NUR 512 Module 1 Discussion Barriers for Advanced Practice Nursing
Sample Answer for NUR 512 Module 1 Discussion Barriers for Advanced Practice Nursing
According to the American Nurses Association (2023), advanced practice nurses (APNs) ought to have access to a platform to fully apply the knowledge and abilities they have acquired via education and training. However, the current obstacles prevent nurse practitioners from fully utilizing their expertise in practice. At the state and federal levels, APNs face several practice barriers.
Advanced practice nurses have a limited role due to collaborating with physicians for hospital admissions and prescription power. It is important to note that some medical practitioners can ruin their cooperative relationship with APRNs by being confrontational or refusing to assist them, such as by opting against signing off reports (Kleinpell et al., 2021). Furthermore, some doctors believe APRNs are encroaching on their domain and cutting into their expertise (Kleinpell et al., 2021). The traditional healthcare model has consistently positioned doctors as the experts; as a result, doctors who are used to this approach exhibit opposition.
According to Kleinpell et al. (2022), the American Association of Nurse Practitioners (AANP) defines three practice contexts: decreased authority, restricted practice, and full practice. Nurse practitioners (NPs) have full practice authority, which allows them to diagnose patients, order and interpret diagnostic tests, write prescriptions, and manage patient care (Kleinpell et al., 2022). However, NPs’ participation in at least one aspect of NP practice in settings with less authority is limited by licensure requirements and practice.
Lastly, the two-level pricing structure is still a barrier even though the Primary Care Health Practitioner Incentives Act permits NPs to be compensated for their services (Torrens et al., 2020). Since independent practice is outside the purview of nurse practitioners, despite their entitlement to full reimbursement for incident-to-services, it presents an additional barrier to the growth of autonomous practices and patient accessibility to advancements. In some cases, reimbursement can get even more complicated when APRNs are required by a collaborative agreement to bill services under a doctor’s name.
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Interprofessional education promotes a collaborative environment between APRNs and doctors to enhance patient outcomes. The training will raise understanding and appreciation of the skills and abilities of APRNs (Kleinpell et al., 2021). Handling concerns regarding the scope of practice will help doctors and APRNs understand their respective roles and duties (Kleinpell et al., 2021). Through interprofessional education, doctors can better appreciate the contributions advanced practice registered nurses (APRNs) make to healthcare and realize that the goal of the modern health model is to enhance patient care.
States are currently putting Full Practice Authority (FPA) into effect after making some of the short-term adjustments made during the COVID-19 pandemic permanent (Giovenco, 2021). In the future, perhaps, more states should pass laws that remove restrictions on advanced practice registered nurses (APRNs’) practice and allow them to practice to the fullest extent permitted by their education and certification (Giovenco, 2021). This is because patient care and outcomes will increase in FPA states, encouraging restrictive governments to loosen their limitations.
Nursing leaders and organizations should advocate for equitable APRN reimbursement by scrutinizing and enhancing existing regulations. As more states enact laws that support and acknowledge advanced nursing practitioners, advancements in resolving payment concerns will be made gradually; advancements can also be made by persistent and ongoing lobbying.
References
American Nurses Association. (2023). Advanced Practice Registered Nurses (APRN). ANA. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/
Giovenco, M. (2021). Lessons the Long-Term Care Industry Can Learn from the COVID-19 Pandemic. Stetson L. Rev., 51, 123.
Kleinpell, R., Myers, C. R., Schorn, M. N., & Likes, W. (2021). Impact of COVID-19 pandemic on APRN practice: Results from a national survey. Nursing outlook, 69(5), 783-792.
Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N. (2022). Breaking down institutional barriers to advanced practice registered nurse practice. Nursing Administration Quarterly, 46(2), 137-143.
Torrens, C., Campbell, P., Hoskins, G., Strachan, H., Wells, M., Cunningham, M., … & Maxwell, M. (2020). Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review. International journal of nursing studies, 104, 103443.
Sample Answer 2 for NUR 512 Module 1 Discussion Barriers for Advanced Practice Nursing
Barriers to Advanced Practice Nursing
Nurse practitioners have numerous barriers to overcome within healthcare. Three top barriers have slowed the progression of advanced nursing practice: regulatory, state, and institutional (Kleinpell et al., 2022). State laws impact APRN practice, disabling nurse practitioners to practice within their total capacity of educational training and board certification. In contrast, the other half is split between reduced and restricted practice areas (Kleinpell et al., 2022). The state laws are guided by the federal statutes from the Centers for Medicare and Medicaid Services and then, dependent on nongovernmental policies and practices across organization groups, could have even more scrutinized limitations applied to nurse practitioners that are generally not limited to medical doctors (Kleinpell et al., 2022). Finally, further policies within institutions may adopt both state and federal regulations and private insurance companies’ guidelines limiting the practices of advanced nurse practitioners (Kleinpell et al., 2022). Strategies are introduced within each barrier listed below.
Federal Barriers
Federal statutes, such as the Nurse Practice Acts, have been enacted for 100 years to protect consumers and provide control of rules through the nursing board with full authorization (Toney-Butler, 2023). For example, the legal definition under section 464.003 states that specific actions such as diagnosis, treatment, and prescriptions are authorized so long as they are under established supervision (Toney-Butler, 2023). Most federal barriers that could cause obstacles are mostly handed down to the state regulators, who happen to be the board of nursing for each state (Toney-Butler, 2023). The biggest strategy that did progress some of these obstacles of practice for APRN is when COVID-19 started, and since then, these temporary rules have been pushing forward to permanent rules (Toney-Butler, 2023).
