NR 509 Week 1: Barriers to Practice

NR 509 Week 1: Barriers to Practice

NR 509 Week 1: Barriers to Practice

The purpose of this essay is to look at various obstacles APNs encounter both within New Jersey and nationwide and why it is necessary to tackle them. Advanced Practice Nurses (APNs) are highly educated healthcare professionals with advanced degrees and specialized nursing experience who provide quality healthcare to underserved areas in the US (Brom et al., 2018). APNs play an invaluable role in delivering this vital service. However, despite their significant contribution, APNs in New Jersey and across the nation often face numerous barriers to practice ranging from legal constraints and limited scope of practice to insufficient reimbursement of services provided and limited resources and technology access. Addressing APN challenges through policy and advocacy efforts is imperative to ensure they can effectively contribute to improving access to quality healthcare for all patients.

Practice Barriers

Nurse midwives must work under physician supervision, which delays care delivery and adds unnecessary costs. Nurse anesthetists face restrictions in providing anesthesia independently, while nurse practitioners may be restricted in prescribing certain drugs and must enter collaborative practice agreements (Schorn et al., 2022). Clinical nurse specialists may be limited in their ability to deliver certain services and have limited job prospects, creating delays in care, higher healthcare costs, and reduced patient access to services. It is essential to address these obstacles so they can provide high-quality patient care.

Competition

APNs face several forms of competition that impede their ability to practice independently, particularly from physicians and physician assistants. Physicians tend to be seen as leaders within healthcare, possessing more resources and influence than APNs themselves (Schorn et al., 2022). Furthermore, some may view APNs practicing independently as an attack on their authority within healthcare systems and might resist APNs being independent providers altogether.

Interest Groups

Numerous interest groups influence APN policy at both state and national levels. These include professional nursing organizations, consumer advocacy groups, and healthcare organizations. Professional nursing organizations like the American Association of Nurse Practitioners and the National Association of Clinical Nurse Specialists advocate for policies to promote Advanced Practice Nurse (APN) practice while removing practice barriers posed by APNs. Furthermore, these organizations aim to raise awareness regarding its significance and expand its scope. Consumer advocacy groups such as the American Consumer Institute and AARP also play an integral role in shaping APN policy. These organizations lobby for policies that ensure access to high-quality healthcare at an affordable cost, including practices like APNs. Their advocacy helps ensure patients receive the care they require regardless of location or financial circumstance. Healthcare organizations such as hospitals and insurance companies also play an integral role in APN policy development. These entities may support policies that expand APN practice to increase access and decrease healthcare costs; conversely, they could oppose expansion due to concerns regarding quality, liability, or financial considerations.

Lawmakers and Interest Groups

Lawmakers play an integral part in shaping APN policy at both the state and national levels. Key figures within New Jersey’s legislative and executive branches that shape policy for APNs include Governor Phil Murphy, Senate President Edward Durr, and Assembly Speaker Craig Coughlin.

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Methods of Influencing Policy

APNs and their supporters can employ various means to sway policy change, such as lobbying lawmakers, organizing grassroots campaigns, advocating for reimbursement policy changes, or simply informing the public and lawmakers of their role in healthcare, benefits provided to patients by APNs, and need for policy modifications that remove obstacles to practice (Eden et al., 2021). By using these processes to initiate change, APNs can contribute to improving healthcare provision in the U.S.

Conclusion

Advanced practice nurses face numerous practice barriers that impede their independence both in New Jersey and across the US, such as restrictions on their scope of practice, educational and certification requirements, collaborative practice agreements, competition from other healthcare providers, and legislative advocacy. Through effective advocacy and education efforts, APNs and their supporters can work to remove these obstacles to increase access to high-quality health services for patients.

