Analysis and Recommendations of Advanced Practice Nursing Issues Essay

Analysis and Recommendations of Advanced Practice Nursing Issues Essay

 

Analysis and Recommendations of Advanced Practice Nursing Issues

The importance of public health is that it focuses on improving the well-being of groups and people. The public health stakeholders in the area encounter varied obstacles that limit their ability to enhance community health (Altman et al., 2018). One of the biggest issues affecting public health is the barriers limiting nurse practitioners’ ability to practice. Some of the barriers that have been listed include 1) significant educational gaps between NPs and physicians; 2) reservations about NPs’ competence to safely administer controlled drugs and opioids; 3) physician scarcity (should endorse measures to boost the number of doctors in the state); 4) staff shortages (NPs will have an impact on the future nursing field); 5) failure to handle healthcare costs (growth of role may result in NP reimbursement equal to physicians); and 6) lack of physician supervision (Torrens et al., 2020). These issues are prominent despite studies indicating the independence of NPs will increase patient care quality and patient safety. This paper will analyze various barriers to NP practice, including the history of the issue, its impact on healthcare delivery, and recommendations to improve the situation.

Contextual Analysis of the Issue

The workforce and workload issues are the main drivers for allowing the international trend to increase nurses’ role in healthcare delivery. Advanced nurse practitioners are increasingly being appointed to take on traditionally left roles to doctors. The covid 19 pandemic highlighted the critical physician and nursing shortages. Torrens et al. (2020) indicate that today, 55% of registered nurses and 52% of active physicians in the workforce are older than 50 years and are en route to retirement. It demonstrated that it is essential for the two professions to work together to ensure the smooth running of healthcare organizations. It means giving NPs tasks customarily assigned to physicians only (Altman et al., 2018). For years, nurses have struggled to move the restrictions.  However, several medical groups have continually opposed practicing and licensure to full practice authority (Schirle et al., 2020). Heated debates on the issue have brought scope-of-practice issues to the forefront and have increased legislator support of the expanded role of NPs. Through training and gaining experience, NPs can fill the staffing gap and offer similar services to physicians. The idea of expanding the scope of practice also increases costs attributed to salaries. Nurses are paid significantly less than other physicians, and therefore the barrier removal will increase healthcare costs and, accordingly, change access to primary healthcare for many people.

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Summary of Historical Development

In 1985, the role of the NP was developed at the University of Colorado. No states had agreed to provide licenses (Torrens et al., 2020). In 1971, Idaho became the first state to recognize the role and therefore provided a scope of service for those in the profession, including diagnosis and treatment. The role was further boosted in 1977 after the enactment of the Rural Health Clinic Act, which demanded that NPs deliver 50% of the services offered by the hospitals. The Omnibus Budget Reconciliation act of 1985 also increased payment for NPs (Schirle et al., 2020). By 1994, only five states had allowed NPs to practice independently.

Socio-Political Influences

Political and social factors influence the removal of the NPs practice. Social factors that impact the issue include population’s age and the service unavailability for rural communities, which have significant growth in demand for quality primary healthcare (Altman et al., 2018). However, the elderly depend on primary healthcare to keep individuals from developing complications that result from hospitalization. Social factors contributing to the issue intensify the pressure for change and the progress in reducing the highly dependent policies and legislation developed via political processes. The evolution of the ACA is due to the expansion in the various insured people in the country (Schirle et al., 2020). The political interventions consider the number of Americans who cannot access healthcare. However, the number of specialists required to provide services does not increase at the same rate. The number of professionals needed to deliver the services does not grow simultaneously. According to the reconciliation bill Act, there was political interference, which allowed for the repayment of NPs. These show that the legislation at the national and state levels are key policies that will determine the barriers’ removal.

Literature Review and Analysis

Today, physicians are not receiving more rigorous training than NPs. Therefore, both professionals provide quality, safe care at the same care level as the physicians. Other doctors show that their education and training are the same as NPs, which adds to the worth of nurse practitioners. The American College of Physicians released a policy paper emphasizing the importance of nurse practitioners in meeting the increased demand for primary care (Schirle et al., 2020). It increases the confusion on the role of nurse practitioners. There is a critical inadequacy in the physicians’ and other healthcare staff’s knowledge of NPs scope of practice. As the healthcare system continues with rapid evolution, physicians and NPs need to collaborate to achieve the best practices. Physicians and NPs have the same goal of improving patient outcomes and increasing health workers’ collaboration (Altman et al., 2018). The lack of NPs’ scope of practice is a barrier to successful cooperation between healthcare professionals.

