Advanced Practice Nurses: Primary Care Status & Barriers - Essay Sample

Introduction

Laws, regulations, and policies every advanced practice nurse should be familiar with to remove barriers to achieving primary care provider status.

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In many nations across the globe, nurse practitioners and certified nurse midwives fight to achieve primary care provider status yet the government should permit them full practice so as they can meet the primary needs of healthcare. These nurses could build a strong workforce that can contribute their unique talents and skills to the community and patient-centered care (Altman, Butler & Shern, 2016). However, there are laws, policies, and regulations that these nurses need to be familiar with so that they can remove the barriers that prevent them from achieving their ambitions. Some of them include state laws, institutional practices and culture, outdated insurance reimbursement, and federal laws (Buppert, 2017). State laws are interpreted by Congress or legislature and its application is determined by the judicial system. These laws and policies may not have a force of law but they dictate daily decisions. Citizens including nurses have limited ability to make changes or influence these rules.

Healthcare institutional at the same time have practices and culture that allows application of rules and policies, which at many time limit nurses from achieving primary care provider status. Nurses should, therefore, be aware that these laws and policies are implemented by executive branch managers and they may influence activities of federal and state agencies. By being familiar with these procedures, they can develop some efforts to change the scope of practice laws, policies, and regulations (Buppert, 2017). Nurses can also track policies such as the use of outdated insurance reimbursement, which restricts their practice and negotiate with the relevant authorities so that they can remove the barriers that limit their practice.

How APNs Can Address Barriers to Achieving Primary Care Provider Status Individually and Collectively

An APN as an individual is a trained nurse who can offer a variety of services following the level of education and training. He/she should, therefore, strive to remove or overcome the barriers by holding privileges such as prescription, which is important in giving drugs to patients and following them up to their homes (Brassard & Smolenski, 2011). Conversely, an APN should ensure that he/she is compliant with reimbursement laws and policies so that they can be given privileges of a full practice (Altman, Butler & Shern, 2016). This means that there will be a high propensity of following nursing policies and guidelines, which require them to abide by the principles of nursing practice.

Collectively, APNs can form an Action Coalition team, which will campaign for the elimination of barriers that restrict them from the full extent of achieving primary care provider status (Brassard & Smolenski, 2011). In addition, nurses who are limited from the full extent of practice can form APNs oversight team that is independent and different from nurse licensing board. This team will be helping to find evidence and common ground points that will contribute to the removal of restrictions hence guarantee nurses full practice. In contrast, all ANPs should collaborate and work towards finding new solutions to removing the barriers that hinder them from achieving primary care provider status.

How the Executive Leadership in the Health Care Sector Can Help to Remove Barriers to APRN Practice

Buppert (2018) recognized that NPs are affected by laws and regulations that hinder them from performing to their fullest scope of education and experience. These laws include; patient confidentiality, medical homes, compensation for referrals, requirements for collaboration, electronic medical records, and reimbursements. Scanlon et al., (2014) states that the hinderances to APRN practice in U.S. include differences in the fifty states on the scope of practice, prescriptive authority, and collaborative practice prerequisites. Executive leadership within the health care system has implemented the APRN Consensus Model (Scanlon et al.,2014). The model intends to foster standardization in licensure, accreditation, certification, and education across all the fifty states (Scanlon et al.,2014). It will help to standardize the APRN role by removing all the barriers that hinder them from performing the nursing practice.

Brassard & Smolenski (2011) asserted that the executive leadership within the health care system have proposed implementing active drives to enhance public cognizance and impact policy to eliminate limitations to practice. The National Council of State Boards of Nursing (NCSBN) has established a consensus model that will guide state boards on the implementation of APRN licensure, accreditation, certification, and education essential for APRN practice (Litchman, Schlepko, Rowley, McFarland & Fiander, 2018). It also helps to elucidate the legal scope of practice and precise roles for ARNs. The consensus model will enhance accessibility to safe quality APRN care across the fifty states of U.S (Litchman, et al., 2018). On the subject of reimbursements, the executives in the health care system are lobbying on behalf of APRNs for equal reimbursement for services offered by physicians instead of 85% fee-for-service offered (Buppert, 2018).The removal will foster the implementation of evidence-based care which aims at improving the quality, and patient outcomes instead of traditional "incident-to" billing.