NR 509 Week 1: Barriers to Practice References

Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120-130. https://doi.org/10.1097/jxx.0000000000000023

Eden, L. M., Merrill, H., & Luthy, K. E. (2021). Empowering nurse practitioners to make health policy CHANGE: Steps to successful passage of legislation in Utah. Journal of the American Association of Nurse Practitioners, 33(12), 1254-1260. https://doi.org/10.1097/jxx.0000000000000561

Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a national survey: Ongoing barriers to APRN practice in the United States. Policy, Politics, & Nursing Practice, 23(2), 118-129. https://doi.org/10.1177/15271544221076524

This is an in-depth and outstanding post. Indeed, practice barriers for APNs in various roles continue on federal and state levels. As you noted, one of the outstanding barriers includes whether an APN can have a full practice, reduced practice, or restricted practice authority. The changing backdrop of the US healthcare system and the increasing diversity of the US population require deep-seated changes in the healthcare delivery system. Specifically, there is a current crisis of shortage of healthcare professionals in the US, which is greatly attributed to the expansion of insurance coverage under the ACA. It implies that if APNs are allowed to practice to the full scope of their education and training could play a significant role in helping to create a vital workforce to achieve the primary care needs of the nation and contribute their distinctive skills to the provision of patent-oriented, community-based care (Barnett et al., 2022).

            Nurses’ influence on health policy is essential in safeguarding the quality of care through access to needed opportunities and resources. Nurses face the routine influence of policy and politics in their practice. Being the biggest group in the healthcare workforce, nurses are exceptionally better placed to observe how health policy influences patients and communities. All APNs can support change, whether in the place of work, government agencies, nursing organizations, or engaging elected officials or policymakers (Hajizadeh et al., 2021). Every APN can add a voice in the formulation and enforcement of health policies. I agree with you that one of the best methods that APNs can use to influence policy change is joining national nursing organizations to achieve power with a collective voice. Nursing organizations often organize conferences to highlight policy priorities, resources and coalitions, and position statements.

NR 509 Week 1: Barriers to Practice References

Barnett, M., Balkissoon, C., & Sandhu, J. (2022). The level of quality care nurse practitioners provide compared with their physician colleagues in the primary care setting: A systematic review. Journal of the American Association of Nurse Practitioners, 34(3), 457-464. DOI: 10.1097/JXX.0000000000000660

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses’ participation in the health policy-making process: a systematic review. BMC Nursing, 20, 1-9. https://doi.org/10.1186/s12912-021-00648-6

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.

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

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)

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

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

  There are four roles that define the advanced practice nurse, this includes midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. In the state of Ohio, there are certain regulatory restrictions on the advanced practice nurse. For example, a nurse practitioner must practice under a standard care arrangement with a physician. This agreement among us includes prescription parameters as well as the nurse practitioner’s performance being reviewed by the physician. Even though the position does not need to practice on site with the nurse practitioner, her performance will be reviewed on an annual basis. Also, an advanced practice nurse does not have permission to admit a patient to a hospital which tells me there is a lack of understanding of the advanced practice registered nurse as well as a lack of recognition. Another barrier I believe is the state mandation , collaborating with a physician may be costly.  But even with these restrictions Ohio is not as strict as other states nationally we are actually considered to be reduced practice regulation state versus the full and the restricted.

      It is said that the exact function of the nurse practitioner is not well understood by physicians (Torrens,2020) and their counterparts. This to me can’t interfere with the ability to practice independently because of the competition received from our constituents.

        Key members of the state’s legislative branch and executive branch are our current governor Mike DeWine, four-year term, Lieutenant governor Jon Husted elected to a four-year term, current attorney general Dave Yost and our Secretary of State Frank LaRose.

       There are a few groups that exist that will influence the advanced practice nurse policy. AANP is one of them, they take on the role in advancing the nurse practitioner on a federal and state level.  OAAPN is an organization that try’s to eliminate practice barriers for all providers that provide quality of care to Ohioans.

       There are different methods turn off lose change in policy what is by changing public opinion and educate them on the role of the APN. When dealing with public health the government must intervene and make appropriate improvements to policies and create new ones(Teitelbaum,2020).

