Analysis And Recommendation of the Issue On Removal Of Barriers to Aprns Ability to Practice
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Jan 08, 2021
Analysis and Recommendation of the Issue on Removal of barriers to Aprn’s ability to practice
The increasing population and continuously changing health landscape in the U.S. calls for a sudden change in the care delivery system. There is a growing shortage of primary healthcare professionals in most states, attributed to the expansion of insurance coverage under the Patient Protection and Affordable Care Act (Peterson, 2017). The report released in 2010 by the Institute of Medicine (2011) suggests that The nation can mitigate this concern if Advanced Practice Registered Nurses (APRNs) are allowed to practice autonomously. Establishing policies in every state that would enable full practice will allow the building of the required workforce necessary to meet the U.S.A.’s primary care needs while also enhancing economic growth. Several barriers in some states have hampered the fight for the independent practice of APRNs to date (Peterson, 2017). This paper aims to discuss the existing barriers from a historical perspective and elaborate on the impact of this health issue regarding peer-reviewed articles. The paper will also give recommendations on the management of the existent full practice barriers and discuss how the proposals will influence APRNs’ practice.
Contextual Analysis of Barriers to Autonomous practice of APRNs
In 1965, Loretta Ford and Dr. Henry Silver decided to handle the growing demand for primary care globally by introducing the first certificate program to provide nurses with the necessary skills to provide primary care to less advantaged populations. In the decades that followed, the nursing field grew rapidly and currently includes specialty programs like neonatal, women’s health, and gerontology with minimum education requirements maintained at masters or doctoral levels (Hain and Flek, 2014). Nursing is no longer limited to pediatrics and families only. Nurses conduct roles that include care provided to the ethnically diverse and underserved populations in all care facilities; thus, leadership prowess has developed as a critical attribute of healthcare nurses. The growing roles have shown a change in the practice criteria, which calls for increased practice autonomy. Currently, four distinct policy and regulation initiatives impact the practice of APRNS. These include The Patient Protection and Affordable Care Act, The existent and inadequate Doctor of Nursing Movement, the 2010 Institute of Medicine report, and the Consensus Model for nurses Regulation (Peterson, 2017). Despite the continuous call for approval of autonomy in different states, some states remain rigid in handling the issue and amendment of existing policies. This is part of the reasons why the triple Aim of healthcare has not been maximumly achieved. Payer policy formulated by leaders has dramatically impacted the extent of nurses’ practice (Hain and Fleck, 2014). These policies are directly linked to statutory laws.
The autonomous practice has dramatically been affected by politics at federal and statutory levels and socially from other care practitioners. The past decade has seen a change of some states’ statutory laws to allows full practice and licensure of APRNs. State Licensure is a vital determinant of the extent of nurses’ practice based on their education and training. It is estimated that only a third of the states have adopted nurses’ practice autonomy with licensure, with the other states either having reduced or restricted practice autonomy. Furthermore, some organizations like the American Medical Association believe that nurses are less capable of providing quality and safe care than physicians who possess longer and rigorous training. Some physician organizations believe that nurses have the same capability as physicians. This has created a divide among the care practitioners, thus preventing collaborative efforts in ensuring autonomy of practice for APRNs. Another social aspect lies with the APRNs who demonstrate a lack of job satisfaction to change their career. The effect of this is the reduction of the quality of care provided and the number of primary care providers, thus making it hard to reach the Triple Aim (better health, lower cost of healthcare, and better care) (Hain and Fleck, 2014, Peterson, 2017).
Literature Review
One of the most significant concerns is whether nurses can perform duties independently compared to nurses. This is an issue of the quality of service delivery and patient safety. Some physicians believe that nurses, no matter their level of training or education, are incapable of providing services similar to them. Laurant et al. (2018) researched to determine if nurses can act as substitutes in primary healthcare. The paper is a systematic review that utilized relevant documents published and uploaded in scientific databases like CINAHL between 2015 and 2017. The article identified 18 relevant randomized trials, and out of this, only one was conducted in a middle-income country. The reports indicate that nurses can substitute nurses since the care they deliver (and the outcome) is similar to and, in some instances, better than doctors for a broad range of patient conditions. The findings also indicate that nurse-led facilities have a slightly lower mortality rate than physicians for specific needs.
