Discussion: Policy Brief NURS 8100

A Sample Answer For the Assignment: Discussion: Policy Brief NURS 8100

A policy brief is a vital tool used to present research findings and recommendations to an audience with no specialization in the policy matter. Policy briefs offer evidence-based policy recommendations to help legislators make informed decisions (Arnautu & Dagenais, 2021). A strong policy brief incorporates research findings supporting the recommended policy and draws clear connections to policy initiatives. Therefore, it should be clear and concise to ensure the target audience adequately understands the recommendations. This paper presents a policy brief on the recommendation from the Institute of Medicine (IOM) report.

Selected Recommendation

The selected IOM recommendation is: “Nurses should practice to the full extent of their education and training.”

Background

The IOM recommendation emphasizes the need to transform nursing practice. The report encourages lawmakers to be guided by the Nursing Practice Act and Administrative Rules to amend state nurses’ scope-of-practice laws. Advanced Practice Registered Nurses (APRNs) are highly trained and competent to provide a wide range of healthcare services. However, they are limited by barriers, such as federal policies, state laws, obsolete insurance reimbursement models, and organizational practices and culture (Sullivan, 2018).

State and federal initiatives are needed to update and standardize APRNs’ scope-of-practice regulations to capitalize on their specialized education and full capacity. Furthermore, the IOM report states that APRNs need to be allowed to practice to the full scope of practice. This will ensure that all citizens can access essential healthcare services and that organizations make the best use of the APRNs’ unique contributions to the healthcare team.

Insurance providers and States should create specific policy, regulatory, and financial changes that offer patients the freedom to choose from a range of health providers, including APRNs, to best, meet their healthcare needs (Sullivan, 2018). Eradicating regulatory, policy, and financial barriers to increase patient choices and patient-centered care is critical in creating a reformed health care system.

Current Characteristics

The scope of APRN practice varies with the state. The American Association of Nurse Practitioners (AANP) defines three types of practice authority for APRNs: Full, Reduced, and Restricted practice. APRNs practicing in states with Full practice authority are authorized to practice to their full scope of training, including evaluating, diagnosing, ordering and interpreting diagnostic tests, and prescribing treatments (AANP, n.d.).

The state board of nursing gives them exclusive authority to practice to their full scope. Currently, 24 states in the U.S and its territories have adopted Full practice licensure laws. NPs practicing in states with a reduced practice are allowed to participate in at least one element of the NP practice. However, they are regulated by a collaborative agreement with a physician (AANP, n.d.). Physician oversight is needed for the NP to prescribe treatment. Sixteen states currently have the reduced practice.

There are 11 states with a restricted practice whereby the state board of nursing mandates APRN supervision or delegation of duties such as diagnosing and prescribing by a physician. Texas lies at the lower end of the spectrum with regards to the freedom it offers APRNs. One of the barriers to expanding APRNs’ scope of practice has been opposed by some physicians and physician organizations. Some physicians argue that APRNs are less competent to provide the services outlined in their scope of practice since they do not undergo rigorous training like physicians (Sofer, 2018).   

The Impact of the Recommendation

Patients perceive that the recommendation on the full scope for APRNs will increase their access to essential health services, especially in rural areas where there are few physicians and APRNs are usually the primary care providers. Currently, the country faces a shortage of primary care physicians, especially in rural and underserved areas (Ortiz et al., 2018). However, there is also an ample supply of specialists, which increase health care expenditures since specialist charge more expensively than primary care physicians. In addition, healthcare consumers perceive that the recommendation will lower the cost of healthcare. This is because full practice authority lowers duplication of services and billing costs caused by the outdated physician oversight (Ortiz et al., 2018). Besides, full practice decreases the unnecessary office visits, repetition of orders, and treatment services.

Nurses and professional nursing organizations argue that if all states allowed APRNs to practice to the full scope of their education and training, it could increase the workforce needed to meet the country’s primary care needs. APRNs would also contribute their specialized knowledge and skills to delivering person-centered, community-based health care (DePriest et al., 2020). Physicians believe that granting APRNs full practice will reduce their workload and increase access to care for patients living in underserved urban and rural areas. This is because states with full practice authority have many NPs working in the rural and underserved areas, which increases access to healthcare.

Nevertheless, some physicians perceive that the recommendation will negatively impact patient care due to the lack of rigorous medical training for APRNs (Sofer, 2018). Various organizations, such as the Kaiser Family Foundation, argue that APRNs could help meet the demand for primary care. They argue that APRNs’ full practice can help meet the demand for primary health care, which is increasing due to a growing aging population (DePriest et al., 2020). Besides, increased access to health care through the Affordable Care Act increases the population in demand for care, and APRNs can help bridge the gap.

