Role And Scope Of Practice Of Nurse Practitioner (NP)

There are four types of Advanced Practice Nurse roles, the nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, and certified nurse-midwife. The Family Nurse Practitioner is the advanced practice role that will be discussed. According to Hamric, Hanson, Tracy, and O 'Grady (2014) the primary care NP provides care for patients in diverse settings, including community-based settings such as private and public practices, acute, and long-term care settings across the life span (pg. 396). Family Nurse Practitioners have faced many challenges in the medical profession to be recognized as health care providers. Most of these challenges where from fellow nurses. According to Hamric, Hanson, Tracy, and O’Grady (2014) conflict and discord about the Nurse Practitioner role continued to characterize relationships between NPs and other nurses (pg. 18). Despite the resistance to NPs in nursing, physicians increasingly accepted NPs in individual health care practices (Hamric, Hanson, Tracy, and O’Grady, 2014, pg. 18). Physicians readily accepted the role of the Nurse Practitioner, working together to improve patient outcomes and safety.

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

There is a growing trend where physicians are choosing different specialties instead of choosing primary care, primarily due to the low reimbursement rate in primary care. According to Iglehart (2014),” the Association of American Medical Colleges (AAMC) still projects a shortage of 130,000 physicians by 2025, split almost equally between primary and specialty care” (para. 1). With this decline comes an answer, an increase in the number of nurse practitioners providing patient care, reported 154,00 in 2012 and growing every year (Iglehart, 2014). This increase in nurse practitioners’ helps fill that gap, allow greater health care access to the community, especially special populations. By gaining access to healthcare were a nurse practitioner is the provider not only with the special population have high quality affordable health care, a trusting long lasting relationship will develop. This relationship will break the barriers of; lack of trust, lack of health care education and discrimination. Nursing is a trusted profession that provides education and care that no other health care professional

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

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.

Budzi, Lurie, Singh, and Hooker (2010) state, “Nurse Practitioners’ (NP) interpersonal skills in patient teaching, counseling, and patient centered care contribute to positive health outcomes and patient satisfaction.” According to their research they encourage healthcare systems in the U.S. to hire more NPs to allow for better access affordable, and quality care (Denisco & Barker, 2016). With the demand for primary care providers, The NP role aids in delivering a solution to some of the healthcare issues that exist today. Organizations like the Institute of Medicine (IOM) and Centers for Medicare and Medicaid (CMS) all agree to allow nurses to practice to their full abilities to make healthcare more accessible and affordable, especially for the aging baby boomers and less accessible rural neighborhoods, and densely populated urban areas. Research has proven that NPs that provide primary care have similar health outcomes to primary care physicians (DeNisco et. al., 2016). NPs particularly take pride in their holistic approach, forming therapeutic relationships between other providers of the healthcare team, patients, and their families, aiding the informed decision making process, use of the evidence based practice approach in health management (Brown, 2005). Some of the other actions or qualities that

In order to reduce excessive expending, over ordering mandatory continuing education units (CEU) as an effort to educating providers on deciphering DME needs appropriately. The CEU education can tailored to specific practice specialty and population. Allowing for all providers to order DME in parallel with diagnosis/ condition within a certain span of time. For instance any provider can order a Continuous Positive Away Pressure (CPAP) machine for a documented sleep apnea patient within the last years. In cost saving efforts if another practitioner or physician orders this same DME within the last 5 years it will not be dispensed as Medicare has already paid for the equipment once. This reduces the duplicate charges for the same DME

The present healthcare system in the United States (U.S) faces various challenges due to changing demographic, economic and political pressures. The need of primary care provides are increasing as a result of increasing access to healthcare, increasing expenditures, and growing populations of the elderly and chronically ill patients. Even with the plenty of evidences that Nurse Practitioners (NP)are well educated, competent, health care professionals who are able to improve access to high-quality health care and lower health care costs, restrictive practice regulations still exist. The quest for NPs independence practice has surpassed and it became a necessary practice transformation to improve the health of the nation (The National Organization

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

New York has joined 16 other States and the district of Columbia in the abrogation of the mandatory regulation that required nurse practitioner to deliver primary care under the supervision of a physician. Dr. Jauhar, explained that the reason behind this law is due to the scarcity in the expanse of primary care physicians. He argued that Nurse Practitioners are thought to be cost-effective because they are remunerated lesser than medical doctors, however, that’s not the case Mr. Jauhar elaborated that Nurse Practitioner, though an asset to medicine, aren 't equipped with enough training and clinical hours to practice self-sufficiently. For example, research from 1999, determined that nurse practitioners ordered more diagnostic test such

Fairman and D’ Antonio (1999) examines how the nurse practitioner movement has redefined the relationship between physicians and nurses. There have been changes to medicine and new prospects resulted, most specifically in the form of the nurse practitioner role. This role was able to take away the monotonous areas of practice for physicians. As the profession has evolved, nurses have become more knowledgeable and were able to care for a more varied range of patients. The American Medical Association and the American Nurses Association disputed issues relating to influence, power, and control. This resulted in noteworthy dynamics and debates regarding hierarchy within the healthcare system. A divergence between medical influence and nursing

Nurse practitioners provide an answer to many of the problems affecting healthcare today (DeNisco & Barker, 2016). For years nurse practitioners have provided cost effective quality care to the public, now with the recent changes in healthcare reform nurse practitioners are in even greater demand. Despite research citing their value, the role of the nurse practitioner must be clarified. To meet and support the growing demands of the health care system, an understanding of the nurse practitioner role is important. DeNisco & Barker state, “Advance Nurse Practitioners are licensed

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

Historically, nurses focused on the diagnosis and treatment of a disease, sickness or condition and emphasis on health promotion was nonexistent. However, today that has all changed. Nurses are now expected to expand their primary care services to include psychosocial nursing, advocacy, behavioral science, counseling and advocacy in addition to patient assessment, clinical diagnosis and patient-case management. In the article “Defining Nurse Practitioner Scope of Practice: Expanding Primary Care Services,” Sherwood, Brown, and Wardell (1997) state “the role of the nurse practitioner continues to evolve in response to changing societal and health care needs as consumers in all settings seek increasing services”. (Sherwood, Brown and Wardell, 1997).