Assignment 2: Health Policy Proposal Analysis (Policy Brief) NURS 8100

h their use and improve patient outcomes. Due to the side effects of SGA use, monitoring for MS is critical in any healthcare setting. Adding the screening and monitoring tool to the patient electronic health record is recommended if the rates of screening and monitoring for MS will improve. In addition, the mental health facility should explore the option of including automatic reminders of monitoring for MS. The reminders will prompt the clinician when the annual labs are due and enable them to adhere to the recommended guidelines.

Follow-up calls to patients by case managers to remind them of the importance and need of getting the blood work done can also improve the screening rate. In addition, integrating laboratory services within the mental health care services can be convenient to the patients and thus improve compliance of getting the lab work done. Lastly, integration of primary care services in the same building with mental health services can foster compliance for monitoring for MS and facilitate close follow-up of patients identified at risk by healthcare providers. Failure to screen patients before putting them on medication leads to the omission of a critical component in screening and monitoring for MS among the adolescent population. This omission leads to a lack of early identification of those at high risk for MS(Wakefield et al., 2018). The chosen project highlights the substantial gap in adherence to screening for MS. The gap displays the laxity among health care providers in screening and monitoring for MS, despite its prevalence. This DNP scholar recommends a screening and monitoring tool that can improve screening and monitoring of MS among the adolescent population. After implementing the screening tool, the screening compliance improved, emphasizing the intervention involved. Many adolescent patients prescribed with SGA are not routinely screened for MS following the best practice recommendations. The screening rates in the pre-intervention period highlight the laxity in screening and monitoring for MS among these patients. Therefore, it is safe to say that the screening and monitoring tool can increase screening rates for MS. This project has highlighted the importance of proper screening and monitoring for MS among adolescent patients for early management and referral. After reviewing the gap in practice with the stakeholders, I will use email, phone calls, reminders to help with their sensibilization(Lee et al., 2020).

References

Lee J,Dalack GW, Casher MI, Eappen SA, Bostwick JR.(2020).Persistence of metabolic monitoring for psychiatry inpatients treated with second-generation antipsychotics utilizing a computer-based intervention.

Wakefield S, Aligeti M, Rachamallu V, Baronia R, Aynampudi R, Parmar A, Peterson P, Masodkar K(2018). Metabolic Monitoring of Child and Adolesc

Sample Answer 2 for Assignment 2: Health Policy Proposal Analysis (Policy Brief) NURS 8100

A policy brief is a vital tool used to present research findings and recommendations to an audience with no specialization in the policy matter. Policy briefs offer evidence-based policy recommendations to help legislators make informed decisions (Arnautu & Dagenais, 2021). A strong policy brief incorporates research findings supporting the recommended policy and draws clear connections to policy initiatives. Therefore, it should be clear and concise to ensure the target audience adequately understands the recommendations. This paper presents a policy brief on the recommendation from the Institute of Medicine (IOM) report.

Selected Recommendation

The selected IOM recommendation is: “Nurses should practice to the full extent of their education and training.”

Background

The IOM recommendation emphasizes the need to transform nursing practice. The report encourages lawmakers to be guided by the Nursing Practice Act and Administrative Rules to amend state nurses’ scope-of-practice laws. Advanced Practice Registered Nurses (APRNs) are highly trained and competent to provide a wide range of healthcare services. However, they are limited by barriers, such as federal policies, state laws, obsolete insurance reimbursement models, and organizational practices and culture (Sullivan, 2018). State and federal initiatives are needed to update and standardize APRNs’ scope-of-practice regulations to capitalize on their specialized education and full capacity. Furthermore, the IOM report states that APRNs need to be allowed to practice to the full scope of practice. This will ensure that all citizens can access essential healthcare services and that organizations make the best use of the APRNs’ unique contributions to the healthcare team.

Insurance providers and States should create specific policy, regulatory, and financial changes that offer patients the freedom to choose from a range of health providers, including APRNs, to best, meet their healthcare needs (Sullivan, 2018). Eradicating regulatory, policy, and financial barriers to increase patient choices and patient-centered care is critical in creating a reformed health care system.

