Nurse Practitioner Report

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 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

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,

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.

Insurers are less likely to reimburse APRN’s in states that mandate physician supervision. Nurses need to push for reform of the regulations governing APRN;s.

Currently, the Affordable Care Act establishes nurse practitioners as providers whom are eligible providers in ACOs; however, the current Medicare Shared Savings program statute prevents beneficiaries of Medicare, who are receiving primary care service from a nurse practitioner, from being assigned to Accountable Care Organizations inside the program (AANP, 2015). The American Association of Nurse Practitioners (2015) also claim the exclusion of nurse practitioners must be repealed if ACOs want to develop further as models of practice, which improve cost effectiveness, patient access and quality.

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.

Affordable Care Act (ACA), and the aging of the population are the three major factors driving healthcare costs at this time (CMS, 2014). The nursing profession has the ability to contribute to refining the cost-effectiveness and efficiency of care through the delivery of evidenced-based treatment strategies to known populations with communal needs, and by advocating for polices that address the fundamental aspects that influence health and healthcare (Curley & Vitale, 2016, p. 5). The NE must be well-informed of laws entrenched in policy, as well as those central to both healthcare delivery systems and payment structures. Having knowledge of policy and law will enable the nurse leader to provide financial stability and sustain quality

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%.

Chism (2016) illuminates the needs for APRN to advance to the doctorate level of preparation to address the Institute of Medicine (IOM) called for safer health care practices. The DNP level of preparation prepares the APRN to: Evaluate evidence based practices for effectiveness, develop new practices based on scientific research, develop health care policies, lead and manage clinical care and health care systems, develop interdisciplinary standards, resolving health care dilemmas, and help reduce disparities in health care (p.10). Chism (2016) defines the DNP practice as a practice direct patient practice and less on research methodology (p 4).

One state, Massachusetts, enacted the legislation guaranteeing universal health coverage, this overwhelmed the state’s primary care physicians by a wave of newly insured patients. This resulted in advanced practice nurses because they

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).

“Nurse practitioners were created in an environment of informal training, a lack of credentialing processes, increasing sophistication of medical care, and opposition” (Medscape). In 1970, Nurse practitioners stated that patients were pleased with their improved convenience of health care services. In the early 1980s, health care encountered challenges to clarify their scope of practice and nursing organizations offered titles and certifications to meet federal regulations for reimbursement (Medscape). Nurse practitioners faced several barriers to gain provider status and needed direct reimbursement to practice as independent health care providers. An aggressive campaign was created and nurse practitioners achieved legislation over 20 years, resulting in provider status in 1997.

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.

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