Current Solutions

The current solution to having nurses to their full extent is advocacy. Many professional organizations are lobbying to remove barriers that limit APRNs from working to the full extent of their education and training (Peterson, 2018). NP organizations in various states have engaged lobbyists to help bring the advocacy efforts to the front line of policymakers. The lobbyists are educating policymakers on what APRN full practice entails.

They clarify that it is not a policy against physicians but rather one that seeks to provide patients with access to quality care (Peterson, 2018). The Campaign by the Future of Nursing is one approach taken to lobby for APRNs to practice to their full scope in states with reduced and restricted practice. Furthermore, the National Council of State Boards of Nursing (NCSBN) monitors the practice roles and bills related to APRN practice to keep APRNs informed of their lobbying efforts.

Current Status in the Health Policy Arena

A report from The Campaign shows that APRN practice authority has expanded significantly since the release of the IOM recommendation report. After the release of the IOM report, 44 state Action Coalitions worked on the recommendation to get rid of barriers in the APRN scope of practice. Besides, 13 states have passed laws granting APRNs full practice authority (Sullivan, 2018).

Since the Campaign’s commencement, eight states amended their laws to grant APRNs full practice and prescriptive authority. Furthermore, some states with reduced and restrictive practices have improved their laws to be less restrictive (Sullivan, 2018). For instance, Florida (reduced practice) passed a bill that requires PMHNPs to practice for the first two years with supervision and then practice to the full scope of their licensure.

Conclusion

The IOM recommendation on allowing APRNs to practice to the full scope of their education and training will increase accessibility to healthcare and lower costs. The health care environment is continuously evolving with an increasing demand for healthcare services from the aging population. Thus APRNs’ full contribution to the health care team is essential. Tremendous progress has been made toward decreasing restrictions on the APRN scope of practice across the U.S. States. The states with restrictive and reduced APRN practice are increasing APRNs’ potential to contribute fully to health care. However, more efforts are needed to hasten the amendments of the obsolete policies. We need more states to grant full practice authority to APRNs as primary care providers.

References

AANP. (n.d.). Issues at a glance: Full practice authority. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief

Arnautu, D., & Dagenais, C. (2021). Use and effectiveness of policy briefs as a knowledge transfer tool: a scoping review. Humanities and Social Sciences Communications, 8(1), 1-14. https://doi.org/10.1057/s41599-021-00885-9

DePriest, K., D’Aoust, R., Samuel, L., Commodore-Mensah, Y., Hanson, G., & Slade, E. P. (2020). Nurse practitioners’ workforce outcomes under the implementation of full practice authority. Nursing Outlook, 68(4), 459–467. https://doi.org/10.1016/j.outlook.2020.05.008

Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare6020065

Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

Sofer, D. (2018). AMA Resolution Opposes Independent Practice by APRNs. AJN The American Journal of Nursing, 118(3), 12. doi: 10.1097/01.NAJ.0000530922.33715.46

Sullivan, T. (2018). Institute of Medicine Report, The future of nursing: leading change, advancing health. Policy and Medicine.

Communities live in different geographical locations with varying health resources, lifestyles, and sociopolitical factors. Jointly and independently, these factors affect public health outcomes since they determine the type and scope of public health issues. As public health nurses and other professionals continue improving health, an in-depth understanding of complex public health concerns is vital.

Such knowledge enables them to design and implement effective interventions through health policies. The purpose of this paper is to discuss a public health issue related to the environment and the purpose of policy in addressing the problem.

Public Health Issue Description

Communities require safe and adequately resourced environments to live healthily. Such environments should be pollution-free and provide people with food, water, and other essentials for a quality life. Unfortunately, climate change threatens the environment and health of all populations. Children, youth, and adults are all affected by climate change irrespective of their location, race, and other factors.

According to the American Public Health Association (2023), climate change creates new risks among children and young people, inhibiting their capacity to shape their future. Older adults, pregnant women, and indigenous communities experience more environmental dangers as climate change intensifies. Since all populations are affected, and collaborative interventions are required, it is right to deduce that climate change occurs at all levels.

The effects of climate change illustrate its severity as an environmental threat and the risk it poses to all populations. Di Napoli et al. (2022) suggested that climate change hampers public health success via direct and indirect pathways. Direct pathways include health dangers caused by significant changes in temperature, such as cardiovascular disease and kidney problems. Indirect pathways include crop failure, reduced labor capacity, and expansion of disease vectors.

Besides, climate change hampers mental health and widens health equity gaps since susceptible groups experience its impact the most (American Public Health Association, 2023; Aylward et al., 2022). Solutions, including policies, disaster response services, and mental health support, should be problem-centered and specific to issues facing a particular group. The impacts show that no particular community group or age is immune to climate change dangers. Therefore, local, state, and nationwide interventions should be combined to address the severe public health concern.

