FON Report Summary

As popular as the ADN is today, there is a huge momentum to encourage nurses to receive their BSN instead of an ADN. Nurses that are already entering the workforce at the BSN level are not only more skilled at following and understanding evidenced based practice, but they are also more prepared to go on to school to complete their masters or doctorate degrees. In the changing face of healthcare, more nurses with advanced degrees will be needed to provide primary care as in the role of nurse practitioners. APRNs are going to be in higher demand in community care, public health nursing, evidence based practice, research, and leadership. Shortages of nurses in these positions create a “barrier to advancing the profession and improving the delivery of care to patients” (IOM, 2010, p. 170). Shortages of APRNs and the increasing need for nurse practitioners to provide primary care is why the IOM is recommending to increase the amount of BSN educated nurses entering the workforce to 80% and to double the number of doctorate nurses by 2020 (IOM, 2010, p. 173) The goal to increase the nursing workforce to 80% BSN educated nurses and double the amount of nurses with doctorate degrees is a formidable goal, but increasingly necessary. Patients are becoming more complex inside and outside of the hospital setting with chronic multiple comorbidities. BSN educated nurses are not only better prepared to care for these

The Board of Nursing in California provides specific guidelines by which a registered nurse can become a nurse practitioner (NP) by means of acquiring advanced practice education. The additional preparation will help the NP in assessing and managing the healthcare needs of their patient population. In 2008 there were an estimated 145,000 NPs nationwide and 13,649 in California (Christian, S., & Dower, J.D., 2008). Although there are federal mandates for the NP role in primary care, the majority of the educational guidelines and scope of practice rules fall to individual states. This creates disparities between states that are evident by the differences in the outlined scope of practice for an NP.

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

This nationwide initiative was intended to guide recommendations and implementation of the IOM report. The visualization of The Campaign is a health care system that promotes high-quality care, in which nurses contribute to their practice to their maximum potential. These efforts are harmonized through an initiative of AARP, the Center to Champion Nursing in America (CCNA), the AARP Foundation, along with the RWJF (Center to Champion, n.d.).

In 2008, the coalition of members from the Alliance for Advanced Practice Credentialing and the National Council of State Boards of Nursing (NCSBN) created the Consensus Model for Advanced Practicing Registered Nurses (APRN’s). This model creates a framework for APRN’s in licensing, accreditation, certification, and education in the United States (Alleman & Houle, 2013). The establishment of this Consensus Model has developed a bases for the ARNP’s comprehensive knowledge base, ability for clinical reasoning, cultural, and ethical competencies, establishing a model of practice for ARNPs in which to follow. These concepts will be further discussed in this paper.

Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine; Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. [The National Academies Press]. Retrieved from http://books.nap.edu/openbook.php?record_id=12956&page=R1

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.

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

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 report shows that the part of nursing must be expanded so that nurses are able to practice to the fullest degree of their education and training. Currently, advanced practice nurses (APRNs) work according to the scope of practice guidelines set forth by their individual state, meaning these highly educated nurses may not be working to the extent of their training but to the individual state laws. The report offers recommendations to streamline these idiosyncrasies and get rid of the red tape so that nurses can work in their appropriate manner and deliver safe quality care to some 32 million Americans who will before long gain access to health care services (American Association of Colleges of Nursing [AACN], 2012). The report correspondingly finds that nurses need to attain advanced levels of education and training through an enhanced education structure which encourages a cohesive academic progression as to safeguard the delivery of quality health care services. Patients are becoming progressively more complex and nurses need to attain the proper skills to care for these persons. Nursing education must embrace the continuous move towards a streamline approach to higher degree programs (Institute of Medicine [IOM], 2010, p. 2). Nurse residency programs

Throughout the process of composing this report, the Committee of the Robert Wood Johnson Foundation Initiative on the Future of Nursing devised and enacted what is known as the Future of Nursing: Campaign for Action. The engendering of the "Future of Nursing: Leading Change, Advancing Health" was a major component of that initiative. The aforementioned organization was not only responsible for conducting the research that this report was based on, but actually provided four essential recommendations that it believed the data supported and that have a direct correlation to the data collection necessary for future workforce policy making and planning, as

In 2008, The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched an initiative to assess and reform the nursing profession to address the complex unique nursing needs for the current world. The IOM report published in 2010 calls on nurses to take greater role in the healthcare system by taking leadership roles and obtaining high level education. The report envisions nurses to use their full potential and attain academic progression to redesign the healthcare profession in United States.

These impose severe constrictions on the ability of the nurse to move forward or advance into the areas of practice where traditional nursing practices were not allowed {Institute of Medicine, 2010}. However with the increase in the number of nurses graduating with advance degrees in nursing; the situation is changing. These well educated nurses are leading the charge to confront the complex issues that the rapidly changing health care situation presents. Regulatory barriers must be lifted so that nurses can practice within their scope in order to be reimbursed by private insurance for the services they provide. These changes can be done through the federal and state legislators as well as supervisory agencies and bodies such as congress and licensing regulatory boards. The IOM also recommends that nurses will expand their scope of practice and increase their responsibility through teaching and counseling of patients. {Institute of Medicine,2010}. The use of Advance Practice Registered Nurses and Physician Assistant in providing primary care services will decrease wait time and increase patient satisfaction. The high turnover of nurses transitioning from school to practice also affects the quality of care. These nurses do not have enough experience to make decisions in patient care.{Institute of Medicine,2010}.The IOM and JCAHO{2012} report supports the recommendations for the introduction of nursing residency

According to the IMO report, all registered nurses, as well as other health care professionals should be allowed to practice their full level of their training and education. I agree with this recommendation as this will help improve our health care system in many ways. This intervention would help ARNPs to practice independently and care for patients, which would enable them to significantly address patient primary care needs, decreasing patient waiting times and the primary care providers's shortage that is estimated to increase by 2020. Furthermore, this would free physicians to care for more complex patients with chronic health conditions that required more of their specialized expertise. In addition, many reports conclude that developing

Being a registered nurse affords one the option of working in many diverse healthcare settings. In any practice setting the climate of health care change is evident. There are diverse entities involved in the implementation and recommendation of these practice changes. These are led by the Robert Wood Johnson Foundation (RWJF), the Institute of Medicine (IOM), nursing campaign for action initiatives, as well as individual state-based action coalitions. Nurses need to be prepared and cognizant of the transformations occurring in health care settings as well as the plans that put them at the forefront of the future.