NR 510 Week 1 dq 1 : Barriers to Practice Discussion

Read the assigned Hain & Fleck article, and discuss the following:

What are the barriers to APN practice identified in the article? Describe these barriers in your own words.
What are your impression of the barriers to APN Practice? (Are you surprised by these barriers? Is this new information to you? Have you ever been involved at the legislative level in nursing? Do these barriers concern you or motivate you toward becoming an APN?)
Do these barriers represent Restraint of Trade? Why, or why not?
Your thoughts on how nurses can influence these barriers.

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Sample Answer for NR 510 Week 1 dq 1 : Barriers to Practice Discussion

The purpose of this essay is to look at various obstacles APNs encounter both within New Jersey and nationwide and why it is necessary to tackle them. Advanced Practice Nurses (APNs) are highly educated healthcare professionals with advanced degrees and specialized nursing experience who provide quality healthcare to underserved areas in the US (Brom et al., 2018). APNs play an invaluable role in delivering this vital service. However, despite their significant contribution, APNs in New Jersey and across the nation often face numerous barriers to practice ranging from legal constraints and limited scope of practice to insufficient reimbursement of services provided and limited resources and technology access. Addressing APN challenges through policy and advocacy efforts is imperative to ensure they can effectively contribute to improving access to quality healthcare for all patients.

Practice Barriers

Nurse midwives must work under physician supervision, which delays care delivery and adds unnecessary costs. Nurse anesthetists face restrictions in providing anesthesia independently, while nurse practitioners may be restricted in prescribing certain drugs and must enter collaborative practice agreements (Schorn et al., 2022). Clinical nurse specialists may be limited in their ability to deliver certain services and have limited job prospects, creating delays in care, higher healthcare costs, and reduced patient access to services. It is essential to address these obstacles so they can provide high-quality patient care.

Competition

APNs face several forms of competition that impede their ability to practice independently, particularly from physicians and physician assistants. Physicians tend to be seen as leaders within healthcare, possessing more resources and influence than APNs themselves (Schorn et al., 2022). Furthermore, some may view APNs practicing independently as an attack on their authority within healthcare systems and might resist APNs being independent providers altogether.

Interest Groups

Numerous interest groups influence APN policy at both state and national levels. These include professional nursing organizations, consumer advocacy groups, and healthcare organizations. Professional nursing organizations like the American Association of Nurse Practitioners and the National Association of Clinical Nurse Specialists advocate for policies to promote Advanced Practice Nurse (APN) practice while removing practice barriers posed by APNs. Furthermore, these organizations aim to raise awareness regarding its significance and expand its scope. Consumer advocacy groups such as the American Consumer Institute and AARP also play an integral role in shaping APN policy. These organizations lobby for policies that ensure access to high-quality healthcare at an affordable cost, including practices like APNs. Their advocacy helps ensure patients receive the care they require regardless of location or financial circumstance. Healthcare organizations such as hospitals and insurance companies also play an integral role in APN policy development. These entities may support policies that expand APN practice to increase access and decrease healthcare costs; conversely, they could oppose expansion due to concerns regarding quality, liability, or financial considerations.

Lawmakers and Interest Groups

Lawmakers play an integral part in shaping APN policy at both the state and national levels. Key figures within New Jersey’s legislative and executive branches that shape policy for APNs include Governor Phil Murphy, Senate President Edward Durr, and Assembly Speaker Craig Coughlin.

Methods of Influencing Policy

APNs and their supporters can employ various means to sway policy change, such as lobbying lawmakers, organizing grassroots campaigns, advocating for reimbursement policy changes, or simply informing the public and lawmakers of their role in healthcare, benefits provided to patients by APNs, and need for policy modifications that remove obstacles to practice (Eden et al., 2021). By using these processes to initiate change, APNs can contribute to improving healthcare provision in the U.S.

Conclusion

Advanced practice nurses face numerous practice barriers that impede their independence both in New Jersey and across the US, such as restrictions on their scope of practice, educational and certification requirements, collaborative practice agreements, competition from other healthcare providers, and legislative advocacy. Through effective advocacy and education efforts, APNs and their supporters can work to remove these obstacles to increase access to high-quality health services for patients.

References

Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120-130. https://doi.org/10.1097/jxx.0000000000000023

Eden, L. M., Merrill, H., & Luthy, K. E. (2021). Empowering nurse practitioners to make health policy CHANGE: Steps to successful passage of legislation in Utah. Journal of the American Association of Nurse Practitioners, 33(12), 1254-1260. https://doi.org/10.1097/jxx.0000000000000561

Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a national survey: Ongoing barriers to APRN practice in the United States. Policy, Politics, & Nursing Practice, 23(2), 118-129. https://doi.org/10.1177/15271544221076524

Sample Answer 2 for NR 510 Week 1 dq 1 : Barriers to Practice Discussion

I agree with you that I had not know many barriers that existed for NP’s despite me studying nursing for 4 + years and working as one for 8 years. You made some great points in your post that NP education and scope of practice should be on the same page with all the States and should be largely mandated by legislation. There is some variations within schools of what is included in the FNP programs, however, accredited such as Chamberlain University follows the recommendations set forth by The Essentials of Master’s Education in Nursing(2011). The literature calls for a evolutionary change in graduate education in efforts to best prepare nurses for higher knowledge and leadership skills. I feel that legislative does set basic requirements such as accreditation and requirements of passing advanced licensing tests, however, I feel it is up to academic institutions based on their own merit to seek proper delivery of education. I feel accrediting nursing boards should adopt the same principles, so education delivery systems follow suit. This was actually a key feature for me in choosing Chamberlain, knowing its philosophy, accreditation and how it prepares me to become an FNP.

An additional noteworthy comment that we have been reading about this week is the restraint of trade as you noted. I do feel like nursing lack of specific identity compared to the medical knowledge based model physicians have follow as a big restraint for us. The general population still lumps nursing into task based, rather than knowledge based. Further more, there is so many nursing models and theories that we have all learned throughout nursing school that it creates a vagueness and lack of census (DeNisco & Barker, 2015). The constant quest to find the balance between scientific expertise and a nursing theory paradigm has often left us not pursing a complete identity. I feel there needs to be a cultural shift adopted by hospitals to instill what theory they identify with and choose to treat there patients with. It does seem like an ongoing task that may not ever be clear.

Reference:

American Association of Colleges of Nursing. (2011). The Essentials of Education in Nursing. http://www.aacnnursing.org/Portals/42/Publications/MastersEssentialsLinks to an external site.

DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Retrieved from https://bookshelf.vitalsource.com

Sample Answer 3 for NR 510 Week 1 dq 1 : Barriers to Practice Discussion

I agree that one must reach out to all available resources when necessary, even if it is just a small question or thought. It is critical for medical professionals to see the full picture when it comes to diagnosing and treating patients, if that full picture includes consulting another provider it is pertitent all providers are not too proud to do so. An established nurse practitioner should be taken seriously and looked upon as a vital resource to ones co workers including physicians. A small study from Canada analyzed the referrals between physicians and nurse practitioners in a primary care setting showing 16% were made by NP’s to physicians and a minute 2% for physicians to nurse practitioners (Fatima, 2009). Nurse practitioners and physicians are trained differently and bring different positive assets to the team evaluating patients and physicians must become more aware of everything they have to offer.

Faria, C. (2009). Nurse practitioner perceptions and experiences of interprofessional collaboration with physicians in primary health care settings (Order No. MR65171). Available from ProQuest Dissertations & Theses Global. (760998386). Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/760998386?accountid=147674

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NR 510 Week 1 dq 1 : Barriers to Practice Discussion