studies indicate that patients have similar if not better experience when they receive primary care from APRNs vs. physicians and often at a lower cost. In the US, 33 states grant APRNs the freedom to diagnose and prescribe, 11 without physician collaboration. Failure to make changes in Texas will result in a worsening of the primary care shortage, compounded by the influx of newly insured individuals. In addition, there is a potential for an increase in the already inflated healthcare costs for services. Please support legislation that addresses the removal of physician oversight restrictions on APRNs currently in place in Texas. APRNs possess the training and experience necessary to provide primary care services to Texas citizens and should be allowed to practice to the full extent of their education and training. This is vital and the best practical solution for addressing the healthcare needs of Texans.

Education and Fast Growing Society Essay

The co-educational system has always been an issue of great controversy. Its supporters claim that separating boys from girls is completely unrealistic since schools are supposed to depict society and prepare children to become its active members. On the other hand, those not in favor of it claim argue that single-sex schools are more effective since they are adapted to each sex’s needs and features. There is little doubt that single-sex schools may be more targeted to each sex’s traits. For example, boys’ schools are stricter in order to achieve discipline while girls’ schools focus on teaching them major principals that will help them lead a successful life not only as professionals but also as family leaders later in life. In addition, boys and girls tend to distract each other during the lesson and therefore make it difficult to concentrate. I am of the opinion that co-education has more to offer to the modern society. First of all, single-sex schools are utterly out-of-date and belong to the past when boys and girls socializing was considered immoral. Nowadays, that both sexes are equal, the mentality of creating and maintaining separate educational facilities is unacceptable. Moreover, having girls and boys in the same environment promotes their competitiveness in a creative way which leads to a high quality learning process. In a final analysis, co-education has proved to be more suitable in answering the increasing demands of our fast growing society. Considering how hard women have fought over the years to gain their rights, wouldn’t it be unfair to have separate schools?

The Secret to Good Topics for a Profiling Essay

The Secret to Good Topics for a Profiling Essay If you wish to take advantage of WordPress you ought to utilize Linux hosting. Even if you're a specialist in a particular field, don't be afraid to use and cite external sources. If you're creating a database driven site you must be cautious. If you are only prone to create a typical site then either Linux or Home home windows will likely be fine. Understanding how to compose a strong argumentative paper will help you advance your very own argumentative thinking. Keep in mind your controversial research paper won't fix the matter, it's required to teach you to examine the matter from all the sides possible and hold the discussion. Conduct a research before you are able to even start to provide an answer here. Discussion Essay Tips Some individuals believe that environmental problems should be solved on a worldwide scale even though others believe it is preferable to address them nationally. If You Read Nothing Else Today, Read This Report on Good Topics for a Profiling Essay Some people believe getting a degree from university is the ideal approach to guarantee a very good job, others feel it would be better to go straight into work and get experience instead. The full thing may have a lot of intended puns but never too ambiguous. You're attempting to show colleges your very best self, therefore it might appear counterintuitive to willingly acknowledge a time you struggled. Among the themes that you will discover among our examples is linked to the effect of horror movies on people. The Rise of Good Topics for a Profiling Essay At this time you've got to compose a paper about education. To compose a strong argumentative essay, students should start by familiarizing themselves with a number of the common, and frequently conflicting, positions on the research topic so they can write an educated paper. If you are fighting with selecting essay topics or writing it, here is the ideal solution. It's therefore important to thoroughly consider different college essay topics. Individual schools sometimes need supplemental essays. In some instances, the college will offer an essay topic for you. Good Topics for a Profiling Essay - Overview The college essay is among the most essential elements of your college application. There are in fact two sorts of dissertation, every one of which has its own rules. For instance, you can opt for a topic for elementary, middle, or higher school. Colleges are more inclined to admit students who can articulate certain explanations for why the school is a great fit about them beyond its reputation or ranking on any list. New Step by Step Roadmap for Good Topics for a Profiling Essay An impromptu speech is the one which you should give with no preparation. Curriculum proposal topics is a means to try. Write about why it is going to be important to you and why you have to get a college education. The ways students ought to be taught about their wellbeing. Good Topics for a Profiling Essay and Good Topics for a P rofiling Essay - The Perfect Combination Your prayers are answered. In some instances, however, you don't have a chance to get ready for that. There is apparently a growing number of serious crimes committed annually. Think about friends and relatives. Thus, in the event that you opted to write about this subject, do so objectively. Attempting to decide on a topic please be gentle and consider your audience. It is possible to pick one of them or produce your own topic if you would like to. When these topics can lead to a superb paper, it's almost always a bright idea to pick a more original topic. It is frequently a fantastic idea to opt for a topic that tends to elicit an emotional reaction. In choosing your topic, it's frequently a good idea to start out with a subject which you already have some familiarity with. You shouldn't go for something that's out of the topic. If you decide on one of these topics, you will surely succeed to draw the interest of your audience only because they involve the latest discussion topics. What's Actually Happening with Good Topics for a Profiling Essay The arguments ought to be presented in the exact same way, and no significant element of the original text needs to be left from the synthese. Once you receive an idea, the practice of writing will be much simpler. Interactive captions will lead you along the way, which means you will not ever forget a word. It is crucial to mention that the idea doesn't need to be a good one. Therefore your choice may be limited to what you will probably finish. To summarize, even though it's simple to see why allowing an elementary school child to have a mobile phone would be convenient for after-school pickups or arranging playdates with pals, there's too much evidence to demonstrate that it's generally not a great idea. The combination is quite rare, but you can discover it only in MyAssigmenthelp.com.

