Research Paper on Advanced Practice Nurses: Enhancing Access, Cost, and Quality

Introduction

The role of the Advanced Practice Nurse (APN) is increasingly developing with additions that have recently introduced unique aspects of the practice such as facilitating access to health care, establishing avenues for cost-cutting in the administration of health care and ensuring that quality standards are enhanced in their mandate as APNs. To this end, continuous assessment and improvement of access, cost, and quality prove critical in enhancing the overall quality environment in the health care delivery system. A discussion on recent APNs quality initiatives associated with cost, access, and quality improvements with regard to quality measures and improvements in relation to APN's role development is presented as under.

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Girouard, DiFusco, and Jennas (2018) acknowledge the role of the APN in continuous quality improvement where knowledge and skills are transferred into actionable deeds with the intent of affecting changes that improve outcomes for individuals, patients, groups, and society at large. The APN has a mandate of making such a change reality through evidence-based practice where it is the responsibility of the APN to test and articulate performance metrics whether it is on cost, quality or access evaluations. The APN's role is to find means through which performance improvements can be attained. According to the Institute of Medicine (2011), "nurses should practice to the full extent of their education and training" (p. 85). Further, that scope of practice should extend to their experiences in the line of work where it is imperative that APNs evaluate their work experiences for various problems arising and consider solutions to the same.

As leaders in their craft, APNs are expected to develop a vision that serves to develop strategies and a well-thought-out plan that will direct teams towards the attainment of future goals (MIddleton, 2011). With the cost implications of health care forming debate in various circles such as employers who are concerned about the cost of health insurance coverage for staff and patients who also are concerned about the cost of health insurance. Nurses also should evaluate the costs of health vare vis-a-vis the implications that arise as pertains to the quality of health care arising from such costs. Afrikhanova (2017) conducted a study on the impact of nurse practitioner scope-of-practice regulations and found that most Staes in the USA allow APNs to carry out roles of physicians due to lack of sufficient numbers of physicians in the healthcare sector.

Consequently, the cost of health care has come down owing to the fact that nurses, unlike physicians, charge patients lower rates when compared to the billings of physicians (Afrikhanova, 2017). Notably, the goal of quality measurement and evaluation is linked to the APN's ability to determine cost efficiency, access and quality of health care as attributes or indicators of quality improvements (Girouard, et al., 2018). Towards that end, it is the mandate of the APN to consistently evaluate the structures and processes used in the delivery of health care for the purpose of performance measure evaluations. Ultimately, gauging the performance level can with effect reveal areas of weakness that require adjustment for the attainment of improved performance levels. MIddleton (2011) notes that as nurse leaders, one of the qualities of leadership is reflection where a thoughtful review of actions is done in a meditative approach to improving outcomes in future attempts.

Access to health care is concerned with the facilitation of patients in obtaining health-related services and that has a lot to do with insurance coverage (Girouard, et al., 2018). As an information gatherer, the APN has an important role in providing patients, employers, and other interested parties with information about insurance coverage that is most effective to suit their needs (MIddleton, 2011). The Institute of Medicine (2011) notes that the Affordable Care Act (ACA) has provisions for insurance coverage that appeal to different patients' needs and specifications. Arming oneself with information regarding ACA can assist patients secure desired health insurance covers. The mandate of the APN, therefore, extends to conducting research about the available health insurance packages in the market and providing such information to patients who need it to cater to their health care needs. Middleton (2011) adds that as an evolving role of the APN, offering policy suggestions to government regarding health insurance is also relevant in advancing cost-effective health care.

Aside from facilitating cost-effective health care, it is also important that the APN provides quality health care to patients. To this end, quality is measured by how well services improve outcomes of treatment (Girouard, et al., 2018). Therefore, the APN's role in facilitating the realization of quality standards requires that he or she should be in a consistent process of measuring quality outcomes for evaluation, review, and adjustment purposes. Such practices include evaluating the patient's satisfaction levels with the quality of the services received in the health care delivery process (Institute of Medicine, 2011). Afrikhanova (2017) adds that quality measurement proves key to process improvement in the delivery of patient satisfactory health services. Girouard, et al., (2018) stipulate that the role of the APN in quality improvement extends to the enhancement of the quality of health for the community at large where the APN investigates challenges in the community with health care and makes deliberate steps towards initiatives that tend to address the same challenges.

The all-encompassing responsibilities of an APN in the modern quality assurance environment pertain to the APN's active role in the assessment of facilities, individual as well as other's performances, and gauging these against set standards of practice for recommendations regarding improvement (Girouard, et al., 2018). Further, the APN has the mandate to gather data, analyze it, and inform stakeholders regarding the need for quality improvement in health care delivery services. To the patient, insurer, and purchaser of health coverage, the APN has the mandate to provide information on choices available for insurance coverage (Institute of Medicine, 2011). In addition, the APN has the mandate to identify performance levels among fellow staff and point out opportunities for rewarding exemplary performance as well as sharing knowledge of the best practice (Afrikhanova, 2017). All these efforts drive quality, cost, and access improvement efforts forward for the purposes of enhancing patient care outcomes.

Conclusion

Conclusively, the role of the APN in the quality enhancement environment is a dynamic and unpredictable one considering the changes taking place on policy concerns surrounding cost, access, and quality of health care (Afrikhanova, 2017). To that extent, the APN must also be flexible and cognizant of the changes that are needed to effectively drive the focus of quality healthcare services delivery upwards. Through executing the responsibilities discussed herein, the APN will position himself or herself appropriately to respond to the cost, access, and quality needs of the health care and in-turn improve the standard of health care offered to patients as discussed.

References

Afrikhanova, A. (2017). The impact of nurse practitioner scope-of-practice regulations in primary care. Santa Monica, California: Pardee Rand Graduate School.

Girouard, S., DiFusco, P., & Jennas, J. (2018). Chapter 24 Measuring advanced practice nurse performance: Outcome indicators, models of evaluation, and the issue of value. In L. A. Joel, Advanced practice nursing: Essentials for role development (pp. 366-386). Philadelphia, PA: F.A. Davis Company.

Institute of Medicine. (2011). 3 Transforming practice. In The future of nursing: Leading change, advancing health (pp. 85-112). Washington, DC: The National Academies Press.

MIddleton, J. (2011, 08 24). Leadership skills for nurses. Nursing Times, pp. 1-34.