Martsolf & Kandrack (2017) defined prescriptive authority as the scope to which an APRN can prescribe medications without supervision or collaborating physician. Prescriptive authority can differ from medication to medication. For instance, some states offer NPs general prescriptive authority but they do not permit them to prescribe narcotics without physician supervision or sign off (Martsolf & Kandrack, 2017). The executives now want those states that permit prescriptive authority for NPs and APRNs to let them diagnose and administer drugs to patients without being supervised or collaborating physician (Martsolf & Kandrack, 2017). The proposed change will help to address the need for APRNs having collaborative agreements with physicians to scrutinize diagnoses and treatment and offer consultations (Martsolf & Kandrack, 2017).

The Ramifications of Specific Elements of Patient Protection and Affordable Care Act for APRN Practice

Most NPs and APRNs are cognizant of state-level regulations that impact their practice, and through their executives, they have been able to seek long term solutions. However, there are still some of them that are oblivious of the ways that federal guidelines impact NP labor force supply and the implementation of primary care (Carthon, Barnes & Sarik, 2015). A good example of such federal ramifications includes; the initiative enacted through the Patient Protection Act and Affordable Care Act that affect the NP and APRNs workforce (Carthon, Barnes & Sarik, 2015).

Carthon, Barnes & Sarik (2015) stated that the Affordable Care Act's authorization of augmented funding to back NP and APRN education and training provides a feasible solution to address the ramifications that affect their workforce supply and patient access. Nevertheless, they will need to resolve several concerns; where they will get funds to implement GNE demonstration tests to augment the number of NPs in order to solve NPs and APRNs workforce supply ramifications (Carthon et al., 2015). The second concern is reductions in financial support to Federally Qualified Health Centers (FQHCs) could reduce the increased access to care as planned by the ACA. The reduction in funding by the executives within the health care system made the new development to stall (Carthon et al., 2015).

The third ramification is access to care might also restrict to cuts in funding to Nurse-managed Health Clinics (NMHCs). It is a challenge since the ACA had previously authorized $50 million for the support and expansion of NMHCs, but only $15 million was essentially shared and divided across ten NHMCs (Carthon et al., 2015). ACA defines a primary care provider as "a clinician who offers integrated available health care services, and is responsible for solving most of personal health care issues of patients. They are supposed to do so by offering preventive and health promotion services (Arifkhanova, 2017).

References

Altman, S. H., Butler, A. S., & Shern, L. (Eds.). (2016). Assessing Progress on the Institute of Medicine report The Future of Nursing. Washington, DC: National Academies Press. Retrieved from: http://jonasphilanthropies.org/wp-content/uploads/2017/10/Assessing-Progress-on-the-Institute-of-Medicine-Report-The-Future-of-Nursing_Dec2015.pdf

Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N., Linda East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues impacting advanced nursing practice worldwide. Online journal of issues in nursing, 19(2), 1. Retrieved from: https://international.aanp.org/Content/docs/AddressingIssuesImpactingAdvNursPractWorldwide.pdf

Arifkhanova, A. (2017). The Impact of Nurse Practitioner Scope-of-Practice Regulations in Primary Care. The Pardee RAND Graduate School. Retrieved from: https://www.rand.org/content/dam/rand/pubs/rgs_dissertations/RGSD300/RGSD396/RAND_RGSD396.pdf

Brassard, A., & Smolenski, M. C. (2011). Removing barriers to advanced practice registered nurse care: Hospital privileges. Washington, DC: AARP Public Policy Institute. Retrieved from: https://assets.aarp.org/rgcenter/ppi/health-care/insight55.pdf

Buppert, C. (2017). Nurse practitioner's business practice and legal guide. Jones & Bartlett Learning.

Carthon, J. M. B., Barnes, H., & Sarik, D. A. (2015). Federal policies influence access to primary care and nurse practitioner workforce. The Journal for Nurse Practitioners, 11(5), 526-530. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596547/

Litchman, M. L., Schlepko, T., Rowley, T., McFarland, M., & Fiander, M. (2018). A scoping review of Advanced Practice Registered Nurses Consensus Model outcomes: Part four of a four-part series on critical topics identified by the 2015 Nurse Practitioner Research Agenda. Journal of the American Association of Nurse Practitioners, 30(12), 710-723. Retrieved from: file:///C:/Users/User/Downloads/Litchmanetal2018AscopingreviewofAdvancedPracticeRegisteredNursesConsensusModeloutcomesPartfourofafour-partseriesoncriticaltopicsidentifiedbythe2015NursePractitionerResearchAgenda.pdf

Martsolf, G., & Kandrack, R. (2017). The Impact of establishing a full scope of practice for advanced practice registered nurses in the state of Indiana. RAND. Retrieved from: https://www.rand.org/content/dam/rand/pubs/research_reports/RR1800/RR1864/RAND_RR1864.pdf