Racism Has Gone Back Underground By Richard Pryor - 952 Words

There s a lot more hypocrisy than before. Racism has gone back underground. Richard Pryor. This quote is a GREAT example of the current disadvantages black families are facing today and have been facing for a lifetime. In the 1910 blatant racism to an individual’s face was something to chide someone about, but the racism hidden in our social structures have remained and is continuing to thrive. Structural racism in the U.S is defined as the normalization and legitimization of an array of dynamics that routinely advantages whites while producing cumulative and chronic adverse outcomes for people of color (Lawrence, Keleher). It is found in institutions such as, education, politics, and economics. As a mixed-status family the individuals in my family have faced many disadvantages and some advantages at the hands of structural racism. It affected our access to Housing, the labor market, healthcare, and education. I asked four of my family members about their personal experience w ith structural racism and I will also include my experience in this paper. To begin, housing discrimination is discrimination based on protected class status, race, ethnicity and so much more in the realm of housing and real estate. It can lead to racial segregation and housing inequality. It began to occur in the United States after the abolition of slavery as part of federal law. In 1934 the Federal Housing Administration, also known as FHA was introduced and was possibly the most heinous of all

The Criticisms of John Stuart Mill and Its Applications in...

â€Å"Absolute liberty is the absence of restraint; responsibility is restraint; therefore, the ideally free individual is responsible to himself† - Henry Brooks Adams. There has been great debate, past and present with regards to what constitutes as an individuals liberty. It has been subject to constant ridicule and examination due to violations of civil rights. Freedom, liberty, and independence are all important human rights represented within John Stuart Mill’s On Liberty. In his essay, Mill explores the two dimensions to liberty; individual and social. Carefully he analyzes the variance between the individual and social sphere through freedom of expression, more specifically, freedom of speech. Throughout the novel, he expresses that†¦show more content†¦Also noted by Mill, dating back to centuries ago the minority was heavily protected by the authority. the stronger. â€Å"To prevent the weaker members of the community from being preyed upon by innumer able vultures, it was needful that there should be an animal of prey stronger that the rest† ( Mill, 2) With that said, Mill’s essay speaks strongly on â€Å"demanding liberty of conscience in the most comprehensive sense, liberty of thought and feeling, absolute freedom on opinion and sentiment on all subjects, practical, or speculative, scientific, moral or theological† (Mill 71) believing that we have the freedom to direct our own destiny. Additionally, Mill also advocates for free speech on the grounds of an individuals safety, more in depth, the physical and emotional safety of a citizen. â€Å"The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will,is to prevent harm to others†( Mill,8) Here, it is obvious that Mill advocates free speech as long as it doesnt hamper another being. Furthermore, Mill also justifies his belief in free speech on the grounds of ones mental well being stating à ¢â‚¬Å"necessity to the mental well being of mankind of freedom of opinion.( Mill,43) It is apparent that Mill asserts freedom of speech is acknowledged on the basis of an individuals safety, both physical and mental. 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Disaster and emergence management program Free Essays

