Advanced Practice Registered Nurse: A Case Study

The aim of the ACA is to provide affordable health care to all Americans, but it still leaves some issues unaddressed that will impact the access to health care. Covino (n.d.), “Though the intentions of the legislation are good, the Affordable Care Act does little to improve the actual health care delivery system” (para.1, page 2). According to the American Medical Association, we are facing an increasing Physician shortage. As of 2010 we faced a shortfall of 13,700 physicians, the estimate is that number will increase to 62,900 by 2015, 91,500 by 2020, and 130,600 by 2025 (Krupa, n.d.), with primary care taking the largest impact. Health Care coverage will be of no benefit if there are no doctors to treat the patients. An example of this occurred in 2002 when Thailand’s’ “30 Bhat Scheme” added (CNN n.d.) “14 million people to the country’s health care system, resulting in long waits and subpar service” (Your health is covered, but who is going to treat you?) Several factors contribute to the physician shortage. Many physicians are reaching the age of retirement, the Association of American Medical Colleges estimates nearly 15 million physicians will be eligible for Medicare in the coming years (CNN n.d.). The increasing cost of malpractice insurance also deters many from pursuing a career in medicine, and is forcing some doctors to retire. Also contributing to the physician shortage is a lack of spots in residency programs. “In 2011, more than 7,000 were left

This paper explores the perception of clinical practitioners to the change in policy related to the advanced practice registered nurse (APRN) full practice authority. The author conducts a one-on-one, open-ended interview of 5 nurse practitioners and 5 physicians licensed to practice in Maryland on their perceptions of the recent passage of the Advanced Practice Registered Nurse Full Practice Authority. A literature review was conducted in a policy report by the professional nursing organization, and discussion within the peer-reviewed article supported an overview, regulatory differences among 50 states, including the District of Columbia. Their policy implication for enhancing APRNs role nationally. The author discusses a critical component

While the demand of healthcare need increasers the United States facing a physician shortage. In recent years the number of nurse practitioners (NPs) and physician assistants (PAs) has significantly increased and they are taking the part in providing healthcare cervices to the majority of patients. I believe nurse practitioners and physician assistants can practice independently from doctors and be free of oversight. Expanding the scope of NPs and PAs is essential to overcome the healthcare crisis we are facing; it will increase patient satisfaction and stabilizing the healthcare economy.

by a nurse equivalent is equivalent to care provided by a physician.. In addition, the

Since the inception of the Nurse Practitioner (NP) role in the 1960s, NPs have thrived in the delivery of primary healthcare and nurse case management. Despite patient satisfaction with NPs ' style of care, nurses have been critical of NPs, while physicians have been threatened by NP encroachment on MD practice. Balancing assessment, diagnosis, and treatment with caring defines NPs ' success as primary care providers. Understand the role and Scope of Practice of NPs is sometimes difficult for some to understand. The purpose of this paper is to define the role and history of NP, compare and contrast licensure versus certifications, understand NP Scope Of Practice and Standards of Care, discuss how the State Practice Acts regulate FNP practice, discuss credentialing and privileging, and differentiate between legislative and regulatory processes.

With the passing of the Affordable Care Act in 2010 approximately 32 million more people will be insured throughout the United States. The need for healthcare workers and providers will be in drastic demand to provide care to these insured Americans. The 2010 IOM report details out how the advanced practice nurse can be a valuable asset in primary, chronic and transitional care and their skill set should be used to promote better healthcare across the nation (IOM, 2010). This impact of this report should help progress advanced practice nurse’s ability to practice without individual state regulation and be governed under one body to server in and outside of the hospital setting

Advanced practice nurse practitioners (APRNs) have been attempting for many years to eliminate barriers that prevent full practice authority nationwide. Each state has its own licensure and regulates APRN practice roles. APRNs benefit health care by addressing two pertinent needs: the lack of available physicians; and, the increase in patient comorbidities (Gray, 2016). Florida is about to experience a shortage of medical practitioners. According to the Physician Workforce Annual Report of 2014, statistics state 13.4% of medical providers are expected to retire within the following five years after 2014 due to an increase

