NURS 8100 Discussion: Policy Brief

Post in your small group thread a cohesive response that addresses the following:

• Briefly summarize the policy proposal you selected from the IOM Future of Nursing Practice Report Brief (Application 2). Based on your analysis of the policy proposal, did the IOM get it right?
• Identify any professional organizations dealing with the issue/recommendation and provide at least two specific ways in which the professional organizations have supported or could support the policy proposal/recommendation.

Read a selection of your colleagues’ postings.

Sample Answer for NURS 8100 Discussion: Policy Brief

The Institute of Medicine (IOM) recommendations asserted the need to transform the work environment, the scope of practice, education, and numbers of America’s nurses by creating a health care system that delivers the right care quality care, patient-centered, accessible, evidence-based, and sustainable at the right time (Peterson, 2017). The IOM noted that even though the APRNS possessed higher and improved levels of education and training, the healthcare industry was not tapping into their total capacity, education, and immense potential to lead innovative strategies. Despite meeting these national standards, the APRNS were denied full practice authority for reasons unrelated to their ability, education or training, or safety concerns, but due to political decisions, and inconsistencies in different state laws (AANP, 2021). The States and insurance companies were to follow through with specific regulatory, policy, and financial changes, to provide patients with the right providers, including APRNs who best meet their health needs. The removal of the regulatory policies and financial barriers with the goal to promote patient choice, and patient-centered care, was recommended as the needed base in the building of a reformed health care system (Stevens, 2013). In response to these recommendations, the Robert Wood Johnson Foundation, AARP, and the AARP Foundation all joined forces and created the Future of Nursing, a group, the Campaign for Action. The group worked in each state to catalyze nurses, health providers, consumers, educators, and businesses, to strengthen nursing in a variety of areas (Altman et al., 2016). The World Health Organization (WHO)  also impacted the IOM recommendations in March 2020 when it declared COVID 19 a pandemic, for which the entire world was unprepared. This disease disrupted organizations and systems worldwide, but caused the most rapid delivery system redesign and health policy implementation ever in American history, as twenty-two state governors temporarily waived the physician supervision of the NPs. This allowed them to practice to their fullest extent, to expand much-needed care access. “a multi-pronged liberalization of nurse practitioner scope of practice, ever unprecedented in the United States” (O’Reilly-Jacob, et al., 2022).

References:

Altman, S. H., Butler, A. S., & Shern, L, (2016). Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington (DC): National Academies Press (US); 22. 2, Removing Barriers to Practice and Care. Available https://www.ncbi.nlm.nih.gov/books/NBK350160/

American Association of Nurse Practitioners (2021). Issues at a glance: Full practice authority. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief

O’Reilly-Jacob, M., Perloff, J., Sherafat-Kazemzadeh, R., & Flanagan, J. (2022). Nurse practitioners’ perception of temporary full practice authority during a COVID-19 surge: A qualitative study. International Journal of Nursing Studies, 126, 104141. https://doi.org/10.1016/j.ijnurstu.2021.10414

Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

Stevens, K., (May 31, 2013) “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4.

Sample Answer 2 for NURS 8100 Discussion: Policy Brief

The Institute of Medicine (IOM) Future of Nursing Report Brief addresses four very important elements of nursing practice that are in need of change. According to Kershaw (2011), the four areas of needed change include nurses practicing to the fullest scope of their license, nurses engaging in seeking and attaining higher levels of education, nurses being considered as equals with their physician colleagues when taking the initiative to redesign health care, and nurses creating a foundation of data through research and evidence-based practice to support policies and procedures in nursing practice.

The area of specific interest to me is item number three. This initiative focuses on nurses becoming full partners with physicians when redesigning healthcare in the United States (Kershawm 2011). The reason this initiative is important to me is that I work in an acute care setting where physicians are still revered as gods by the hospital leadership and nurses are considered the handmaiden to the physician. It is a large hospital but set in a rural community and the founding fathers who opened the community hospital 16 years ago (Now part of a larger system) were very physician-focused. The bylaws do not promote employing mid-level practitioners, they do not recognize that certified nurse-midwives can practice independently, and have a strong working relationship with a Kaiser Permanente group that feels very threatened by the thought of utilizing mid-level providers and advance practice nurses (APNs). According to Abraham et al. (2019), APNs are far more cost-effective than physicians, and they increase patient experience scores and clinical outcomes. Constable et al. (2022) describe an increase in provider communications scores from 69% to 85% when APRNs were used in the acute care setting. This specific article also outlined a reduction in endotracheal tube-associated pressure injuries by 50% because of the care the APN provided to this population. The reason for this is that APNs are trained to treat patients holistically and not be solely focused on a diagnosis or disease. Physicians are trained with a primary focus on disease. Collaboration between these two groups is essential when health care reform is being considered.

The IOM report brief nailed this issue on the head. There is a need to include APNs in health care reform and the recommendation in the article suggests this will happen through leadership training and the attainment of leadership competencies by all APNs. The American Organization of Nurse Executives (AONE) offers leadership training for all levels of nurse leaders. The sole focus of the AONE is to promote leadership excellence among nurses, advance the practice, increase the engagement of research by nurses, and facilitate the preparation of nurses who will influence legislation and public policy (www.aha.org). For far too long the shape of health care has been formed by only a select portion of the population who provides it. Now is the time to think globally about healthcare reform and invite all of the contributors to the table.

References:

Abraham, C. M., Norful, A. A., Stone, P. W., &Poghosyan, L. (2019). Cost-Effectiveness of Advanced Practice Nurses Compared to Physician-Led Care for Chronic Diseases: A Systematic Review. Nursing Economic$, 37(6), 293–305.

American Organization of Nurse Executives. (February, 2022). AHA releases 2022-2024 strategic plan and updates to vision and mission statements. Retrieved: https://www.aha.org/special-bulletin/2022-02-08-aha-releases-2022-2024-strategic-plan-and-updates-vision-and-mission

Constable, M., Mulkey, M., &Aucoin, J. (2022). Hospital value–based purchasing: How acute care advanced practice nurses demonstrate value. Journal of the American Association of Nurse Practitioners, 34(1), 12–17. https://doi.org/10.1097/JXX.0000000000000606

Kershaw, B. (2011). The future of nursing – leading change, advancing health. Nursing Standard, 26(7), 31–31. https://doi.org/10.7748/ns2011.10.26.7.31.b1274

Sample Answer 3 for NURS 8100 Discussion: Policy Brief

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 for NURS 8100 Discussion: Policy Brief

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/