State Barriers
State regulations require APRNs to provide their certification (Toney-Butler, 2023). In Florida, they can obtain a provisional state certification if the board is given information regarding education entities that are acceptable to the specific state (Toney-Butler, 2023). To further understand how this works, APRNs must understand the laws in each state they practice in (Toney-Butler, 2023). The strategy behind this is to function by understanding and acknowledging the state laws and providing proper certification to practice to their full extent if applicable for each state (Toney-Butler, 2023).
Organization Barriers
Workload and workforce are drivers of expanding nursing roles, but the time and complexity of collaboration of multidisciplinary teams can hinder progress (Torrens et al., 2020). Depending on the state for best practices, the APRNs may have little autonomy within teams regarding what constituted activities are allowed, what is to be supervised, or whether they can apply practice activities independently from supervision (Torrens et al., 2020). Nurse leaders and some MDs can assist in breaking down these obstacles for APRNs so long as they have relationships within the multidisciplinary teams or even with the board and organization itself (Kleinpell et al., 2022).
References
Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N.(2022 April-June). Breaking Down Institutional Barriers to Advanced Practice Registered Nurse Practice. Nursing Administration Quarterly 46(2),137-143, DOI: 10.1097/NAQ.0000000000000518.
Toney-Butler, T.J. (2023, January 2). Florida Nurse Practice Act Laws and Rules. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gv/books/NBK532859/
Torrens, C., Campbell, P.., Hoskins, G., Strachan, H., Wells, M., Cunningham, M. P., Bottone, H., Polson, R., & Maxwell, M. (2022, April 1). Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: A scoping review. International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2019.103443
NUR 512 Module 2 Discussion Primary Care NP Role vs. APN Roles
The quality and access of healthcare services depend on the availability of care providers. As a result, adequately skilled nurses ready to provide care are critical to the expanding healthcare system and achieving Healthy People 2030 goals. According to the American Association of Nurse Practitioners (2022), millions of Americans highly regard a nurse practitioner (NP) as their preferred primary care provider. This preference underscores the value of NPs in health promotion and creating a healthy, productive populace. This discussion explores the role of primary care NPs versus other advanced practice nurses.
Serving as an advanced practice nurse requires an in-depth understanding of primary care provision and preparation through education, skills, and continuous training. NPs are masters-prepared nurses with board certification in a particular population segment. Approximately 88% of NPs are certified in an area of primary care provision, and 70.3% of the current workforce deliver primary care (American Association of Nurse Practitioners, 2023). Broadly, the role encompasses tasks that ensure patients receive timely, high-quality, and patient-centered care. They include assessing patients, ordering medical tests, diagnosing conditions, and prescribing medications (American Association of Nurse Practitioners, 2022; NurseJournal Staff, 2023). Commonly, they work as independent primary care providers or as part of a larger medical team.
NPs share similar roles with other advanced practice nurses, including certified nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), and certified nurse midwives (CNMs). Regarding duties and responsibilities, all these advanced practice nurses can assess patients, order medical tests, and diagnose conditions (Boehning & Punsalan, 2023). Besides, they primarily focus on managing patient problems and offering advanced care to reduce the risk among individuals and groups while guiding patients on appropriate health choices. Despite these similarities, the roles differ in the scope of work and specialization. For instance, CNMs can supervise births, and CRNAs can administer anesthesia. The CNS can specialize in leadership, clinical research, or training (NurseJournal Staff, 2023). These roles show that the specialty focus differentiates primary NP and other advanced practice nurses’ roles. In this case, other practitioners deliver a particular type of care as NPs focus on a particular population.
Communicating the role to a healthcare provider and a consumer would primarily involve outlining the duties and the relevance of primary care NPs in the current and future healthcare system. As Wheeler et al. (2022) posited, APNs have the desired capacity to ensure the world achieves the Sustainable Development Goal of universal health coverage. This is a critical point when stressing the role of NPs to a healthcare provider and the continuous need for their growth and support. Besides the regular primary care duties like assessment, diagnosis, and treatment, primary care NPs should bring a personal touch and comprehensive perspective to healthcare (American Association of Nurse Practitioners, 2022). As a result, evidence-based practice (EBP), collaboration, and patient-centeredness are critical for NPs to excel in primary care provision. To a consumer, the role of primary care NPs or other advanced practitioners should be communicated in terms of their purpose in delivering the promise of medicine. A consumer should know that NPs are sufficiently skilled and knowledgeable in primary, acute, and chronic care to all patients of all ages and backgrounds. As such, they should be the initial contact at points of care, playing a fundamental role in meeting patients’ and populations’ healthcare needs.
References
American Association of Nurse Practitioners. (2022). Nurse practitioners in primary care. https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioners-in-primary-care
American Association of Nurse Practitioners. (2023). NP fact sheet. https://www.aanp.org/about/all-about-nps/np-fact-sheet
Boehning, A. P., & Punsalan, L. D. (2023). Advanced practice registered nurse roles. National Library of Medicine.
National Council of State Boards of Nursing, Inc. (2024). APRNs in the U.S. https://www.ncsbn.org/nursing-regulation/practice/aprn.page
NurseJournal Staff. (2023). NP vs. APRN. What’s the difference? NurseJournal. https://nursejournal.org/resources/np-vs-aprn/
Wheeler, K. J., Miller, M., Pulcini, J., Gray, D., Ladd, E., & Rayens, M. K. (2022). Advanced practice nursing roles, regulation, education, and practice: a global study. Annals of Global Health, 88(1), 42. https://doi.org/10.5334/aogh.3698