Dynamic Growth of the Nursing Profession

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Assignment 1

The growth of nursing practice as a unique health care profession is not surprising given the evolving health care landscape that includes changes in education and curriculum as well as reality of increasing population needs and medical staff shortages. Since the first formalized nursing certificate education program targeted at primary care introduced by the nursing pioneer Loretta Ford in conjunction with Dr. Henry Silver, nursing education has evolved and grown to include more specializations (such as pediatrics, neonatal, women’s health, gerontology and so on) with higher minimum education requirements for different roles and responsibilities. There are some roles, such as nursing leadership and management, that could require a minimum of Master’s level or Ph.D. level of education. While the growth and evolution of the nursing profession is undeniable, it is equally undeniable that the profession faces significant barriers that limit practice both at the state and national levels (Peterson, 2017).

Advanced practice registered nurses (APRN) practice is regulated at the state level through policies and regulations presented by each state’s board of nursing. About 44% of all states have adopted full practice authority laws and licensure for APRNs. In this case, full practice authority is defined as the state licensure and practice laws providing for APRNs to evaluate and diagnose patients, order and interpret the diagnostic tests, and initiate and manage treatments, with all activities conducted within the professional environment under the exclusive licensing authority of the state’s board of nursing. About 34% of the states allow for reduced practice among APRN such that they have the ability to engage in elements of professional practice that are regulated by the use of collaborative agreements with physicians to provide patient care. About 24% of the states allows for restricted practice among APRN such that they have the ability to engage in elements of professional practice that require team management, delegation or supervision by a physician or another health profession to provide patient care (Zaccagnini & White, 2017).

Bosse et al. (2017) adds to the discussion by noting that the lack of full practice authority for APRN is a barrier to the provision of comprehensive, high quality cost effective and efficient health care services. APRN have the experience, skills, knowledge and education necessary to provide comprehensive and basic primary care service. In fact, APRN are a ready workforce that has been ideally positioned to improve health care access while contributing to efforts to low the cost of providing health care and reduce health care disparities. APRN practice would provide significant benefits to payers, health care system and patients by significantly reducing the need for emergency room visits to address non-emergency health care needs, providing care at significantly lower costs than physicians, improving medication management and reducing overdose incidences, and improving teamwork between APRN and other medical professions in the provision of primary care. However, the lack of full practice authority acts as a barrier that prevents APRN at the national and state levels from practicing to the full extent to which their training and education have prepared them (Bosse et al., 2017).

The Institute of Medicine (IOM) alongside the Robert Wood Johnson Foundation (RWJF) published a report in 2010 that envisioned the ideal future for the nursing profession. The report outlined four focus areas that needed attention. Firstly, the report recommended that nurses should practice to the full extent of their education. Secondly, it recommended that nurses should be subjected to an improved education system that is supported by seamless academic profession to enable them achieve higher training and education levels. Thirdly, it recommended that nurses should be full partners with other health professionals to include physicians in redesigning the national health care system. Finally, it recommends that there is a need for improved information structures and better data collection to support efforts targeted at effective work force planning and policy making. The recommendations presented in the report make it clear that the regulations government the scope of practice for nurses in the USA are overly restrictive and act as a significant barrier to care accessibility. As a follow-up to the report published in 2010 was the report published in 2015 that lauded the industry for activing on the recommendations made in the first report and making significant progress. Still, the follow-up report pointed out that much still needs to be done as substantial barriers still exist with more work required to eliminate them (Weberg & Davidson, 2020).Dynamic Growth of the Nursing Profession

Despite the IOM and RWJF report from 2010, the health care system still struggles against the barriers identified in the report. In some of the states, efforts to improve the scope of practice for nurses is further impeded by archaic bylaws. In fact, it is not uncommon for nurses with the same national certification and level of practice to face restrictions when relocating from one state to another state thereby limiting their scope of practice. The variations in the regulations governing the scope of practice for nurses across different states has a direct impact on health care delivery as it influences payer policies and practice opportunities for APRNs. Federal regulations add to the barriers at the state level, specifically the Primary Care Health Practitioner Incentive Act that introduced payment reforms that affects nurses. It allows nurses to receive 100% reimbursement for incident to services, but adds that they cannot receive the reimbursement independently thereby acting as a barrier to independent nurses practice (Butts & Rich, 2018).

The calls for nurses to have full practice authority to include prescriptive privileges is echoed by the National Association of Pediatric Nurse Practitioners (NAPNAP). This association advocates for all nurse practitioners to have full prescriptive authority as well as dispensing privileges to match their certification, licensure, training and education. APRNs have completed a formal educational program in specific practice areas and have met the regulations of the state board of nursing government advanced practice nursing. The education programs prepare the APRN for independent clinical decision making, management skills and advanced clinical assessment. The training and education includes a comprehensive foundation on advanced physiology, pharmacology, and prevention and management of diseases/ailments. It allows them to provide cost-effective and safe health care (McEwen & Wills, 2018).

