NR 510 Week 1 DQ 1 : Barriers to Practice Discussion

NR 510 Week 1 DQ 1 : Barriers to Practice Discussion

NR 510 Week 1 DQ 1 : Barriers to Practice Discussion

Advanced practice registered nurses’ roles include nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. The main practice barriers for these role in Florida include scope of practice since they have reduced practice environment, portability of their license, and need for supervision. The lack of full practice authority for nurse practitioners in Florida and even across several states at the national level is a core practice barrier (Fealy et al., 2018). Further, clinical nurse specialists in Florida and even across the country face prescriptive barriers that hinders their ability to practice to full authority and training.

Nurse practitioners have been practicing in various healthcare settings in states but face varying scope of practice laws across the states. The implication is that APNs have varying levels of practice from one state to another implying that the various creates a competitive pressure in states that allow them to practice to full authority (O’Reilly-Jacob et al., 2022). As such, they compete with physicians, nurse assistants, and nurse practitioners who enjoy changing levels of autonomy in practice. APNs are considered as quality, cost-effective and competent providers who can fill the physician shortage gap in care provision (Schirle et al., 2018).

Key lawmakers at the state level, Florida, include Ben Albritton who is the majority leader in the Senate, Lauren Book who is the minority leader and a Democrat, and Kathleen Passidomo who of the president of the Senate (The Florida Senate, 2023).

Interest groups on state and national level impact policy reform for APNs. These include professional nursing organizations like the Florida Nurse Practitioners Association at state level. The American Association of Nurse Practitioners (AANP) is a professional interest group at the national level that advocates issues concerning the NP specialty. Influencing policy change in terms of competition, state legislative and executive branches of government as well as interest groups entail using a raft of approaches that include lobbying, provision of education and training for nurses, and regulations (Schirle et al., 2018). These approaches ensure that nurses understand the legislative approach to providing patient care.

References

Fealy, G. M., Casey, M., O’Leary, D. F., McNamara, M. S., O’Brien, D., O’Connor, L., … &

Stokes, D. (2018). Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers. Journal of Clinical Nursing, 27(19-20), 3797-3809. https://doi.org/10.1111/jocn.14550

O’Reilly-Jacob, M., Perloff, J., Sherafat-Kazemzadeh, R., & Flanagan, J. (2022). Nurse

practitioners’ perception of temporary full practice authority during a COVID-19 surge: A qualitative study. International journal of nursing studies, 126, 104141. https://doi.org/10.1016/j.ijnurstu.2021.104141

Schirle, L., Norful, A. A., Rudner, N. & Poghosyan, L. (2018). Organizational facilitators and

Barriers to optimal APRN practice: An integrative review. Health Care Management

            Review, 45(4): 1-10. DOI: 10.1097/HMR.0000000000000229

The Florida Senate (2023). 2022-2024 Senators. https://www.flsenate.gov/Senators

Much of this week’s reading by Authors DeNisco & Barker (2015) focused on your very question! Since the inception of the advanced nurse practitioner in the 1960’s universities, institutions and organizations have been advocating for the expansion of role development, increased competencies in clinical knowledge, leadership and administrative roles.  As the author’s note, NP’s make up one of the largest groups of advanced nurses, but are still facing barriers almost sixty years later.  According to the Institute of Medicine, a major goal of was to increase the amount of and capacities of NP’s to meet the needs of people who not have access to healthcare (Institute of Medicine,  2010). Given the initial goals of what an NP is and our current medical needs in our society (especially since the passing of the Affordable Care Act), I do not believe the entry level for practice should be at the DNP level. I feel increasing the credentials of the specialty will create additional barriers. First off, the development of the DNP was to clear up confusion that had arisen from nurses who held PhD in education and other nursing sciences that hold the title Dr. with a focus on research. DNP was created to have more clinical practice with a higher level of education which require an additional 500 to 600 clinical hours and align with more recommendations from the Institute of Medicine (DeNIsco & Barker, 2017).

While, I always commended and advocate for higher level of nursing, I do not DNP should be the minimum required entry until the present barriers that exist be resolved. First, not all NP’s have equal licensing privileges across the county and vary within the States. For example, in Vermont NP’s have full practice authority, whereas Florida NP’s must practice under the supervision of a MD. The barrier to various license capability means inability for some to seek appropriate care. Second, not all professional organizations acknowledge the capabilities of NP’s practice and professionalism. It is asserted by Hain & Fleck, (2014) that the American Medical Association for Physicians NP’s do not have the same level of training and knowledge, thereby fueling a sourced of incapable opinions. Third, a States policy of practicing rights of an NP affects how they are reimbursed financially. As a result, many insurance companies do not acknowledge NP’s as the primary provider but as providers who provide follow up services after the MD’s. Companies reimburse accordingly on a lower scale for follow up services (Hain & Fleck, 2014). On a final note, I do not believe DNP will gain more respect as compared to MD’s because the hold the word “nurse” in there title. I believe there needs to be more of a work culture shift of roles, powers and state policies shifting the differences.

