Barriers to Practice
1. Identify and describe practice barriers for all four APNs roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner and clinical nurse specialist.
2. Identify forms of competition on the state and national level that interfere with APN’s ability to practice independently.
3. Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
4. Discuss interest groups that exist at the state and national levels that influence APN policy.
5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government and interest groups.
A scholarly resource must be used for EACH discussion question each week.
Barriers to Practice
Practice Barriers for All the Four APNS Roles in IOWA State
There are numerous barriers to practice for various advanced practice nurse roles. Generally, the highest barrier for Nurse Midwife, Nurse Anesthetist, Nurse Practitioners, and Clinical Nurse Specialists in my state is licensure portability. Licensure portability is essential since, for one, it assures there’s meaningfully increased public access to appropriate care, and it creates minimum standards for safe practice.
Nurse Midwife provides essential maternity care, particularly in rural areas. A key barrier to Nurse Midwife practice is clarifying the scope of practice and that of midwifery roles (Fealy et al., 2018). A “lack of differentiation from the nursing and midwifery” has formed lack of distinguishing care a midwife affords from an individual nurse. This makes it hard on both the state and national levels to push for the legislation following lack of staff studies concerning the retention of the midwives and development of quality-based care.
Nurse Anesthetists face practice-based barriers associated with performing their responsibilities without a supervising Anesthesiologist. This causes limitations on the nurse anesthetist to complete their duties while waiting for an available Anesthesiologist for supervision. This, as a result, creates problems in rural areas where smaller hospitals rely on nurse anesthetists for procedures.
NPs face a restriction barrier from the full practice authority (O’Reilly-Jacob et al., 2022). Also identified as independent practice, the full practice authority comprises practice and licensure laws permitting the nurse practitioners to practice to the full extent of their education.
Clinical Nurse Specialists besides face prescriptive barriers on state and national levels. There has been a push for the nurses to practice to the full extent of their licensure. Though, they face prescriptive barriers and aren’t able to practice fully. Clinical Nurse Specialist has changing levels of prescriptive privilege in the 35 states and currently is dependent on physician agreement before prescribing in IOWA. Thus, Clinical Nurse specialists have inadequate prescriptive authority and cannot practice to the full extent of their education freely. This similarly varies at the national level, where some states permit autonomous prescriptive authority, others need collaborative agreement, and others lack prescriptive authority.
Forms Of Competition on State and National Level Interfering with The APN’s
Capacity to Practice Autonomously.
Nurse practitioners have been practicing in numerous healthcare settings quite for some time. While the APNs are generally certified, scopes for practice are personalized from state to state. This reveals that APRNs can have several capacity levels to practice from one state to another. Whereas there has been a rise in NPs to fill in the gaps in primary care, there’s a lack of reliability across the nation. Presently, there’re physicians, their assistants, and nurse practitioners who have changing levels of autonomous practice. This forms a competitive market for the providers. Initial laws for the medical practice were drafted from physicians and the scopes of practice law for the rest of healthcare providers (De Bruijn-Geraets et al., 2018). This formed a divide between what APN would perform. APNs are seen as quality, cost-effective providers educated to fill the physician shortage. With the formal education for APNs, there’s more support to make the practice autonomous. Whereas the states still afford scope of practice, generally, there has been a push for the national support of nurse practitioner scope. The capacity for the APNs to be reimbursed now for providing care has minimized this particular initial practice barrier.
Specific Lawmakers at State Level
IOWA state senators are Charles Ernest Grassley and Joni Kay Ernst (Tobias.,2019). The state delegate is Pete Buttigieg, and the IOWA state U.S members of congress are Ashley Hinson, Mariannette Miller-Meeks, Cindy Axne, and Randy Feenstra.
Interest Groups Existing at State and National Levels That Impact APN
There’re numerous groups on state and the national level that impact policy reform for the APNs. IOWA Nurse Practitioner Society plays a significant role in increasing awareness of NP role and simplifying improvement of NP role by suggesting and influencing the state and national healthcare-based policy via the legislative process following their website. At the national level, the American Association of Nurse Practitioners (AANP) “signifies APN and their clients on the critical issues connected to licensure, care access, patient-based safety, and the healthcare reform” following the AANP website (Ross et al., 2018).
Methods Used to Influence the Change in Policy
Following the AANP website, there’re numerous resources to impact the policy change. First is providing current educational chances on the latest issues impacting NP. AANP wants the care provider to understand the main issues influencing the practice. As a result, one may become conversant with AANP’s position on education, policy and regulation, and patient care. AANP website affords resources for apprehending state policies affecting individuals’ prescriptive and the practice authority (Macklin.,2018). They learn more about current and pending policies via policy briefs to develop knowledge. AANP encourages NP to track policies and write out the elected officials concerning these policies and embraces sample messaging.
De Bruijn-Geraets, D. P., van Eijk-Hustings, Y. J., Bessems-Beks, M. C., Essers, B. A., Dirksen, C. D., & Vrijhoef, H. J. M. (2018). A national mixed-methods evaluation of the effects of removing legal barriers to full practice authority of Dutch nurse practitioners and physician assistants. BMJ Open, 8(6), e019962. http://dx.doi.org/10.1136/bmjopen-2017-019962
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
Macklin, J. R. (2018). Exploring Needs of Advanced Practice Nurses Attempting to Operate Community Healthcare Clinics in Rural and Underserved Areas (Doctoral dissertation, Northcentral University). https://www.proquest.com/openview/746f504c44e7e5c59a9828f48f6bb404/1?pq-origsite=gscholar&cbl=18750&diss=y
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
Ross, A., Brooks, A. T., Yang, L., Touchton-Leonard, K., Raju, S., & Bevans, M. (2018). Results of a national survey of certified nurse coach with implications for advanced practice nurses. Journal of the American Association of Nurse Practitioners, 30(5), 251-261. Doi: 10.1097/JXX.0000000000000041
Tobias, C. (2019). Senator Chuck Grassley and Judicial Confirmations. Iowa L. Rev. Bull., 104, 31. https://heinonline.org/HOL/LandingPage?handle=hein.journals/iowalrb10&div=3&id=&page=