The Importance Of Aprn's Scope Of Practice

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

With increasing number of Physicians choosing not to go into primary care and increasing number of baby boomers crossing 65 years by the 2030, there is a very high demand for APRNs to fill up those gaps. The consensus model, which was first initiated in 2004, has been revised many times and finalized in 2008. It helps to regulate APRNs with licensure, accreditation, certification and education (Stanley, 2012).

Many studies exist which highlight the benefits of APRN full practice authority. One study from Duke University, by Conover and Richard (2015), contained this strong statement regarding APRN practice, “studies vary in their methodological rigor, each has concluded that APRN practice outcomes are equivalent or better to those of physicians” (pg. 4). The study goes on to say that three cost effective benefits to full practice authority APRNs are: lower training costs, lower compensation and limited use of expensive resources or procedures. The study also discusses how full practice laws would increase access to care by decreasing primary care provider shortages (pg. 6).

been restricted on what they can and can’t do including signing certain documents and orders they can prescribe. With the Affordable Care Act the demand for primary care providers is growing (Gadbois, Miller, Tyler, & Intrator, 2015). This means that the need for APRNs is rising and the need change is approaching. In the primary care setting, there is a variety of medical staff working including medical assistance, LPNs, and RNs. This can become more for the APRN when delegating medication administration. When the APRN cannot delegate medication administration the quality of patient care is sacrificed and is not productive in providing care to the patients.

According to reports found on the web page MEDPAGETODAY (2014) there has been an increase in the independent practice for advanced practice registered nurses (APRN). The article quotes data from the American Association of Nurse Practitioners (AANP) which reports 17 states and the District of Columbia allowing “full practice” with this meaning the APRN evaluates, diagnoses, orders testing, prescribes medication and initiates and manages treatments. 21 states require “collaborative agreement” with a physician and 12 requiring supervision of a physician. Collaborative agreement scope of practice varies by state and institution of employment.

Advance Practice Registered Nurse (APRN) is a broad term that is used to define the masters prepared nurse that participates directly in patient care. This definition includes four different facets of nursing: certified nurse-midwives, nurse anesthetists, clinical nurse specialists and nurse practitioners (Joel, 2009). Of these four professions that are included in the APRN definition, Western Carolina University offers two: nurse anesthetist and nurse practitioner. Nurse educator and nurse leader, which are also offered at Western Carolina University, are not currently included in this definition.

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.

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 should be impartial and fair governing board oversight of APRNs. Access to care should also be improved by authorizing third-party cover of APRN care and allowing patients to select providers of their choice. The healthcare workforce should also be given more support by creating more clinical training and graduate level education opportunities for nurses. The primary goals for these changes include giving APRNs the chance to practice their training and education to full limit, filling the gaps created by physician shortages, and improving

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.

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.

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.

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.

The APRN Consensus Model was released in July of 2008 to define advanced practice registered nurse, identify the titles to be used by APRNs, and define specialty area of practice. The Consensus Model also describes population foci, suggests a process for recognition of new APRN roles, and recommends requirements for implementation (American Nurses Association [ANA], 2010). The APRN regulatory model helps uniform scope of practice of APRN across the United States, which benefit individual APRN, enhance patient outcomes, and improve the quality of care. Consensus Model consists of Licensure, Accreditation, Certification, and Education. The Education criteria in LACE Consensus Model relate to all APRN programs regardless of master’s or doctoral

As the young and rapidly-aging population continues to increase, the demands of primary, acute and chronic disease management will also increase. As a result, more health care professionals who provide primary care will be needed to meet these demands. Thus, the emergence of Advanced Practice Registered Nurse (APRN) evolve. APRN is a nurse who has completed a graduate degree and has acquired advanced knowledge and skills. APRNs are grounded with theory, concepts and principles that enable them to assess, diagnose, treat and manage their patients. APRNs can work in conjunction with other health care professionals or independently. APRNs improve access to health care by providing care in the rural and underserved areas. APRNs also reduce the cost to health care (Joel, 2013).