The Obamacare/ACA, might have helped numerous of individuals in acquiring health care, but the health professionals are facing a shortage of reimbursement difference for their services. As a result, Hospitals and healthcare providers were force to layoff personal and come up with innovative solutions. This point is proven by the renowned author, Amy Anderson by stating as follows: “The American health care framework has had shortages of personnel for quite some time and would not be prepared to give the adequate service to this amount of patients in need of medical attention. Training new professional health services personnel could take years. There is a shortage of graduates from medical and nursing schools. Doctors, nurses and health professional are sharing responsibilities prospective patients will face a longer wait time”. (Anderson, 2014)

Defining the scope of practice for an advanced practice nurse (APRN) can be a difficult task. Currently, in the United States, each state has its own policies regarding APRN scope of practice. State policies/laws vary from restrictive to independent. States under a restrictive policy of APRN scope of practice may have strict physician collaboration regulations. For example Missouri requires the collaborating physician to review a percentage of charts and be within so many miles of the APRN’s work place. Restrictive scope of practice can also limit prescriptive authority and decrease reimbursement of services (Hain & Fleck, 2014). States with more independent scope of

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

As the young and rapidly-aging population continues to increase, the demands of primary, acute and chronic disease management will also increase. As a result, more health care professionals who provide primary care will be needed to meet these demands. Thus, the emergence of Advanced Practice Registered Nurse (APRN) evolve. APRN is a nurse who has completed a graduate degree and has acquired advanced knowledge and skills. APRNs are grounded with theory, concepts and principles that enable them to assess, diagnose, treat and manage their patients. APRNs can work in conjunction with other health care professionals or independently. APRNs improve access to health care by providing care in the rural and underserved areas. APRNs also reduce the cost to health care (Joel, 2013).

Healthcare reform and politics are on the forefront of most citizens throughout the United States. Our access to healthcare has become a barrier for many citizens, and a hurdle for the advanced practiced registered nurses (APRN) throughout the years. Strict state laws have burdened APRNs and limited their practice throughout Ohio. It would be prudent to follow suit of other states, and retire the Collaborative Agreement; Richards and Polsky (2014) noted an immediate 20 to 30 percent increase in nurse practitioner providers in those particular states after it was retired. House Bill 216 (H.B. 216) helps modernize the Nurse Practice Act and the retire the mandatory collaborative agreement and extensive drug formulary. Within this paper, the contents and purpose will begin to unravel as I describe the meeting Naserin Salameh and I were able to connect with Representative Margaret Ann Ruhl of Ohio House District 68 on March 30, 2016, about H.B. 216.

IHAC found that barriers exist around nurses practicing at the top of their scope, and lack of diversity among health care providers. Legislators and consumers were educated about the information demonstrating the existence of barriers for the nurse to work to the entire capacity of their education and competency, since in Illinois APRNs have no full practice authority (IHAC, 2016). IHAC conducted a detailed APRN survey and held follow-up gatherings, including boards of specialists from practice, training and research, with centered proposals on enhancing diversity of APNs, and additionally other health care providers (IHAC, 2016).

For instance, the physician must start the initial treatment, and thereafter, the NP may conduct follow up visits with that patient. However, the incident to billing rules become ambiguous as to if the physician must perform service for every new problem or NP use their provider number (Bupper. C, 2011). This would need to be clarified and each interpretation may differ. Many facilities may consider the initial history and physical needing to be completed by the physician and then subsequent visits could be performed by the NP, and continue to use the physician’s provider number. If the NP is working at a facility where the physician is not present, then the NP must bill service under their provider’s number (Bupper. C, 2011). If they use the physician’s provider number, then this will be considered an illegal practice in regards to incident to billing rules. It is very important that the NP understands and follows the rules and regulations in respects to incident-to bills, and be able to perform services and practice under this legal

One of the major challenges facing the health delivery system today is governmental policies; the availability of doctors for the increasing number of patients. Currently the United States spends approximately $2.2 trillion on healthcare (Sayles, 2013). Healthcare has become multifaceted, this includes more specialists for chronic health care issues and the inclusion on technologies in the delivery of healthcare (DeVry University, 2015). The Affordable Care Act was developed to improve people’s access to health insurance and healthcare in the United States. However, this policy change enables millions more individual to get healthcare without and an immediate increase in the number of physicians and specialists. 2.8 million more healthcare