Nurse Practitioners: Supporting Health Demands of the Population - Essay Sample

Introduction

Primary care professionals have been at the forefront of developing effective preventive and health promotion interventions to reduce the morbidity and mortality of many health problems facing the population. Nurse Practitioners (NPs) assist with the most frequent health problems in primary care, with an abundant demonstration of the quality provided and the global cost-effectiveness (Peterson, 2017). The need for NPs is justified by the increasing health demands of the population. However, various barriers exist which limit their capacity to practice both at the national and state levels, making access to quality care a major problem for patients. This paper explores ways of overcoming barriers to NP practice to improve the quality of preventive care. Nurse Practitioners possess a wealthy set of skills, knowledge, experience, and qualifications to provide healthcare needs to the majority population and improve preventive care.

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Barriers to Practice

One of the main barriers to NPs practice is the lack of adequate legislation by regulatory government agencies in updating existing laws to modernize health care (Poghosyan et al., 2016). The American Association of Nurse Practitioners (AANP) has observed two restrictions to nursing practice in several states; a reduced practice where NPs are only allowed by law to handle selected roles through a collaborative arrangement with an external health discipline; and restricted practice where the NP is restricted to various roles under supervision or care team (Peterson, 2017). These regulatory restrictions negatively impact on the ability of these professionals to provide preventive care services in an otherwise underdeveloped healthcare system.

Another barrier to NP practice is the dominant professional culture, professional motivation, the degree of development of professional practices and the theoretical conceptualization that supports them. Culture can be understood as the values perceived within an organization (Poghosyan et al., 2017). In any health center, different cultures (especially based on professional practices) can be identified which are defined in two profiles or models: biomedical and care. Community nursing where preventive care is based is identified with the care model. The dominant culture within many organizations places NPs specific contributions are secondary, restricting their capacity to offer more services in preventive care.

Most nurses have elaborated their professional being, identifying with the biomedical model which not only has been and is hegemonic within the health system but on many occasions was the only one they were able to know (Stankovic, 2017). In daily practice, the biomedical model assumes the predominance of delegated activities of medical diagnosis and treatment, over the care and health promotion, materializing in a very clear result: a lower offer of nursing services at the level of a certain professional. The reality of the centers shows the great capacity of assimilation that this professional conception has, or its consequences, in front of the new generations of professionals, as a factor of opposition to professional development (Poghosyan et al. 2017).

The prevailing reality in the public administration, which is the main employer of the nursing workforce also discourages professional motivation among NPs (Williams et al., 2019). The difficulty of implementing an adequate incentive policy (both positive for the compliant and negative for the non-compliant), if not non-existent, means that everyone receives the same compensation even if they perform a different job, and therefore those who perform the most over time get demotivated. Both factors, culture, and motivation act synergistically: in a work context where everyone earns the same at the end of the month, where there are strong pressures for imposed uniformity (due to a misinterpretation of the constitutional principles of equality, merit, and capacity, which are reduced to equality by the minute), the easiest option is represented by the aforementioned biomedical model (Stankovic, 2017).

Molina-Mula et al. (2018) asserted that for those professionals who choose to work more in exchange only for their satisfaction, the comparative grievances of the indolent system will take care of changing their minds over time. This synergy is one of the keys that explain the aforementioned assimilation capacity of the "easy option" compared to new professionals. To this situation is added the "power anorexia" of nurses, understanding power as the ability to influence ethical decision-making related to the care of its users (agency relationship) and political decisions. According to these authors: "nurses are not aware of their power, or underestimate it, in such a way that they end up lacking it. When nurses give up using their power, for the benefit of other professional classes, they are limiting the quality of the care their patients receive (Molina-Mula et al., 2018).

Overcoming Barriers to Practice

The health reform has meant a resurgence of nursing in Primary Care (PC) especially. Different national and regional regulations create the necessary conditions for professional development: an increase in staff, new functions, new areas of work, new forms of organization, and introduction of new figures of facilitators in the new organization chart (directors, coordinators, and nursing assistants), etc. (Moore, 2017). The World Health Organization and the demands of the users and of various professional groups (among which was a sector of nursing) have recommended reform guidelines that ensure that the new functions of the nursing profession (prevention, promotion, and health education are considered a priority in the delivery of care.