Impact of the Current Policies

Policies include integrated interventions, such as laws and regulations, implemented to promote society’s health and wellness. President Biden’s administration has embraced various policies to prevent environmental degradation by controlling climate change. They include rejoining the Paris Climate Agreement and the infrastructure bill to fund renewable energy programs (Kennedy et al., 2022).

The Paris Climate Agreement requires member states to pursue efforts to limit global warming to 1.50C. Renewable energy technologies include biofuels for transport to reduce the increased reliance on fossil fuels, mitigating climate change dangers by reducing carbon emissions (White, 2021; Perera & Nadeau, 2022). If successfully implemented, the policies will reduce health concerns stemming from extreme temperatures and other effects of climate change.

Changes to the Current Policies and Steps for Initiating Policy Change

Policies implemented to reduce carbon emissions are vital for a healthy nation presently and in the future. However, achieving the desired outcomes could be challenging if laws hindering policy implementation are not abolished. For instance, the Supreme Court recently limited Environmental Protection Agency’s authority to regulate emissions from power plants (Kennedy et al., 2022).

Such laws should be reviewed or prevented to encourage companies to use renewable energy sources. Commonly, policy change requires political willingness, where policymakers collaborate with politicians to propose and support policy change. Proposals can be reviewed and passed by Congress and other organs involved in policy formulation and implementation.

Stakeholders and their Importance

Policy change is an intensive process with different stakeholders depending on the type and scope of change. Policy changes involving health laws can be initiated by government officials at the state and federal levels.

Their primary role is to design appropriate interventions for health problems, search for government funding, and be directly involved in policy implementation. During implementation, government officials such as politicians can mobilize human, material, and financial resources necessary for successful policy change.

Impact on the Health Care Delivery System

Health-related policies are crucial in creating healthy populations hence reducing the illness burden in the health care delivery system. According to the World Bank (2022), global food insecurity has increased progressively due to global warming and other adverse effects of climate change.

Climate control interventions can prevent such an increase and reduce the number of people with health conditions stemming from food insecurity. The mental health burden would also reduce, considering climate change is linked with hopelessness, anxiety, and depression (American Public Health Association, 2023). Addressing these issues through policy implies reducing health care spending while improving public health through illness prevention in the community.

Conclusion

Clean and safe environments are crucial for high-quality public health. Since climate change causes global warming, food insecurity and other health dangers, preventing it should be prioritized by health care providers and governments at all levels.

Health policies can effectively address climate change by preventing emissions and obligating organizations to implement measures for preventing global warming. Among others, such interventions can reduce the national disease burden and enable communities to live healthily.

References

American Public Health Association. (2023). How climate change impacts health. https://www.apha.org/Topics-and-Issues/Climate-Change/Health-Impacts

Aylward, B., Cunsolo, A., Vriezen, R., & Harper, S. L. (2022). Climate change is impacting mental health in North America: A systematic scoping review of the hazards, exposures, vulnerabilities, risks and responses. International Review of Psychiatry, 34(1), 34-50. https://doi.org/10.1080/09540261.2022.2029368

Di Napoli, C., McGushin, A., Romanello, M., Ayeb-Karlsson, S., Cai, W., Chambers, J., … & Robinson, E. J. (2022). Tracking the impacts of climate change on human health via indicators: Lessons from the Lancet Countdown. BMC Public Health, 22(1), 1-8. https://doi.org/10.1186/s12889-022-13055-6

Kennedy, B., Tyson, A., & Funk, C. (2022). Americans divided over direction of Biden’s climate change policies. Pew Research Center. https://www.pewresearch.org/science/2022/07/14/americans-divided-over-direction-of-bidens-climate-change-policies/

Perera, F., & Nadeau, K. (2022). Climate change, fossil-fuel pollution, and children’s health. New England Journal of Medicine, 386(24), 2303-2314. https://www.nejm.org/doi/full/10.1056/NEJMra2117706

The World Bank. (2022). What you need to know about food security and climate change. https://www.worldbank.org/en/news/feature/2022/10/17/what-you-need-to-know-about-food-security-and-climate-change

White, T. (2021). Countering climate change with renewable energy technologies. Federation of American Scientists. https://fas.org/publication/countering-climate-change-with-renewable-energy-technologies/

The Institute of Medicine (IOM) Future of Nursing Report Brief addresses four very important elements of nursing practice that are in need of change. According to Kershaw (2011), the four areas of needed change include nurses practicing to the fullest scope of their license, nurses engaging in seeking and attaining higher levels of education, nurses being considered as equals with their physician colleagues when taking the initiative to redesign health care, and nurses creating a foundation of data through research and evidence-based practice to support policies and procedures in nursing practice.

