Analysis and Recommendations of Advanced Practice Nursing Issue of Restrictive Practice Setting Assignment

Analysis and Recommendations of Advanced Practice Nursing Issue of Restrictive Practice Setting Assignment

Analysis and Recommendations of Advanced Practice Nursing Issue of Restrictive Practice Setting

Introduction

The healthcare needs of the U.S population are expanding. Paradigm shifts are required to address not only population care needs by also resolve existing gaps in the delivery of healthcare services. One radical approach proposed and implemented involves expanding the roles and empowering Advanced Practice Registered Nurse (APRNs) to undertake more responsibilities that would enhance primary care. However, this fundamental shift has encountered diverse challenges, such as restrictive practice setups. Restrictive practice setting continues to pose a significant challenge to APRNs. This paper demonstrates the extent of restrictive practice setting as one of the core challenges facing APRNs through a critical analysis of socio-political factors. It also articulates fundamental approaches to mitigating this nursing practice issue. IOM report raises concerns about a shortage of primary care health practitioners in the U.S and suggests that APRNs if permitted to practice to the maximum degree of their education and training, could aid in building the healthcare workforce necessary to address U.S primary care needs and facilitate the delivery of patient-centered, community-based health care (Wakefield, Williams & Le Menestrel, 2021). The restrictive practice problem facing APRNs should be critically evaluated and contextualized to develop feasible solutions that would help achieve accessibility, quality, affordable and equitable care Analysis and Recommendations of Advanced Practice Nursing Issue of Restrictive Practice Setting Assignment.

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Contextual analysis of the issue

Restrictive nursing practice setting is a challenge that is historically grounded. Despite the growing demand for primary healthcare services, APRNs continue to face practice restrictions arising from skepticism surrounding training and potential power imbalance. The growing demand for primary care necessitates the optimization of available human resources for health. In 1965, the advancement of the first certificate program to equip nurses with the skills to deliver primary care to underserved populations (Peterson, 2017). This step was a response to the growing demand for primary healthcare services, and since the inception of such first program, the primary healthcare fields have expanded to include women’s health, adult and geriatric health, neonatal, and other specialty roles, with minimum requirements of qualifications being master or doctoral level of education (Peterson, 2017). Despite qualified NPs’ willingness and ability to deliver quality, cost-effective care, the governmental bodies have continued to ignore legislation that would modernize health care and empower nurses to undertake more roles.

The healthcare setups in the U.S significantly feature reduced practice for nurses. Nurse practitioners can engage in at minimum of one component of the nursing practice, but this is controlled via a collaborative contract with an external health area when providing patient care. Besides this, nurse practitioners are empowered to engage in at minimum of one aspect of nursing practice, but such practice needs to be accompanied by supervision, delegation, or team management by an external healthcare discipline when delivering patient care. This reduced practice could be partly linked to socio-political factors. According to O’Rourke et al. (2017),28 states practiced laws and regulations that constrain the capability of nurse practitioners to practice to the full degree of their education and training, thus, limiting patients’ access to healthcare services.

The political turbulence in the U.S. led to far-reaching shocks in the healthcare system post-2016 elections. Nurse practitioners’ political efficiency and proactive participation are essential factors for nurturing affordable and high-quality care for U.S citizens. The 2016 U.S Campaigns were unconventional, contentious, disruptive, and marked by political unrest. By the beginning of 2017, more than 12 million people were added to the already strained health system, yet the shortage of primary care providers continued to persist as a problem. The Institute of Medicine and the National Governors Association had earlier advised about removing restrictive state regulations to enhance access to nurse practitioners’ services to address the provider shortage. In addition, the Federal Trade Commission (2014) supported the avoidance of physician supervision clauses in nursing practice state practice acts because of anticompetitive environments.

Relative political inactivity amongst nurse practitioners could have partly contributed to the slow transformation in changing laws or dealing with outdated regulations or laws. Historically, most nursing practitioners haven’t been politically proactive in creating and sustaining political change. Currently, nursing practice doesn’t gain from robust policy development and advocacy influence, yet there are 425,000 licensed registered nurses in California (about twelve percent of the national nursing workforce). It is worrying to note that five percent of nurses are integrated into hospital boards. Legislative efforts to advance full practice authority for APRNs hit a snag in California and other states. Even though nursing has been ranked as the most trusted and ethical profession for a long time (Spurlock ,2020), its collective voice is significantly unheard by policymakers, decision-makers, and legislators Analysis and Recommendations of Advanced Practice Nursing Issue of Restrictive Practice Setting Assignment.

Literature Review and Analysis

The law, policies, and regulations continue to restrict the role of APRNs in healthcare despite their immense benefits to healthcare. Perloff et al. (2019) argued that State scope of practice (SoP) laws restrict the services that APRNs may legally offer in primary care and other settings. However, this restriction is not beneficial but counterproductive. Growing evidence suggests that states with highly restrictive SoP regulations lead to declining productivity amongst APRNs, thus, reducing healthcare access (Perloff et al.,2019). According to Kleinpell et al. (2022), APRNs substantially account for increased health promotion, better disease prevention, and enhanced disease management, but many impediments to APRN practice exist. Kleinpell et al. (2022) cited state, regulator, and institutional barriers, as factors that hinder nurses’ ability to exploit the entire degree   of qualification and certification. It appears that APRNs face a myriad of challenges that restricts their practice. It is unsettling that APRNs continue to encounter barriers even in states with FPA, where such challenges are attributed to federal statutes and regulations in many institutions, such as hospitals and nongovernmental policies. For instance, these broad spectra of barriers include the lack of hospital APRNs’ rights to admit, reimbursement models/policies, and credentialing practices and policies that do not acknowledged APRNs’ services (Kleinpell et al.,2022).

