NR 510 Week 1: Barriers to Practice

NR 510 Week 1: Barriers to Practice

The barriers to APN practice that were identified in the article are state practice and licensure, physician related issues, job satisfaction, payer policies and not being allowed to follow patients who are admitted to acute care facilities (Hain &Fleck, 2014).

These barriers to me mean that APN are restricted in their practice. They do not get to practice to the best of their education. I do feel that in the beginning there does need to be some guidance from a physician. The barriers can cause dissatisfaction with the job because of the amount of control taken from the APN regarding their decisions with their patients. This should be done in the first five years or so of practice. This would give the ANP the guidance needed while caring for patients. These barriers also mean the ANP does not get the same compensation as does a physician and payers will not pay at the same rate as they would for a patient being seen by a physician.

These barriers are not new to me nor do they come as a surprise. I have spoken with a few FNPs who have mentioned the fact that they are restricted to a certain extent. When working in the emergency room a lot of times the APNs would only be allowed to work on the lower acuity patients. In the event that there was someone who ended up being a higher acuity the APN would have to go to the physician for their opinion. This I did not see as a bad thing. It is always good to have the extra resource which can provide an additional set of eyes and knowledge for a situation. These restrictions do not concern me currently. I feel my motivation is seeing how certain physicians welcome the APN and are willing to work with them. Many I have seen give the APN more room to do their thing once they gain confidence in the APN.

These barriers do represent restraint of trade. They do not allow the APN to see patients and prescribe medications without restrictions. They have rules and regulations that restrict them and only allow them to practice in certain ways.

Nurses can influence these barriers by forming organizati0ons to appeal to their states about the way they are allowed to practice. To do this they will need to research and provide data stating the care they give, and the care given by physicians. They will need evidence about practices to be able to change the minds and get regulations changed. This will not be an overnight process, so they will also need to be willing to commit to making a change over years.


NR 510 Week 1: Barriers to Practice Reference

Hain, D., & Fleck, L. (2014, May). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, Vol. 19, No. 2, Manuscript 2, doi: 10.3912/OJIN.Vol19No02Man02

The barriers identified in the articles include state practice licensure issues, physician related issues, payer policy issues, and prescriptive issues (Hain, Fleck, 2014). These issues do not come as a surprise as physicians have dominated the medical field for a very long time. It is the same concept to the work field with male dominance and women fighting for equality. We have been living in a world that aims to maintain dominance, we are seeing it today in the financial world with the United States and their protectionist views by implementing trade tariffs. If we go all the way back in time, there has been wars and attempted genocides to ensure one’s beliefs dominate the world. So, for physician dominance to occur in the medical field is not a surprise to me. On the positive note, we do have organizations that fight for nurse practitioner equality in the medical field such as the American Association of Nurse Practitioner (Hain, 2014).

I believe these barriers are occurring naturally in a world that aims to maintain dominance. But we live in a time where change needs to occur, because the fact is we are short in primary care physicians in an aging population and a work force that will be reduced with baby boomers retiring, which will only add to the shortage in primary care physicians in a world where people are requiring more medical attention. The healthcare cost is also increasing at such a fast rate, where it will not be sustainable in the future. I believe these restraints will be resolved. The main driver of this resolution will be cost.

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NR 510 Week 1: Barriers to Practice Reference:

Hain, D., & Fleck, L. M. (2014). Barriers to NP Practice that Impact Healthcare Redesign. Online Journal Of

NR 510 Week 1 Barriers to Practice

NR 510 Week 1 Barriers to Practice

Issues In Nursing19(2), 5. doi:10.3912/OJIN.Vol19No02Man02

I am aware of patient barriers. My father had an MI a few years back and he was following up with a cardiac NP for his routine follow up appointments. At first he was skeptical of his treatment plans and knowledge in medicine. I had to educate him and inform him that NPs are knowledgeable and are fully educated with medicine as much as doctors. They might even be more compassionate with patients, which can greatly improve their care. I provided him examples and had him rethink some of his past experiences with doctors on how some of them lack compassion. After this he was able to compare the difference and he did mention how the NP actually talks to him like a regular person and explains things in ways where he can understand.

I believe educating the population is extremely important to break these barriers. The population is not informed of the education NPs have to achieve in order to become providers. One way to do this is to inform the population with research in how effective NPs can be in treating common and chronic illnesses. Throughout this NP program, I have come across many scholarly articles that proved NPs are more effective in managing chronic illnesses compared to MDs, such as diabetes mellitus type 2. Therefore, we must do a better job in educating the population in the role of NPs and the extensive education and training they go through to become providers.

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.


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.

NR 510 Week 1: Barriers to Practice 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.


NR 510 Week 1: Barriers to Practice 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.

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.

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.