The area of specific interest to me is item number three. This initiative focuses on nurses becoming full partners with physicians when redesigning healthcare in the United States (Kershawm 2011). The reason this initiative is important to me is that I work in an acute care setting where physicians are still revered as gods by the hospital leadership and nurses are considered the handmaiden to the physician.

It is a large hospital but set in a rural community and the founding fathers who opened the community hospital 16 years ago (Now part of a larger system) were very physician-focused. The bylaws do not promote employing mid-level practitioners, they do not recognize that certified nurse-midwives can practice independently, and have a strong working relationship with a Kaiser Permanente group that feels very threatened by the thought of utilizing mid-level providers and advance practice nurses (APNs).

According to Abraham et al. (2019), APNs are far more cost-effective than physicians, and they increase patient experience scores and clinical outcomes.

Constable et al. (2022) describe an increase in provider communications scores from 69% to 85% when APRNs were used in the acute care setting. This specific article also outlined a reduction in endotracheal tube-associated pressure injuries by 50% because of the care the APN provided to this population.

The reason for this is that APNs are trained to treat patients holistically and not be solely focused on a diagnosis or disease. Physicians are trained with a primary focus on disease. Collaboration between these two groups is essential when health care reform is being considered.

The IOM report brief nailed this issue on the head. There is a need to include APNs in health care reform and the recommendation in the article suggests this will happen through leadership training and the attainment of leadership competencies by all APNs. The American Organization of Nurse Executives (AONE) offers leadership training for all levels of nurse leaders.

The sole focus of the AONE is to promote leadership excellence among nurses, advance the practice, increase the engagement of research by nurses, and facilitate the preparation of nurses who will influence legislation and public policy (www.aha.org). For far too long the shape of health care has been formed by only a select portion of the population who provides it. Now is the time to think globally about healthcare reform and invite all of the contributors to the table.

References:

Abraham, C. M., Norful, A. A., Stone, P. W., &Poghosyan, L. (2019). Cost-Effectiveness of Advanced Practice Nurses Compared to Physician-Led Care for Chronic Diseases: A Systematic Review. Nursing Economic$, 37(6), 293–305.

American Organization of Nurse Executives. (February, 2022). AHA releases 2022-2024 strategic plan and updates to vision and mission statements. Retrieved: https://www.aha.org/special-bulletin/2022-02-08-aha-releases-2022-2024-strategic-plan-and-updates-vision-and-mission

Constable, M., Mulkey, M., &Aucoin, J. (2022). Hospital value–based purchasing: How acute care advanced practice nurses demonstrate value. Journal of the American Association of Nurse Practitioners, 34(1), 12–17. https://doi.org/10.1097/JXX.0000000000000606

Kershaw, B. (2011). The future of nursing – leading change, advancing health. Nursing Standard, 26(7), 31–31. https://doi.org/10.7748/ns2011.10.26.7.31.b1274

Professional nursing organizations have influenced the policy agenda by identifying
needs, generating ideas, and bringing them into the policy arena; they have had a
positive impact on the profession of nursing as well as nursing practice. This week’s
Discussion asks you to consider the policy proposal you examined for the policy brief
(Assignment 2, assigned in Week 3) and reflect on the opportunities a professional
nursing organization might have to further the issue.

To prepare:

 Review this week’s media presentation focusing on Dr. White and Dr. Stanley’s
comments on the role of professional organizations in the policy process.
 Consider the policy brief you developed for Application Assignment 2 (due this week),
and evaluate how a professional nursing organization might provide additional support
or influence.

By Day 3

Post in your small group thread a cohesive response that addresses the following:
 Briefly summarize the policy proposal you selected from the IOM Future of Nursing
Practice Report Brief (Application 2). Based on your analysis of the policy proposal, did
the IOM get it right?
 Identify any professional organizations dealing with the issue/recommendation and
provide at least two specific ways in which the professional organizations have
supported or could support the policy proposal/recommendation.
Read a selection of your colleagues’ postings.

By Day 6

Respond to at least two of your colleagues in one or more of the following ways:
 Ask a probing question, substantiated with additional background information, evidence
or research.
 Share an insight from having read your colleagues’ postings, synthesizing the
information to provide new perspectives.
 Offer and support an alternative perspective using readings from the classroom or from
your own research in the Walden Library.
 Validate an idea with your own experience and additional research.
 Make a suggestion based on additional evidence drawn from readings or after
synthesizing multiple postings.
 Expand on your colleagues’ postings by providing additional insights or contrasting
perspectives based on readings and evidence.

Note: Please see the Syllabus and Discussion Rubric for formal Discussion question
posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting.
Note what you learned and/or any insights you gained as a result of the comments
made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning
Resources and any additional sources.
Submission and Grading Information

Grading Criteria

To access your rubric:
Week 7 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 7 Discussion