Collaborative Agreement Scope Of Practice

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

The role of the nurse practitioner began in the 1960’s, with the development of an advanced nursing role in pediatrics in Colorado, to meet the need of treating children of low-income families. Since the inception of the advanced nursing role, there has been controversy in educational standards, educational requirements, knowledge base needed, and state imposed restrictions on practice. It is through the rapid development of ARNP programs and inconsistencies in educational standards that have created obstacles in the advancement of these roles, licensure differences, and restrictions that have minimized the role of the ARNP (Stanley, 2011).

These organizations developed the Consensus Model document in 2008 to unify practice, identify APRN clinical roles, identify the acceptable titles to for NPs, and define the requirements for general practice and licensure. Note to mention that laws and regulations statute on the APN scope of practice may vary by states, whereas some adhere to full scope of practice, other to reduced practice, or restricted practice. For instance, the state of Florida defines advanced registered nurse practitioner as a licensed person with ability to practice professional nursing and certified to in advanced or specialized nursing practice (Buppert, 2011). The four advanced clinical specialized roles include certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialist, and nurse practitioners (Buppert, 2011). In terms of licensure, 46 states out of 50 require nurse practitioners to pass a certification exam. The Florida Board of Nursing requires certification by an appropriate specialty board and graduation from a program leading to a master’s degree (Buppert,

There have been concerns regarding the identification and credentialing of advanced practiced registered nurses (APRNs). A APRN is a registered nurse who has successfully completed an accredited graduate-level education program, in which the individual is well prepared and successfully passed the nationwide certification examination (APRN Consensus Model, 2008). However, there are still debating issues of who would fall under the APRN category. The National Council of State Boards of Nursing (NCSBN) has identified four APRNs who are deem fit to be called ARPNs; however, only two will be named. They would be certified registered nurse anesthetists (CRNAs) and certified nurse practitioners (CNPs). Whereas, the nurse informatics and the nurse administrations are not considered to be APRNs; although, they are still license registered nurses but they do not provide direct patient care and are not required to take the national certification examination (ARPN Consensus Model, 2008).

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

In recent years, APRNs have been very vocal through many nursing coalitions and associations. The voices of all ARNPs seeking full practice authority has been heard with the proposed bills. The Florida Panhandle Nurse Practitioner Coalition (FRNPC), has given information to all ARNPs to keep ahead in legislative issues. A white paper published by the American College of Physicians have been shared to all Floridian ARNPs through the

Healthcare reform in the United States (U.S.), continues to be a hot topic in the news. Whether it discusses how the program will be financed, the need to redesign the organization, or how the process of delivering healthcare will be implemented; one thing that is a frontrunner, is the need for registered nurses (RNs) and advanced practice registered nurses (APRNs) to fill the increased demands on the primary care system (Institute of Medicine, & Robert Wood Johnson Foundation, 2011, p. 375). “Several programs and initiatives included in the health reform legislation involve interdisciplinary and cross-setting care coordination and care management services of RNs” (Institute of Medicine, & Robert Wood Johnson Foundation, 2011, p. 377).

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

The role of Advanced Practice Nursing continues to change and develop. In the past few years, state legislatures authorized Nurse Practitioners to receive direct payment and write prescriptions. These changes have increased the Nurse Practitioner 's independence. This has resulted in Nurse Practitioners establishing independent practices that provide the same health care of primary care physicians, or they can also work in practices where the Nurse Practitioner and the doctor care for patients together (Spitzer 1974). "Many states are increasing the level of authority and reimbursement for Nurse Practitioners. Most private insurance companies and health maintenance organizations cover the services of Nurse Practitioners (Pearson 1993). Some blame the nursing shortage partly on Advanced Practice Fields. Registered Nurses are obtaining their master 's degree in order to earn more money and have more opportunities.

State licensure controls NP practice and is a barrier to NP practice to the fullest extent of their education and training. Full practice authority allow the Np to assess patents, diagnose, order and interpret diagnostic tests, initiate and manage treatments including prescribing medications independently. At present only one third of the nation has adopted full practice authority and practice laws for NPs. The remainder of the NPs in the U.S have reduced or restricted practice licensure (Hain & Fleck, 2014). In reduced practice, state practice and licensure law reduces the ability of NP to engage in at least one element of NP practice. State law necessitates a regulated collaborative agreement with an outside health discipline for the Np to provide patient care or limits the settings or scope of one or more elements of NP practice. Whereas in restricted practice, State practice and licensure law restricts the ability of a NP to engage in at least one element of NP practice. In Texas, Np practice is restricted. State requires supervision, delegation, or team-management by an outside health discipline in order for the NP to provide patient care in Texas (American Association of Nurse Practitioners, 2017). Full practice authority for NP referred to autonomous practice or independent practice. The IOM report has identified, restrictive scope of practice regulation is one of the most serious barriers to accessible care. Variation in scope of practice across states has an indirect impact on patient care since the degree of physician supervision may affect practice opportunities and payer polices for NPs (Hain & Fleck, 2014). In 2010, a full practice status model was recommended by the institute of medicine and national council for state boards of nursing. However, 29 states including Texas, still holding reduced or restricted practice regulations for NPs (Simmons School of Nursing

According to the Massachusetts board of nursing (2015), all APRNs, except the CNM are mandated by law to practice in accordance with written prescriptive guidelines developed in collaboration with the nurse and a physician. This regulation which was written in 1994, in no doubt limits the APRN to have the autonomy to practice without interference from a physician

Whether the changes are related to evidenced-based practice or laws related to practice, the nursing field is constantly evolving. Although APRNs are heading in a great direction, there are still many limitations to their practice. As shown in Barton Associates’ (2015) law guide, there is a trend in the chart that shows more restrictions placed on NPs the farther southeast one works. Considering I live in South Carolina, I witness these restrictions first hand. However, to our advantage, South Carolina has a lot of influence from the military community considering it’s high population of military personnel. “The Department of Veterans Affairs (VA) is proposing to amend its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment” (Department of Veterans Affairs, 2016). Therefore, APRNs will be able to practice independently within the VA system, regardless of the state’s rules and regulations. I am looking forward to the changes this will bring within the next few years. I believe this will help motivate states to relieve some, if not all, of the restrictions placed on APRNs as they see more efficient use of healthcare resources in the VA system in every

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).

The role of Advanced Practice Nursing (APN) has changed dramatically in recent years. Currently, the Unite States (U.S.) health care is focusing on delivering a cost -effective health care to all patients. In the last decades, there were many efforts to control health care over spending in the U.S. One of such efforts is to focus on applying proven principles of evidence-based practice and cost-effectiveness to find the least expensive way to produce a specific clinical service of acceptable quality (Bauer, 2010). The vast changes in health care system, such as cost, need for high productivity, limitation on reimbursement, and the inadequacy on access have made APNs to think in a way where they most fit to provide independent care for

As the healthcare system in America is overhauled, advanced practice nurses are going to increasingly assume the role of primary care providers. Many states have kept up with the evolving expansion of