When I graduate with an advanced practice nursing degree, I hope to practice in Illinois. In the state of Illinois, Nurse practitioners are required to operate within a reduced-practice jurisdiction. A physician must supervise the patient (AANP, 2018). A practicing advanced practice nurse who has completed 250 hours of continuing education and/or training and 4,000 hours of clinical practice after being certified by the department can practice autonomously, without the guidance of a physician (Illinois Nurse Practice Act) without a written collaborative agreement.  The state of Illinois prohibits APNs from prescribing Schedule II opioids and benzos without consulting a physician who will oversee the prescription (Illinois Nurse Practice Act). There are times when an APRN must partner with a physician, even if they have full practice authority (Illinois Nurse Practice Act). Nurse practitioners can practice, administer, evaluate, and prescribe regulated medications in 23 states, according to the American Association of Nurse Practitioners. The Illinois practice has been modified in 16 states. Nurse practitioners must have a mutual agreement with licensed physicians in order to administer such narcotic medications and medical maintenance. In addition, the majority of traditional practices occur in 12 southern states. Traditionally, states instruct a professional healthcare provider to supervise medical care for a lifetime. Throughout my exploration of obstacles at both the federal and state levels, the most frequently encountered obstacle was the lack of understanding of the critical position held by nurse practitioners (Wheeler et al, 2022). Patients are diagnosed and managed by nurse practitioners in collaboration with physicians. Consequently, physicians perceive nurse practitioners as intimidating. Doctors are much more expensive than nurse practitioners for healthcare. It reduces the cost of healthcare and makes it more accessible to many people if they are held to an equivalent level of accountability.

 Additionally, ANPs need to be acknowledged and understood for what they do and whether they have the appropriate training (Reebals et al, 2022). The Illinois House of Representatives is represented by Raja Krishnamoorthi, a Democrat. The 8th Congressional District in Illinois is represented by him. Tammy Duckworth and Dick Durbin are the state senators. Both belong to the Democratic Party. J.B. Pritzker, the state’s newly elected Democrat Governor, was elected in January 2019. Exploring APRN Interest groups, I was surprised to discover how many there are. The majority of nursing specialties and career paths have their own interest groups. Two of the most important interest groups (Professional Nursing Organizations) are the American Association of Nurse Practitioners and the Illinois Society for Advanced Practice Nursing. Two kinds of policies are described in the Health Care Policy textbook: direct actions to enhance and save health, and positions and administrations of public health. It is the responsibility of state and local officials to promote public health and safety and to regulate private corporations and individuals. The concepts of taxing or exempting from taxing enable Congress to experience healthier manners implicitly (Hult et al., 2021). Getting involved with different groups and communities is one method to influence policy reform. Participating in a group that aids nurse practitioners in working with their state and national governments obtains you one stage closer to changing regulation. For instance, if you have an intellectual approach to enhancing healthcare by helping nurse practitioners in accomplishing their jobs adequately, being associated with an industry that deals directly with the government would authorize you to have your voice heard. Conveying the recommendation to your representative primary would enable you to develop a legitimate strategy, which your representative will then grant to the government. Participation, in my belief, is one of the most effective techniques to produce change.

There are so maany similarities between the state of illinois aand ohio with the expectation that APNs need to work under physicain. The importance of understanding the role of APNs siinnce they do go to school to advance there knowledge and have more responsibilities. Many times APNS have to makae themselves visible to ensure they are involved in the team to prevent their role and responsibilities (van Hecke, et al., 2023). It is the unclear role description to the interproofessiionaal team andd lack of coaching and guidance that makes it difficult for APNs to practice. THee only way APNs can have full lawful authorities is by getting approved by local board of nursing and educating healthcare workers on NPs role andd responsibilities. 

Van Hecke, Vlerick, I., Akhayad, S., Daem, M., Decoene, E., & Kinnaer, L.-M. (2023). Dynamics and processes influencing role integration of advanced practice nurses and nurse navigators in oncology teams. European Journal of Oncology Nursing : the Official Journal of European Oncology Nursing Society, 62, 102257–102257. https://doi.org/10.1016/j.ejon.2022.102257