Reaction Paper. The Historic Article By Safriet (1992)

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

Nurse practitioners (NP) are committed to serving communities, patients, and other health care professionals. They are trained to operate within a prescribed scope of practice. This means that patients can be assured of receiving optimal health care services. Despite this, battles still remain regarding the scope of practice for NPs. Some physicians are uncomfortable, unsupportive, and impediment the progress made for NS. With this, the issues of restraint of trade surfaced as an argument against the NP scope of practice. According to Miller (2010), NPs are working to achieve consensus in all states for Np scope of practice, while physicians are inclined to safeguard their profession as they assert that NPs are extending into their territory.

Bahadori and Fitzpatrick conducted a study regarding the actual level of autonomy of the APRNs in primary care settings. They compared clinical outcomes for patients assigned to either APRNs or physicians and found there was no significant differences in reported health status between patients treated by NPs or by the physicians. Also Bahadori and Fitzpatrick (2009) stated within their report although the APRNs had more restrictions regarding their professional authority and struggle with maximal autonomy they recommend APRNs have more autonomy and decision-making authority to allow them to work as competent professionals, and improve patient care outcomes.

The afore= mentioned issues being addressed through legal channels by the AANP are barriers to effective and efficient practice, the type of barriers that were to be eliminated by the expansion of the Affordable Care Act (ACA) (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Only twenty-two states have allowed full practice authority, which is less than half of the nation. It is imperative that every advance practice nurse has a voice that is heard in their state and the nation, this is the message of the AANP (Hain & Fleck,

Results indicated a 25% decline growth rate of NP’s was slower in the most restrictive states

Advanced Practice Registered Nurse (APRN) has evolved tremendously since it was establish in 1965 to service vulnerable populations, however there are still barriers that must be addressed in order to free APRNs from limitation imposed by state scope of practice (SOP) laws and payers, which disrupts health care financing/costs, access, delivery, and quality patient care. Currently, only one third of the states in the U.S. permit APRNs to fully practice within their scope without limitations (Hain & Fleck, 2014; Yee, Boukus, Cross, and Samuel, 2013).

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

The APRNs Regulatory Model specializes roles and titles and population foci within a regulatory framework (Hamric, Hanson, Tracy, & O'Grady, 2014). This was implemented to resolve the issue of inconsistent rules, policies and standards of care across states. APN practice is faced with many barriers or obstacles put in place with notion of regulating practice and provision of quality and safe care. This have led to reviewing of the regulations to broaden the spectrum of APN practice as health care is fast evolving. Diverse regulatory criteria like variable accreditation standards, licensing requirements, inconsistent population foci and scopes of practice, represent barriers to optimize APRN function within today’s complex health care system

by a nurse equivalent is equivalent to care provided by a physician.. In addition, the

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

The Texas Nurses Association is a strong proponent of permitting APRN’s to practice with full authority using their clinical skills and education to their fullest potential (Cates, 2017, p. 2)l. The TNA is a member of the APRN Alliance, which encompasses four statewide associations (Cates, 2017, p. 2). The APRN Alliance joined forces with the Coalition for Health Care Access (CHCA). This coalition is comprised of “over 20 business, consumer-advocacy, and health care stakeholder groups” (Cusack, 2017, p. 2). Currently, APRN’s barriers include expenses associated with partnering physicians (Holmes & Kinsey-Weathers, 2016). Granting APRN’s full practice authority would results in a monetary loss to these physicians. The AMA and AAFP oppose the passing of HB 1415 (Hooker & Muchow, 2015, p. 89). The pushback from these organizations stands regardless of strong evidence of the positive outcomes with allowing APRN’s full practice authority.

There are several barriers limiting the ability of the APN to practice to their full capacity. First, state practice and licensure is regulated by each respected state and regulations vary from state to state (Hain, & Fleek, 2014). It is the goal of the Advanced Practice Registered

They can influence the people throughout their state, in order to practice independently. They can conduct quality assurance and add improvements to healthcare (Chilton 2015). The nurse practitioner can affect health care policy by writing to their state legislators; they work closely with their patients and can help to reduce complications and provide a method of care (Chilton 2015). As the Affordable Care Act brings more patients into the healthcare system, the demand for NP’s services can only increase and therefore there will be a need for their services. NP’s can move beyond their limitations and restrictions and have more control and autonomy into their practice to better assist their patients. NP’s have to deal with inequalities in the healthcare system and they are qualified to practice independently (Edmunds 2013). Nurse practitioners have been excluded or restricted on a scale and are not recognized or supported to practice independently in their state (Edmunds 2013). NP’s have the ability to apply their knowledge & clinical expertise to influence and initiate a health care policy (Danna 2009). The suggestion of a policy concept is regarding the issues in healthcare that are require for modification. NP’s can provide possible solutions

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

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