From a conceptual point of view, the new professional functions of the nursing community in PC were concretized in the passage from a situation characterized by the performance of delegated and collaborative tasks, focused on the assistance and healing of the individual, to another in which, in addition to the above activities, functions related to care and health promotion appear at an individual, family and community level (Bell et al., 2018). Caring for individuals and families appeared as the main element of nursing work, fundamentally in its aspect of self-care, as a way to train individuals and families in the management of their health decisions, in the solution of their care needs and in the way they adapt and respond to a health-disease situation or a specific life stage, encompassing not only attention at the biophysiological level, but also at the psychological and social level (Poghosyan et al., 2017).

The most significant strategy of overcoming the barriers to NP practice is for the health system to be able to discriminate between professionals based on performance and their contribution to healthcare. In this sense, tools such as management by competencies, the introduction of variable tranches based on performance and the development of a more real and agile policy of sanctions, are and will be quite useful, provided they are not diluted by the inertia of the system or the interests of the different power groups (for different reasons: maintenance of the status quo, the aforementioned equality poorly understood, etc.), being converted into small annotations to the margin that does not vary the main script (Stankovic, 2017).

Already from the perspective of community nursing and preventive care, it is clear that its viability as a project depends, ultimately, on its ability to solve problems for the people, families, and communities it serves, and from the professional point of view to the extent that that is identified with care as a professional differentiating element. Based on these premises, a series of strategies are necessary to improve professional practices, reorient certain services already established and achieve an adequate "sale" of the profession to those who finance it, direct or use their services (Brom et al., 2018; Moore, 2017; Poghosyan et al., 2017; Williams et al., 2019):

The promotion of home care: We have previously seen that home care is being and will be one of the fastest-growing care modalities in preventive care. Also, it has all the necessary elements for adequate social recognition of the profession (need felt, well-valued by users). For its proper development, apart from the organizational measures already mentioned and other issues, it is necessary to rationalize the nursing consultation, as well as to carry out a reanalysis of nursing activities, eliminating those that do not add any value. With all this, it is possible to "free up" time to dedicate to home care. It is also necessary to continue enhancing its active and programmed nature.

Problem-oriented group health education: In addition to being essential, as already mentioned, the limitation of NPs group only for the solution of those problems where its effectiveness has been demonstrated is also necessary to use an approach oriented to specific problems as a way of improving the impact of the performances. For this, NP groups that have the purpose of solving problems should be aimed at users who have the same self-care problem (and not only the same pathology and sociocultural characteristics), and in them, a single problem should preferably be treated (diet, insulin self-injection, self-esteem, etc.). All this is in contrast to other approaches where users are included from the medical diagnosis, but with different and disparate problems.

User orientation in delegated activities: Users continue to evaluate and value the nursing community mainly for the delegated activities of medical diagnosis and treatment. This means that small improvements in the accessibility and comfort of common nursing services will have a great social impact and high professional profitability, which can and should also be used to transmit the professional value of care, eliminating stereotypes that are deeply rooted in the image of the nurse.

Social promotion strategies for community nursing: The best way to promote community nursing socially is by solving user problems. However, it is also necessary to demonstrate this social utility to the politicians who finance and regulate services, and to the managers who direct them. Therefore, the nursing collective must communicate and negotiate both with each other using their language: the effectiveness and efficiency of care. Professional scientific associations and societies play an important role in this work.

Conclusion

An analysis of the current scope of nursing practice allows the identification of the achievements and failures of healthcare provision in the context of growing health demands. Although professional advances have been important and irreversible in the field of care development as a differential element of the nursing profession and as the nucleus of the new offer of services, the general population continues to identify the nursing profession with the delegated activities of diagnosis and medical treatment, without being aware of the offer of care or demanding said offer. Unfavorable regulatory restrictions to practice for NPs means that healthcare is not very visible or accessible to those in need.

NPs have the skills to instruct about health in nursing interventions and, even more, to apply the knowledge of diverse teaching and learning modes with individuals, families, and communities; constantly evaluating learning and understanding of health practices to improve healthcare. The barriers to practice must, therefore, be lifted to fill on the demand for care and prevention services f...