Descriptive Authority For Nursing

The types of managed care are differentiated by definition, operation, structure, and information needs. `HMOs were the most common type of MCO until commercial insurance companies developed PPOs to compete with HMOs' (Douglas, 2003, p.331). `HMOs are business entities that either arrange for or provide health services to an enrolled population after prepayment of a fixed sum of money, called a premium' (Peden, 1998, p.78). There are three characteristics that an HMO must have. The first is a health care financing and delivery system that provides services for members in a particular geographic area. Second, is ensured access to a complete range of health care services, health maintenance, treatment, and routine checkups. Last, health care must be obtained from voluntary personnel that participate in the HMO. The five HMO models related to the participating physicians are the Staff

In the United States, health care accessibility, quality, and affordability continue to be ongoing topics of discussion that effect many Americans on a regular basis. The need for affordable, quality healthcare continues to grow, not only due to a growing elderly population, but also as a result of the Affordable Care Act which has allowed millions of previously uninsured Americans access to health insurance and therefor better access to healthcare services (Patient Protection and Affordable Care Act, 2010). According to the Institute of Medicine (IOM) the projected demand increased for healthcare have led to a call for expansion of primary care services by policy makers (Institute of Medicine, 2010; National Governors Association, 2012). Since Advanced Practice Nurses or Nurse Practitioners (APNs or NPs will be used interchangeably for the purpose of this paper) are one of the fastest growing groups of healthcare providers, and continue to practice and provide care in a range of settings including primary care, it is important to investigate and address any potential barriers to practice. This author believes that allowing APNs to write prescriptions for commonly used controlled substances will help improve timeliness and flexibility in health care delivery; studies have shown that there is a positive impact on high

First, the state licensure regulates NP practice and it has been a big issue since NPs are not able to practice to the fullest extent despite of their education and training. NPs practice is regulated by state licensure and only about one-third of the nation has adopted full practice authority licensure and practice laws for NPs (Hain & Fleck, 2014). The American Association of Nurse Practitioners (AANP) reports that, under a full practice authority model, NPs are still required to meet

It is believed that NPs can overcome challenges with billing and coding, as well as Medicaid and Medicare, third party payers, commercial managed care companies’ reimbursements through appropriate coaching and remaining up to date on regulations. As mentioned earlier, implementing compliant electronic systems, staying well-informed of billing regulations, evaluating weekly reports, and consulting with compliance experts can aid in accurate reimbursement for NPs in primary care.

All accredited educational programs include didactic learning that includes advanced assessment, pharmacology and pathophysiology and clinical experience gained through rotations and preceptorship. APN’s complete master’s degrees or post master’s programs in preparation for certification. Certification is granted by The American Academy of Nurse Practitioners and the American Nurses Credentialing Center. Certifications are earned in adult and family, acute care, pediatrics, psychiatric, gerontology and women’s healthy specialties. APN’s are licensed by individual state boards of nursing and they are certified in advanced specialty areas. APN’s have prescriptive authority in all 50 states and can practice without direct physician supervision in several states. They work in a variety of settings including hospitals, clinics, schools, colleges and urgent care facilities. APN’s must recertify every five years with 1000 hours of clinical practice and 75 continuing education hours in the area of

In order to apply for prescriptive authority in Indiana you must submit proof of and unencumbered registered nurse (RN) license, the nursing program will then submit an official transcript to the Indiana State Board of Nursing showing successful completion of the graduate program. The college that the graduate program is completed needs to be accredited by the Commission on Recognition of Postsecondary Accreditation. It is also required to submit proof of successful completion of graduate level pharmacology course consisting of at least two semester hours, and written practice collaborative agreement (Indiana Professional Licensing Agency, n.d.). If you received a bachelor 's degree rather than a graduate degree, you must submit proof of current national certification (Indiana Professional Licensing Agency, n.d.). APNs with

The Nurse Practice Act of Illinois State is 225 ILCS 65. IL offers an APN to diagnose, interpret labs and order diagnostic tests. APNs is able to provide counseling and education for prevention of illness and promotion of health. They can provide palliative and end of life care, and can supervise and delegate to task to LPNs and RNs. APNs have prescriptive authority if they have a written collaborative agreement with a physician and are limited to 30 days (IGA, 2014). In order to practice as an APN in IL one must have a current unrestricted RN license, have a masters degree approved by the State Board of Nursing in the specialty of choice and a national certification. State Board of nursing is the regulatory authority of IL APN practice, and they accept certification from ANCC or AANP or certification from specialty agencies. APNs in IL requires 50 hours of continuing education in a 2-year license renewal period. IL is one of the States that offers versatile certification opportunities for APN in addition to advocating for the full practice authority of APNs. A systemic review done by Kuethe (2013) finds it is better for an NP to manage chronic diseases such as asthma and diabetes for their better control and healthcare cost reduction as physicians do not have enough time to provide comprehensive care (p. 5).

According to the Pearson Report, there is a total of 147,295 Nurse Practitioners throughout the United States (Pearson, 2009). However, for NPs in some states the battle continues over some forms of prescriptive authority or physician involvement in NP prescribing, such as the state of Pennsylvania. State regulatory approaches to NP prescribing range from no authorization for prescribing (in Georgia, 2006 legislation passed which recognized NPs as prescribers, but the rules have not been approved at the time of this writing) to unencumbered prescriptive authority (Arizona, DC, Montana, Oregon, Washington, and Wyoming) (Lugo, O’Grady, Hodnicki & Hanson, 2007).

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.

Reimbursement for the advanced practice nurse (APN) is improving but how they fit into reimbursement systems is vey important. One question that arises is if the APN should be paid the same fee for service as a physician or should only a percentage of the payment be received. Most third-party reimburses, which include a few large insurance companies are now reimbursing APNs and more states are getting on board with reimbursements by developing reimbursement models for APNs (Hamric, 2009). For example, Aetna US Healthcare, Anthem Blue Cross and Blue Shield of Kentucky, Medicare and Medicate all credential NPs as primary care providers and pay at 85% of the physician rate. Tricare of Kentucky credentials NPs and pays 100%.

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).

There is an increasing demand for nurse practitioners, which makes this a crucial period in the development of their practice and profession. Nurse practitioners must face increased opportunity and continuing opposition towards independent practice all while defining their role in health care delivery and establishing their connections. The practice of nurse practitioners still varies widely across the states. These inconsistencies make it difficult for nurse practitioners as well as patients when practice

The adult-gerontology acute care nurse practitioner (AGACNP) has many responsibilities. In addition to providing excellent patient care, the AGACNP must also know how to code for patient services, bill appropriately and know how much they should expect in reimbursement for specific treatments. Many legal issues arise for the AGACNP, including several forms of negligence; the AGACNP should be educated on the essential elements. Finally, the AGACNP must educate themselves and be prudent to avoid legal issues related to malpractice. In the following paragraphs, each of these issues will be discussed.

Time, money, and accountability, are exceptional evidence based practice barriers. Along with those three examples, increased responsibility is additionally attributing as many health care organizations are expecting all staff to “working to the top of licensure”. The transition is maximizing to decrease expenses, offset hiring, and provide exceptional quality patient care among team member assets. This not only affects current registered nurses scope of practices, but also those pursing advanced degrees such as nurse practitioners including state by state regulations. On April 25, 2017, an email was sent out from Wisconsin Department of Safety and Professional Services, reaching out to all registered nurses in the state of Wisconsin

Many nurses need to take their own professional liability insurance, although insured by the employer. Most of the company policies are created to meet their own needs. (Eisenburg, 2010, p. 25.)