The main aim of integrating NPs fully into practice is to fill the gap within healthcare due to insufficient employees in the workplace (Schirle et al., 2020). By 2035, the global deficit of healthcare personnel is expected to reach 12.9 million. At the moment, that number stands at 7.2 million. Healthcare employees are allocated inequitably, with significant disparities between rural and urban locations, with the latter suffering the most (Torrens et al., 2020). The inadequacy leads to fatigue, burnout, and medical errors, impacting patient outcomes and diminishing patient satisfaction. Legislators play a critical role in ensuring a conducive environment for NPs to practice. Their acceptance of NPs in practice can change the perceptions of various healthcare professionals and their attitudes towards integrating NPs into primary care.

Recommendation and Impact on APRN Role/Setting and Practice Dimensions

Based on the literature review recommendations, three recommendations can be made to increase APRNs and NPs to their full potential by eliminating the current barriers. First, all states need to recognize the critical role of nurses in the healthcare industry. This will allow legislators to push for NP-specific policies. Therefore, NPs will have an expanded role and scope of tasks for their patients (Torrens et al., 2020). Thus, APRNs will diagnose and prescribe medication without fear of legal action being taken against them. Secondly, it is critical to rethink delivering quality, efficient primary care in an environment with staff shortages. Schirle et al. (2020) suggest that NPs create partnerships with specialty doctors and primary care providers as part of an integrated staff. The physicians will refer NPs with expertise to various patients. In such environments, NPs will take outcome-driven approaches to care and demonstrate innovativeness to improve care for populations.

Lastly, there should be reimbursement policies for primary care that are fair. In the past, policies such as Omnibus Budget Reconciliation Act had other reimbursements for NPs working in rural areas. Additionally, NPs are paid significantly less than physicians who provide similar services (Schirle et al., 2020). These issues prevent nurses from advancing their education since they will not be paid enough to cover education costs and time. Fair reimbursement based on services delivered rather than profession will ensure that nurses are motivated to advance their education and patients will receive improved quality care.

Conclusion

The APRN role is designed to increase the capacity and access of healthcare to ensure increased patient satisfaction. This can be done if all healthcare professionals work together to increase the capacity and quality of healthcare systems. Since NPs are not trained less than physicians, they should be allowed to offer similar services to physicians and should be adequately reimbursed. These issues can be solved by resolving barriers that deny APRNs the chance to practice fully. Legislators should be at the forefront of supporting the laws that allow NPs to practice fully without forcing them to work under other physicians. These laws should be accompanied by establishing career pathways for NPs and streamlined reimbursement.

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References

Altman, S. H., Butler, A. S., Shern, L., & National Academies of Sciences, Engineering, and Medicine. (2018). Removing barriers to practice and care. In Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK350160/

Schirle, L., Norful, A. A., Rudner, N., & Poghosyan, L. (2020). Organizational facilitators and barriers to optimal APRN practice: An integrative review. Health Care Management Review, 45(4), 311-320. https://www.nppostgradtraining.com/wp-content/uploads/2020/08/Organizational_facilitators_and_barriers_to.99685.pdf

Torrens, C., Campbell, P., Hoskins, G., Strachan, H., Wells, M., Cunningham, M., … & Maxwell, M. (2020). Barriers and facilitators to implementing the advanced nurse practitioner role in primary care settings: A scoping review. International Journal of Nursing Studies, 104, 103443. https://doi.org/10.1016/j.ijnurstu.2019.103443

Analysis and Recommendations of Advanced Practice Nursing Issues

The purpose of this 5-6 page paper is 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.

Other sources for topic identification may include the Gerontological Advanced Practice Nurses Association and/or your local/state chapter of the AANP.

The expected length of the paper is approximately 5-6 pages, which does not include the cover page and reference pages. Lastly, review the Assignment rubric to ensure you have met the assignment criteria.

Submission Parameters:

Please use the following as a guide for drafting your 5-6 page paper.

Introduction (including purpose statement)
Contextual analysis of the issue
Provide a brief summary of the historical development of the issue
Provide a brief summary on the socio-political influences
Literature Review and Analysis on the selected issue
Identify at least 2 primary sources that examines the impact of the selected issue
Recommendations
Provide some recommendations to solve the issue
Determine how the recommendations may impact the APRN role/setting and practice dimensions
Conclusion

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 2-3 page limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Spelling, grammar, and organization is appropriate
Include a reference list (this is not part of the 2-3 page limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP)