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Barriers for Advanced Practice Nursing

Describe three barriers that have slowed down the progress of advanced practice nursing and strategies to help overcome these barriers. (Saunders, 2014)

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.

POST 1

M1 Discussion

It is known that the public health system in the United States is changing and every day is increasing the necessity of new policies and procedures for the well-being of the population. In order for someone to life a health life, it is important to understand that the aging process is more than getting older without any disease, but to advance in age with physical support, managing chronic diseases and preventing new illness (Gronek et al 2021).

In order to fulfill the health promotion, patients have been relying on the primary care provider (PCP). One profession that has been increasing in demand for PCP is the role of the nurse practitioner (NP). An NP is a registered nurse who advanced in the career and is trained to prevent, assess, diagnose, interpret diagnostic tests and treat disease based on nursing principles (Taylor et al 2021). Challenges exist regarding roles of the nurse practitioner. Addressing those problems can help find strategies and solutions for the full practice of NP.

One first barrier that we encounter and may slow down the progress of advanced nursing practice is policy restrictions of NP practice. In the United States, 22 states and the District of Columbia permit full practice autonomy to NP, meaning they can work independently without a physician overseeing, 16 states are under reduced-practice states and 11 states with restricted practice, including Florida (AANP, 2021). Studies have shown that states which an NP holds full practice have saved costs to Medicare in comparison with states that have reduced or restricted practice laws for nurse practitioners (Chattopadhyay & Zangaro, 2019). In addition, one solution for the shortage of primary care physicians would be the increase of NP as a primary care provider with full autonomy to practice (Liu et al 2020). As a strategy for this problem would be some comprehensive reform in the health care system, allowing NP to practice without restrictions (Altman et al., 2016).

A second challenge for the progression of the profession would be a lack of understanding roles of nurse practitioner. In the 1960s the NP role was created in the and in nowadays there are more than 325.000 NP in the US (AANP, 2021) (Kilpatrick et al., 2021). One study showed that patients who preferred physicians as their primary care provider, chose because of skills; meanwhile, patients preferred NP as their PCP because of their bedside manner (Leach et al 2018). In a lot of clinical settings, NP and physicians work in harmony and have as a priority a better outcome for the patient. Medical Doctors (MD) recognize the importance of NP for the work team and trust their decision by using collaborative practice (Poghosyan, Norful & Martsolf, 2017) (Renshaw, 2019). One solution would be communication between NP and patients, educating them regarding NP role as a PCP and explaining differences between NP and MD (Kleinpell et al., 2014).

Then, listing a third problem that the advance of NP profession encounter is the shortage of nurses in the U.S. There are about 3.8 million registered nurses, which represent the largest healthcare workforce (AACN, 2019). However, the need for nurses is visible as the population changes and grow older, the need for preventive care and the demand for nurses in acute care or primary care settings are increasing. To avoid current shortage, by the year of 2030, more than 1.1 million registered nurses would be needed (ANA, 2021). It is important to highlight the consequences of the increase demand for nurses and the shortage of the profession amidst healthcare. Unfortunately, nurses may feel overworked and underpaid which may lead to a burnout and consequently leave the profession (New Zealand Nurses’ Organisation, 2021). Some strategies to decrease the shortage of nurses would be investing in jobs that pay incentives for nurses as well creating an environment that appreciates, respect and motivate nurses. Second, it is crucial for the profession to have access to education. Creating differential student loans for nurses, flexible schools that allow nurses to study while continuing working are some opportunities for nurses to advance their career as they earn their master’s doctorate or PhD certificates.

Furthermore, advance practice nurse progress may encounter different barriers that may slow down the profession. However, it is a career in high demand nowadays, and it is necessary to create an opportunity to talk about NP roles, changes in the system regarding shortage of nurses, and the importance of revising laws that regulate the profession, allowing more autonomy for the NP.

References

Altman, S. H., Butler, A. S., Shern, L., Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health, Institute of Medicine, & National Academies of Sciences, Engineering, and Medicine (Eds.). (2016). Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US).

American Association of Colleges of Nursing (AACN). (2019, April 1). Nursing Fact Sheet. https://www.aacnnursing.org/news-Information/fact-…

American Association of Nurse Practitioners (ANNP). (2021, August 4). State Practice Environment. https://www.aanp.org/advocacy/state/state-practice-environment (Links to an external site.)

American Association of Nurse Practitioners (ANNP). (2021, May). NP fact sheet. https://www.aanp.org/about/all-about-nps/np-fact-sheet

POST 2

Barriers for Advanced Practice Nursing

Three barriers have slowed down the progress of advanced nursing practice. First, the Association of American Medical Colleges predicted that by 2025 the U.S. would have a shortage of 35,600 primary care doctors (Peterson, 2017). However, despite their training and education, Nurse Practitioners (NPs) will not fill the gap of primary care doctors due to barriers in federal and state laws that prevent them from practicing to the full extent of their license. NPS are trained to evaluate, diagnose, treat, and prescribe medications for disease management. Their extensive training to provide quality care has provided relief during the COVID-19 pandemic. Emergency regulatory and policy changes have expanded NPs scope of practice, but this is a temporary solution (Stucky et al., 2021). To this date, there are still 27 restrictive states that continue to deny NPs the right to practice to the full extent of their license despite the critical shortage of primary care doctors slowing down the progress of advanced nursing.

Second, the American Medical Association believes that physicians have extensive training and long years of practice, and NPs cannot provide the same quality care to the patients. Despite their differences in education and training, physicians value NPs but most are unaware of the significant role NPs play in the outpatient care settings. Like physicians, many people do not have a clear differentiation of the NP and M.D. roles. The NP Role confusion and the lack of clarification are seen in job advertisements calling for either an NP or P.A. to fill the role despite differences in training and education (Hamric et al., 2014). Poorly defined roles negatively impact patient care, quality of care and increase poor patient outcomes.

Finally, the decrease of primary care providers has given rise to the need for Advanced Practice Nurses (NPs)in primary care settings. Nevertheless, NPS are faced with a dilemma; the NPS scope of practice varies by state. Hence the scope of practice for NPS has not been defined; NPs can treat and prescribe medications without physician supervision in one state but may not be allowed to perform the same duties in another state (Hamric et al. 2014). The lack of consistency from state to state may put traveling NPs licensed in numerous states in jeopardy of committing errors punishable by law.

There are several strategies to overcome these barriers. For example, NPs and nurses, in general, can help seal the nursing shortage crisis by supporting senator Lauren Underwood’s bill H.R. 851; if passed Health Resources and Services Administration (HRSA) would invest 1 billion dollars in restructuring the nurse workforce (Congress, 2021). Restructuring the nursing workforce would lead to more nurses entering the field and empowering the nursing profession. NPS must continue to pursue role clarification and demand to establish one scope of practice for all states. Establishing one scope of practice will benefit in role clarification and working in different states. Finally, organizations should create NP Residency programs for new practitioners. The residency programs will create an evidence-based clinical environment suitable for new NPs to learn and collaborate with interdisciplinary teams to provide quality patient care. Residency programs and teaching hospitals encourage NPs to pursue higher education degrees.

References

Congress.gov(2021a). H.R.851. https://www.congress.gov/bill/117th-congress/house- (Links to an external site.)

bill/851/text

Hamric, A., Hanson, C., Tracy, M., & O’Grady, E. (2014). Advanced practice nursing: An

integrative approach (5th). Elsevier.

Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner

Focus. Journal of the advanced practitioner in oncology, 8(1), 7