Current Characteristics

The scope of APRN practice varies with the state. The American Association of Nurse Practitioners (AANP) defines three types of practice authority for APRNs: Full, Reduced, and Restricted practice. APRNs practicing in states with Full practice authority are authorized to practice to their full scope of training, including evaluating, diagnosing, ordering and interpreting diagnostic tests, and prescribing treatments (AANP, n.d.). The state board of nursing gives them exclusive authority to practice to their full scope. Currently, 24 states in the U.S and its territories have adopted Full practice licensure laws. NPs practicing in states with a reduced practice are allowed to participate in at least one element of the NP practice. However, they are regulated by a collaborative agreement with a physician (AANP, n.d.). Physician oversight is needed for the NP to prescribe treatment. Sixteen states currently have the reduced practice.

There are 11 states with a restricted practice whereby the state board of nursing mandates APRN supervision or delegation of duties such as diagnosing and prescribing by a physician. Texas lies at the lower end of the spectrum with regards to the freedom it offers APRNs. One of the barriers to expanding APRNs’ scope of practice has been opposed by some physicians and physician organizations. Some physicians argue that APRNs are less competent to provide the services outlined in their scope of practice since they do not undergo rigorous training like physicians (Sofer, 2018).

The Impact of the Recommendation

Patients perceive that the recommendation on the full scope for APRNs will increase their access to essential health services, especially in rural areas where there are few physicians and APRNs are usually the primary care providers. Currently, the country faces a shortage of primary care physicians, especially in rural and underserved areas (Ortiz et al., 2018). However, there is also an ample supply of specialists, which increase health care expenditures since specialist charge more expensively than primary care physicians. In addition, healthcare consumers perceive that the recommendation will lower the cost of healthcare. This is because full practice authority lowers duplication of services and billing costs caused by the outdated physician oversight (Ortiz et al., 2018). Besides, full practice decreases the unnecessary office visits, repetition of orders, and treatment services.

Nurses and professional nursing organizations argue that if all states allowed APRNs to practice to the full scope of their education and training, it could increase the workforce needed to meet the country’s primary care needs. APRNs would also contribute their specialized knowledge and skills to delivering person-centered, community-based health care (DePriest et al., 2020). Physicians believe that granting APRNs full practice will reduce their workload and increase access to care for patients living in underserved urban and rural areas. This is because states with full practice authority have many NPs working in the rural and underserved areas, which increases access to healthcare. Nevertheless, some physicians perceive that the recommendation will negatively impact patient care due to the lack of rigorous medical training for APRNs (Sofer, 2018). Various organizations, such as the Kaiser Family Foundation, argue that APRNs could help meet the demand for primary care. They argue that APRNs’ full practice can help meet the demand for primary health care, which is increasing due to a growing aging population (DePriest et al., 2020). Besides, increased access to health care through the Affordable Care Act increases the population in demand for care, and APRNs can help bridge the gap.

Current Solutions

The current solution to having nurses to their full extent is advocacy. Many professional organizations are lobbying to remove barriers that limit APRNs from working to the full extent of their education and training (Peterson, 2018). NP organizations in various states have engaged lobbyists to help bring the advocacy efforts to the front line of policymakers. The lobbyists are educating policymakers on what APRN full practice entails. They clarify that it is not a policy against physicians but rather one that seeks to provide patients with access to quality care (Peterson, 2018). The Campaign by the Future of Nursing is one approach taken to lobby for APRNs to practice to their full scope in states with reduced and restricted practice. Furthermore, the National Council of State Boards of Nursing (NCSBN) monitors the practice roles and bills related to APRN practice to keep APRNs informed of their lobbying efforts.