Reference:

DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Retrieved from https://bookshelf.vitalsource.comLinks to an external site.

Hain, D., & Fleck, L. (2014, May). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, 19(2)

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.iom.edu/Rep;orts/2010/the-future-of-nursing-leading-change-advancing-health.aspxLinks to an external site.

To answer your question, I feel this regulation causes yet another barrier for NPs. However, the rules guiding the ACNP scope of practice is to avoid malpractice or negligence suits that stem from the NP providing care outside his or her training, knowledge, and skill level (Hoffman & Guttendorf, 2017). To become an Acute Care Nurse Practitioner (ACNP), a nurse must choose a patient population (pediatric or adult/gerontology patients) to focus on. Upon receiving a master’s degree from an accredited school, the ACNP becomes licensed as a PNP-AC (pediatric nurse practitioner) or AG-ACNP (adult gerontology). NPs without ACNP credentialing are still qualified to work with these patient populations because all NPs (especially FNPs and CNSs) are trained to diagnose, treat, and manage acute conditions and chronic illnesses for all patient populations (Hoffman & Guttendorf, 2017). However, FNPs and CNS’s typically provide treatment to patients with acute conditions that are not life-threatening).

The dynamics of care and treatment change when a patient’s health is deteriorating. Furthermore, not all NPs have detailed or exhaustive training to diagnose and treat medical conditions for patient populations in certain settings (Nurse Journal, 2018). More so than the CNM or CNA, the FNP and CNS are better qualified to treat patients of all ages with chronic diseases (Nurse Journal, 2018). The distinction is slight but clear since the goal of NP training is to make it patient population specific. It would not be wise for a CNM or CNA to take a contract providing health services to a 45-year-old patient who is bedridden, overweight and suffering from hypertension and type II diabetes. The new clause is to help NPs understand what type of work and work environment is best suited for their training and specialized skills. The key words are specialized skills. While I feel the new clause is restrictive, it is a good measure to integrate. NPs should look at the new clause in a positive way, sort of like the difference in training and skill level of a family practitioner, brain surgeon, cardiologist, gynecologist, etc. Some nurses may feel this extra provision forces them to get training in things they already know how to do; however, they should look at it as professional pre-caution. Listing you know how to do something on your resume is one thing; having the certification to prove you know how to do it is better. The goal is to provide a high level of patient centered care and address uniformity and simplification measures. Under the new APRN Consensus Model, NPs can become qualified experts in a specific role instead of general experts in multiple roles (Hoffman & Guttendorf, 2017). While all these rules are confusing, they are necessary.

References

Hoffman, L. A., & Guttendorf, J. (2017). Preparation and evolving role of the acute care nurse practitioner. CHEST Journal, 152(6), 1339-1345. Retrieved from DOI: https://doi.org/10.1016/j.chest.2017.08.007

Nurse Journal. (2018). FNP vs ACNP core differences. Retrieved from https://nursejournal.org/family-practice/fnp-vs-acnp-core-differences/

Read the assigned Hain & Fleck article, and discuss the following:

• What are the barriers to APN practice identified in the article? Describe these barriers in your own words.
• What are your impression of the barriers to APN Practice? (Are you surprised by these barriers? Is this new information to you? Have you ever been involved at the legislative level in nursing? Do these barriers concern you or motivate you toward becoming an APN?)
• Do these barriers represent Restraint of Trade? Why, or why not?
• Your thoughts on how nurses can influence these barriers.

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It seems there are some similarities between the state of Illinois and New Jersey with the exception that in Illinois you can work towards moving away from the collaboration agreement if you have enough clinical hours. It looks as if APRNs of Illinois aren’t completely free of supervision from physicians because they need supervision to prescribe schedule ll narcotics? I believe that is true freedom from collaboration. The importance of having full practice authority for an APRN is under appreciated. An APRN with full practice authority will be governed only by the local board of nursing and no longer have to abide by physician involvement (Hahn & Cook, 2018). This allows the APRN to have lawful control and full liability for decisions made regarding patients in their care. One of the main benefits to full practice authority is elimination of financial barriers related to entrepreneurship, allowing for fair market competition (Hahn & Cook, 2018). APRNs offer cost effective care with high quality outcomes, delivering care that is not just medicine but shows consideration for patient needs on all levels. As nurses we have so much to offer and can focus on caring for our patients holistically. APRNs have potential to fill provider gaps where there is a higher demand due to the baby boomers generation aging, legislative changes, and incentives for wellness and prevention (Hahn & Cook, 2018).

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