Similarly, nurses are better at managing chronic diseases like hypertension, and the patient satisfaction level is always higher. Furthermore, in nurse-led primary care facilities, the quality of life of patients is slightly higher. The facilities have longer consultations with more return visits as compared to doctors-led facilities. All the other factors remained similar in the two test primary care facilities with a lack of certainty of reducing cost in nurse-led-primary facilities due to low assurance of assessment of the evidence (Laurent et al., 2018).
Therefore, Laurant et al. (2018) indicate that trained nurses are capable of efficient care delivery for urgent physical complaints and chronic ailments as provided by physicians. This means that they can substitute doctors in practice and, as a result, work independently if allowed to enhance achieve the triple aim. The articles help in solving the barrier from physician organizations against the autonomous practice of APRNs. The data also confirms that The I.O.M. report needs to be implemented by each state to allow full training in the U.S.
The article, “Leveraging health care reforms to accelerate nurse practitioners full practice authority: Corrigendum,” is also instrumental in examining the actions undertaken to enhance the autonomy of practice of APRNs.The paper focus on the impact of federal policy change (the Affordable Care Act) impacted the expansion of nurses’ scope of practice. The paper is a retrospective descriptive study that utilized data sourced from annual reports on nurse practitioners legislation., media coverage, and state-level legislation. In the article, Brom et al. (2018) reported that the Affordable Act passage led to the adoption of nurses’ full practice authority in eight states between the years 2011 and 2016. As compared to the previous years, this was considered a two-fold increase of states with full practice authority. Another impact of the affordable act was the adoption of Medicaid expansion in seven states. Different organizations and politicians started supporting the movement to the autonomy of practice of APRNs. In that year, only 28 states remained without full practice authority. This means that the policy amendment meant is necessary to shape and eliminate the barriers of the limited scope of practice.
Recommendations
The involvement of all the nurses in the creation and support of policy initiatives is essential. This majorly concerns the need for financial support of nursing organizations by members and other supporting organizations, like the American Association of Nurse Practitioners, to facilitate the policy and legislation initiatives’ rapid movement. Many dialogues have been conducted with little or no success due to the inadequacy of funds for campaigns and other administrative duties. Additionally, there is a need for standardization of APRN regulation to enhance nationwide consistency and quality of nurses education programs to ensure uniformity among graduates in all states. Similarly, all APRNs should have a single-Advanced practice license that allows independent practice in all the states proposed in the Consensus Model for APRN regulation (APRN Joint Dialogue Group Report, 2008; Hain and Fleck, 2014).
The involvement of all members in financing the organizations that drive the independence of practice will enhance the organization’s collaborative efforts and stability, thus improving the quicker amendment of policies and better managing other issues affecting nurses. On the other hand, eliminating variance will ensure uniformity in all states and prevent practice regulation in any state. One can learn in one state and practice in other states without doubting their education of service delivery capabilities.
Conclusion
The fight for the autonomy of practice does not only benefit APRNs, but it affects every citizen. The current state of healthcare needs more quality service delivery, and this is hampered by existing regulations and a lack of understanding by some organizations. To attain the Triple Aim in healthcare, it is necessary for each person first to understand why nurses need to have full practice authority, and secondly push for implementation, be it through financial assistance or publicizing of the significance. Despite the existent challenges, it is evident that more states continue to reform. It is an indication that with more effort, APRNs will meet the desire for full practice authority.
References
APRN Joint Dialogue Group Report (2008). Consensus model for PRN regulation: Licensure, accreditation, certification, & education. Retrieved from www.aacn.nche.edu/education-resources/APRNReport.pdf
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
Hain, D., Fleck, L., (May 31, 2014) “Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign” OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 2. https://doi.org/10.3912/OJIN.Vol19No02Man02
Institute of Medicine (U.S.) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. National Academies Press (U.S.).
Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, A. J. (2018). Nurses as substitutes for doctors in primary care. The Cochrane database of systematic reviews, 7(7), CD001271. https://doi.org/10.1002/14651858.CD001271.pub3
Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.
Question
to identify a critical issue that relates to population health and the role of the Advanced Practice Registered Nurse (APRN). Some examples may include improving patient access to Medicare Hospice services, removing barriers to nurse practitioners’ ability to practice, enabling APRNs to participate fully as members of hospital and medical staff. Additional examples are included on the American Association of Nurse Practitioners website.