Current Status in the Health Policy Arena

A report from The Campaign shows that APRN practice authority has expanded significantly since the release of the IOM recommendation report. After the release of the IOM report, 44 state Action Coalitions worked on the recommendation to get rid of barriers in the APRN scope of practice. Besides, 13 states have passed laws granting APRNs full practice authority (Sullivan, 2018). Since the Campaign’s commencement, eight states amended their laws to grant APRNs full practice and prescriptive authority. Furthermore, some states with reduced and restrictive practices have improved their laws to be less restrictive (Sullivan, 2018). For instance, Florida (reduced practice) passed a bill that requires PMHNPs to practice for the first two years with supervision and then practice to the full scope of their licensure.

Conclusion

The IOM recommendation on allowing APRNs to practice to the full scope of their education and training will increase accessibility to healthcare and lower costs. The health care environment is continuously evolving with an increasing demand for healthcare services from the aging population. Thus APRNs’ full contribution to the health care team is essential. Tremendous progress has been made toward decreasing restrictions on the APRN scope of practice across the U.S. States. The states with restrictive and reduced APRN practice are increasing APRNs’ potential to contribute fully to health care. However, more efforts are needed to hasten the amendments of the obsolete policies. We need more states to grant full practice authority to APRNs as primary care providers. 

References

AANP. (n.d.). Issues at a glance: Full practice authority. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief

Arnautu, D., & Dagenais, C. (2021). Use and effectiveness of policy briefs as a knowledge transfer tool: a scoping review. Humanities and Social Sciences Communications, 8(1), 1-14. https://doi.org/10.1057/s41599-021-00885-9

DePriest, K., D’Aoust, R., Samuel, L., Commodore-Mensah, Y., Hanson, G., & Slade, E. P. (2020). Nurse practitioners’ workforce outcomes under the implementation of full practice authority. Nursing Outlook, 68(4), 459–467. https://doi.org/10.1016/j.outlook.2020.05.008

Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare6020065

Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

Sofer, D. (2018). AMA Resolution Opposes Independent Practice by APRNs. AJN The American Journal of Nursing, 118(3), 12. doi: 10.1097/01.NAJ.0000530922.33715.46

Sullivan, T. (2018). Institute of Medicine Report, The future of nursing: leading change, advancing health. Policy and Medicine.

Sample Answer 3 for Assignment 2: Health Policy Proposal Analysis (Policy Brief) NURS 8100

The unpredictability of scope-of-practice regulations across states may hinder advanced practice nurses from giving care they were trained to provide and contribute to innovative health care delivery solutions. Though most nurses are registered nurses, over a quarter million are advanced practice registered nurses (APRNs), who hold master’s or doctoral degrees and have passed national certification examinations. APRNs include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. Although some states have regulations that allow nurse practitioners to see patients and prescribe medications without a physician’s supervision, most states do not. The federal government is well suited to promote reform of states’ scope-of-practice laws by sharing and providing incentives for the adoption of best practices (IOM, 2010).

First recommendation is to remove Scope of Practice Barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training. To achieve this goal, the committee recommends actions for the following entities: State Legislatures, Congress, Centers for Medicare and Medicaid Services, Office of Personnel Management, Antitrust Division of the Department of Justice, Federal Trade Commission, which has long sought to eliminate anticompetitive behavior in the health care industry, including restrictions on health care providers’ business practices and policies that could operate as a barrier to entry for new competitors (IOM, 2010).

In conclusion, the country has an opportunity to transform its health care system, and nurses are in the forefront and should play a critical role. However, the ability to improve current regulatory, business, and organizational conditions does not rest only with nurses; government, corporations, health care organizations, professional associations, and the insurance industry all have a role to play (IOM, 2010).

References

Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine

Report The Future of Nursing: Leading Change, Advancing Health; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine; Altman SH, Butler AS, Shern L, editors.

Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington (DC): National Academies Press (US); 2016 Feb 22. 2,

Removing Barriers to Practice and Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK350160/

Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future

of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health.

Washington (DC): National Academies Press (US); 2011. 1, Key Messages of the Report.

Available from: https://www.ncbi.nlm.nih.gov/books/NBK209881/