Disaster Management can be defined as the administration and organization of responsibilities and resources for dealing with all human centered aspects of emergencies, in particular preparedness, action and recovery in order to reduce the effect of disasters. A disaster can be described as an abrupt, calamitous event that severely cut off the functioning of a society or community and results in material,economic and human or environmental losses. We will write a custom essay sample on Disaster and emergence management program or any similar topic only for you Order Now Disaster and emergence management program. This essay focuses on the overall idea of how to manage effectively disasters and emergence cases on a national level so as to minimize losses to people and property. The main objective is to reduce the outcome of the disaster on people,the environment and property. To effectively control events,stop escalation and rehabilitate the affected persons or population in order to speed up recovery. In order for this objective to be archived several measures have to be undertaken and strictly implemented. Being prepared for emergencies is of paramount importance since disaster can strike quickly and without warning. Four major steps need to be followed so as to come up with a comprehensive plan that will tackle disasters and emergencies effectively. First of all is the issue of putting in place appropriate public policies and plans that either adjust the repercussions of disasters or lessen their effects on people, property, and infrastructure. This will include proper installation of a coordination,organization and command structure along with efficient competent and capable personnel. In order to reduce the effects of inescapable disasters measures such as carrying out vulnerability analyses updates, following the laid out building codes and regulations,setting up preventive health care and public education have to be set. All these measures have to be integrated in the national and regional development planning and its proficiency will rely on the accessibility of information on hazards,sudden risks and countermeasures to be taken. These plans are put in place in anticipation of a disaster . The second step is to set up preparedness plan in order to achieve a reasonable level of readiness to counter any emergency situation through programs that reinforce the technical and managerial capacity of organizations, communities and governments. These measures can be described as logistical preparedness to deal with disasters and can be elevated by having response mechanisms and procedures, practice performances, developing long-term and short-term procedures, public education and installing early warning systems. Preparedness can also take the form of ensuring that strategical reserves of water, food, medicines, equipment, and other fundamentals are maintained in cases of national or local calamity. During the preparedness phase, organizations, individuals and governments,build up plans to save lives, reduce disaster damage, and strengthen disaster response operations. Preparedness measures include preparedness procedures; emergency exercises/training; warning tactics; emergency communications machinery; evacuations procedures and training; resource inventories; emergency personnel/contact lists; collective aid agreements; and public education. The third step is the human centered action and it normally involves the humanitarian agencies which are often called upon to deal with instant response and recovery. To be able to act effectively, these agencies must have well versed leaders, competent personnel, sufficient transport and logistical support, pertinent communications, and guidelines for carrying out emergencies. If the needed preparations have not been made, the humanitarian agencies will not be able to handle the imminent needs of the people. There is also the issue of response which aims at providing instantaneous assistance so as to maintain life,encourage the morale of the affected community and enhance health Such contribution may range from providing specific but limited aid, such as helping refugees with transport, impermanent shelter, and food, to establishing temporary settlement in camps and other locations. It also may involve primal repairs to damaged substructure. The main focus of this step is to meet the basic needs of the population until more lasting and sustainable solutions can be established. Ashman, John. (1995. ). The final stage of the disaster management plan is the recovery stage. As the emergency is brought under manageable levels, the affected population is notable of embarking on an increasing number of activities targeted at restoring their lives and the substructure that helps them. There is no particular point at which instant relief changes into recovery and then into long-term bearable development. There will be numerous opportunities during the recovery period to enhance anticipation and increase readiness, thus lessening vulnerability. Ideally, there should be a smooth change over from recovery to on-going development. Recovery activities go on until all systems are back to normalcy or better. Recovery plans, both long and short term, include returning crucial life-support systems to minimal operating standards; semi-permanent housing; public information; adequate health and safety education; rebuilding; counseling programs; and economic effect studies. Information resources and services include data collection and review related to reconstruction, and documentations of lessons acquired. Ashman, John.(1995. )Feinstein, R. (1989/90, 5(1) ). The capacity of human resource involved in a disaster management program especially on a national level can not be quantified. There are numerous stakeholders that are involved and must be integrated for it to be a success such as decision makers,policy makers, professionals ,administrators, (architects, engineers and others at various levels) financial institutions (banks,house financing institutions, insurance,) and NGOs and voluntary organizations. The same applies to financial and material resources which are vast. In the case of finances professional accountants should be involved so that they can clearly evaluate th possible extent of financial damage resulted by different types of disasters including the verification of estimates and valuation of disaster affected assets. They evaluate the different options of coping with disaster from the financial perspective and advise, devise and evaluate different procedures for assuring that resources would be available for disaster mitigation at the right time and place needed. The accountants should also advise on alternative strategies for post-disaster management and rehabilitation with specific regard to assuring financial security to the affected, availability and proper use of financial resources for bringing forth new economic opportunities etc. Institute of Education, Library and Media Services,(June 1996. ) How to cite Disaster and emergence management program, Essays

Evaluate Success of Your Website

Question: Discuss about the Evaluate Success of Your Website. Answer: Introduction: To identify and engage talented volleyball players and open up professional opportunities for them in the topflight professional leagues To profile players and their achievements in order to motivate them to explore their talents optimally and perform better To help the client generate traffic and use the site for sports related adverts To evaluate a website success, one needs to consider the various metrics. They include: Page views this tracks the number of people who viewed the content on the website Video views tracks and displays the number of people who viewed a video on a website such as players engaging in a match. Achievable using YouTube Insights or other hosts specializing in video (Hawes, 2017). Sharing metrics these show the number of people sharing a websites content through share buttons and links from Facebook, Google+, Twitter etc Comments by readers on a website. This is achievable through comment system such as Disqus. Time spent on pages measures how long a visitor hangs out on a page (Wahhab, 2016). Target audience Volleyball fans Young people to help them grasp what is volleyball Volleyball hobbyists and researchers Advertisers and financiers/sponsors References Hawes, T. (2017). 5 Ways To Evaluate The Success of Your Website. HostGator Blog. Retrieved 6 April 2017, from https://www.hostgator.com/blog/5-ways-evaluate-success-website/ Wahhab, G. (2016). 6 Metrics Every Successful Website Needs To Track. Square2marketing.com. Retrieved 6 April 2017, from https://www.square2marketing.com/blog/6-metrics-every-successful-website-needs-to-track