O’Rourke et al. (2017) study results showed that APRNs restricted roles as a result of regulation, policies, and laws, could be attributed to their low political efficacy. O’Rourke et al. (2017)    described APRNs as ‘‘politically alienated Americans’’ where their political activity in the U.S is mainly limited to voting and contact with legislators. The physician signatures for prescriptive and hospital admission rights restrict nurse practitioners’ roles. More often, APRNs are not listed as a provider of records, and records don’t often capture APRN care. These challenges negate APRN’s ability to communicate with patients, offer appropriate follow-up care, limit them as the patient’s proffered source of care, thus, rendering APRN care invisible in the care settings. A critical review of the organization of core shows that poor comprehension of the APRN role, poor physician relations, missing professional recognition and improper administrator interrelations continue to exacerbate impediments and restrictions to optimal APRN practice (Kleinpell et al.,2022). Thus, a critical focus on these barriers portrays the full extent of the problem.

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Recommendations

There is a need for a multifaceted approach to address restrictive practice settings for APRNs. Firsts, outdated laws or regulations must be revised to allow APRNs to practice to the full degree of their education and training to ensure better access to healthcare services (O’Rourke et al.,2017). Second, nurse practitioners need to be more politically efficacious by understanding factors that are linked to political efficacy and how they can promote efforts undertaken by nurse leaders in promoting a change in state regulation and rules involving nursing practice (O’Rourke et al.,2017). Nurses need to identify strategies to engage in the political arena with a core focus on contemporary efforts to transform state laws and regulations that constrain advanced nursing practice.

Third, of their sheer numbers and nursing ranked as the most trusted and ethical profession, nurses’ practitioners need to be proportionally represented in leadership organizational and healthcare boards, which gives them necessary platforms to advance their agenda (Houskova, 2018). Legislators, policymakers, and decision-makers should hear their concerns. Besides, nurse leaders at the helm of management of leadership positions need to play an essential function in helping limit needless institutional or organizational barriers to APRN practice (Kleinpell et al.,2022). These recommendations significantly impact the APRN roles, settings, and practice dimensions. For instance, the nurse will need to be more politically proactive. Besides their political efficacy and proactive leadership, nurses need to develop robust competence to deliver quality and safe healthcare services when highly restrictive laws are revised or amended Analysis and Recommendations of Advanced Practice Nursing Issue of Restrictive Practice Setting Assignment.

Conclusion

U.S laws and policies tend to disfavor APRNs practice despite their critical role in bridging the gaps in healthcare provider shortage. Although different starts have varying levels of restriction on nursing care practice, it is evident that such restrictions could be counterproductive. The restrictive practice setting for APRNs is a complex and multifaced problem that requires objective and critical discussion to find solutions that would enhance primary care access while maintaining quality and safety. Outdated laws ought to be revised, while nurses must assume active leadership, advocacy, and political roles in advocating for fair and equitable legislation.

References

Houskova, M. (2018). Nursing Engagement in Policy Development and Advocacy.

Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N. (2022). Breaking Down Institutional Barriers to Advanced Practice Registered Nurse Practice. Nursing Administration Quarterly, 46(2), 137-143.

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), 74.

Perloff, J., Clarke, S., DesRoches, C. M., O’Reilly-Jacob, M., & Buerhaus, P. (2019). Association of state-level restrictions in nurse practitioner scope of practice with the quality of primary care provided to Medicare beneficiaries. Medical Care Research and Review, 76(5), 597-626.

O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). Political efficacy and participation of nurse practitioners. Policy, Politics, & Nursing Practice, 18(3), 135-148.

Spurlock Jr, D. (2020). The nursing shortage and the future of nursing education is in our hands. Journal of Nursing Education, 59(6), 303-304.

Wakefield, M., Williams, D. R., & Le Menestrel, S. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. National Academy of Sciences.

Analysis and Recommendations of Advanced Practice Nursing Issues

The purpose of this 5-6 page paper is to identify a critical issue that relates to population health and the role of the Advanced Practice Registered Nurse (APRN). Some examples may include removing barriers to nurse practitioners’ ability to practice, enabling APRNs to participate fully as members of hospital and medical staff. Additional examples are included on the American Association of Nurse Practitioners website.

Other sources for topic identification may include the Gerontological Advanced Practice Nurses Association and/or your local/state chapter of the AANP.

The expected length of the paper is approximately 5-6 pages, which does not include the cover page and reference pages. Lastly, review the Assignment rubric to ensure you have met the assignment criteria.

Submission Parameters:

Please use the following as a guide for drafting your 5-6 page paper.

1. Introduction (including purpose statement)
2. Contextual analysis of the issue

o          Provide a brief summary of the historical development of the issue

o          Provide a brief summary on the socio-political influences

3. Literature Review and Analysis on the selected issue

o          Identify at least 2 primary sources that examines the impact of the selected issue

4. Recommendations

o          Provide some recommendations to solve the issue

o          Determine how the recommendations may impact the APRN role/setting and practice dimensions

5. Conclusion

 

In regards to APA format, please use the following as a guide:

• Include a cover page and running head (this is not part of the 5-6 page limit)
• Include transitions in your paper (i.e. headings or subheadings)
• Use in-text references throughout the paper
• Use double space, 12 point Times New Roman font
• Spelling, grammar, and organization is appropriate
• Include a reference list (this is not part of the 5-6 page limit)
• Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. NCSBN, AANP) Analysis and Recommendations of Advanced Practice Nursing Issue of Restrictive Practice Setting Assignment