Medication prescription is essential to APRN practice. Their ability to prescribe medication without limitation enhances their ability to provide patient care by promoting continuity and greater continuity of care, augments accountability and safety, and increases cost effectiveness. Restrictions on APRN prescribing authority limits their ability to provide comprehensive health care services. Including full prescribing authority for APRN would improve access to health care provided by highly qualified APRN (Raingruber, 217).

It is clear that even in the presence of evidence and recommendations supporting full practice authority for APRN to include prescribing privileges, there has not been much progress in this direction. This state of affairs has been largely blamed on failure to employ an evidence base in APRN regulations and the patchwork of varied regulations across the country with different states applying highly varied rules ranging from full practice authority to reduced and restricted practice. Although APRN roles first presented more than 50 years ago, with almost an equal length of time worth of research demonstrating the safety and efficacy of APRN, the reality is that they do not as yet have full practice authority across the whole USA. The limitations imposed on APRN practice authority typically involve other medical professions, typically doctors/physicians, in the authority for prescribing, practice and/or licensure (Milstead & Short, 2019).

The American Association of Nurse Practitioners (AANP) adds to the discussion with its statement on Nurse Practitioner Prescriptive Authority. The statement recognizes that the practice and scope of nurses should include prescribing, and this should not be considered as a distinctive act differentiated from or outside of nursing practice. The AANP explains that the prescriptive authority of nurses should be solely regulated by the state board of nursing, but the regulation should be in accordance with the certification, education and role of the nurse. It is important for nurses to have prescribing authority over controlled and legend medication, durable medical equipment and other supplies and equipment, health care services, and devices. Such a move would be essential in providing quality, cost effective and timely health care (American Association of Nurse Practitioners, 2020).Dynamic Growth of the Nursing Profession

APRN are knowledgeable and educated professionals with the capacity for independent practice. The question then becomes why should nurses not be offered prescriptive privileges. Only 44% of APRN are to practice to the full extent of their training and education. Furthermore, resolution 214 of the American Medical Association (AMA) hinders efforts to allow APRN with multistate licenses to have independent practice across different states. AMA has always held the idea that only physicians are qualified to lead, thereby excluding APRN from leading and thereby providing independent patient care. However, it is important to note that, with their experience, training and education, APRN can be a valuable asset to the health care system as with the capacity to provide independent patient care that includes prescriptive privileges (DeNisco, 2019).

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APRN can provide quality patient care in different care settings, to include health departments, clinics and hospitals. Particularly in the present health care environment that is characterized by an aging and growing population, APRN can help to meet the rising demand for primary care providers through being given the authority to provide independent patient care. The proper utilization of APRN can help to improve health care access in which case APRN would be allowed to practice to their full extent with expected positive impact on the community and this may also be cost effective. Giving nurses full practice authority does not imply that their scope of practice is being broadened. Instead, it implies that they would be allowed to practice to the scope defined by the extent of their licensure. Overall, this discussion makes it clear that there is a need for policy changes to enhance the practice environment of APRN by giving them prescriptive authority to support the delivery of quality, cost effective and timely health care.

References

American Association of Nurse Practitioners (2020). Position Statement: Nurse Practitioner Prescriptive Authority. https://storage.aanp.org/www/documents/advocacy/position-papers/NP-Prescriptive-Authority.pdf

Bosse, J., Simmonds, K., Hanson, C., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. Nursing Outlook, 65(6), 761-765. https://doi.org/10.1016/j.outlook.2017.10.002

Butts, J., & Rich, K. (Eds.) (2018). Philosophies and Theories for Advanced Nursing Practice (3^rd ed.). Jones & Bartlett Learning, LLC.

DeNisco, S. (2020). Advanced Practice Nursing: Essential Knowledge for the Profession: Essential Knowledge for the Profession (4^th ed.). Jones & Bartlett Learning, LLC.

McEwen, M., & Wills, E. (2018). Theoretical Basis for Nursing (5^th ed.). Wolters Kluwer.

Milstead, J. & Short, N. (2019). Health Policy and Politics: A Nurse’s Guide (6^th ed.). Jones & Bartlett Learning.

Peterson, M. (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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/

Raingruber, B. (2017). Contemporary Health Promotion in Nursing Practice (2^nd ed.). Jones & Bartlett Learning, LLC.

Weberg, D., & Davidson, S. (Eds.) (2020). Leadership for Evidence-Based Innovation in Nursing and Health Professions. Jones & Bartlett Learning, LLC.

Zaccagnini, M., & White, K. (Eds.) (2017). The Doctor of Nursing Practice Essentials: A New Model for Advanced Practice Nursing (3^rd ed.). Jones & Bartlett Learning, LLC. Dynamic Growth of the Nursing Profession