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Restrictions of Roles of Nurse Practitioners and Advanced Practice Nurses

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Based in the following journal, please complete the following topics:
1-Evaluation strategies
2- Conclusions

Restrictions of Roles of Nurse Practitioners and Advanced Practice Nurses
DeVonn Bourg, Curt Miller, Arahis Mola, and Neliudis Navarro
Kaplan University
Restrictions of Roles of Nurse Practitioners and Advanced Practice Nurses
Since the 1960s when nurse practitioners (NPs) first began to practice, they have been pushing for more independence to practice to the full capability of their
knowledge and training. When the Affordable Care Act (ACA) was implemented, NPs were an integral part of the health care plan because they would be used to provide
services that physicians traditionally provided, but would presumably be too busy for once the ACA was fully implemented. However, only about half of the states in the
United States allow NPs to practice independently, which includes opening and managing a clinic, prescribing medications, and several other services that NPs are
perfectly capable of providing for patients. The other half of the states either have some restrictions on practice or require NPs to practice only under the authority
of a physician. In terms of the ACA, that caused the health care systems in the many states who restrict NPs to be backed up and needing to hire more physicians, when
they could just change their policy toward NPs and solve the problem. However, there is strong opposition to NPs practicing independently and most of it comes from
physicians. The American Medical Association (AMA) says that doctors, NPs, registered nurses and other health care professionals should all act as a team to give the
patient the best care possible. NPs agree, but also think that easing some of the burden on doctors would make health care better. The AMA and other physicians groups
say that allowing NPs to practice would create two classes of medical care: poorer people would go to NPs for their medical care and wealthier people would see a
doctor. Yet, they forget that an NP is limited in his/her knowledge compared to a doctor, and if an issue arose that a doctor should address, NPs usually have referral
privileges.
The Proposed Policy Change
The policy change that should occur is that NPs should be given the freedom to practice independently in every state. If those states who do not have such laws in
place already wanted to implement the change incrementally, that would be a good compromise. However, the states that do not allow NPs to practice independently should
start doing so for the good of patients, the ACA, and the economy.
Agenda Setting
Moving the policy change of removal of restrictions of NPs and APNs up the legislative ladder, in order to gain attention from the government, is called agenda setting
(Furlong, 2016). Â The agenda is to include, but not limited to: (1) decreasing, if not eliminating, restrictions on NPs and APNs, (2) all NPs and APNs to practice at
full scope of practice, (3) help the growing population that has new healthcare by introducing more providers to the areas.Â
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Model or Theory
Many barriers exist to the proposed change. Of course, the opposition from the AMA and other physicians groups are the biggest barrier to overcome. Iglehart (2013) of
the New England Journal of Medicine explains that the AMA criticizes studies that show how successful NPs are, yet the studies exist. Physicians groups emphasize how
the successes are due to physician-led teams, so they conclude that physicians should lead teams. However, the studies are done in states where NPs are allowed to
practice independently too. The research by the AMA and state medical societies has shown that most states that allow such practices do not document which nurse
practitioners actually have independent practices (pp. 1937-1938). In other words, some of the studies may have been done on independent NPs, who are not on a doctor-
led team. This means that recent studies that do separate the two should be done to start the implementation of a federal law/policy that allows NPs to practice
independently.
 Another barrier to independent practice for NPs is the payer model that the ACA uses. Hain and Fleck (2014) of the OJIN: The Online Journal of Issues in Nursing
explain that in states where NPs are allowed to practice independently or semi-independently, restrictive scope-of-practice may lead to stricter payer policies
limiting NPs ability to practice independently (Hain & Fleck, 2014). This means that another part of the model for change would have to address the payment issue for
NPs. Academic structures promoting global health nursing need to place strong emphasis on increasing nursing role in global health policymaking in order to improve
care of patient populations. Global health nursing should embrace and support globally recognized benchmarks, such as the Sustainable Development Goals, as well as
promote policies which broaden nursing and other healthcare certification and regulatory standards both nationally and globally. Empowering nurses to be stronger
patient advocates, rigorous scientists and activists at the global, national and local levels can ameliorate the lost investment and lost lives that result from
nursing exclusions at decision-making tables. The main change in policy would be at the state level of the states that do not now allow NPs to practice independently.
They need to pass laws to change this and allow NPs to practice to their full ability. The next step according to the 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 and National Academies of
Sciences, Engineering, and Medicine (2016) who wrote Assessing Progress on the Institute of Medicine Report The Future of Nursing, is requir[ing] third-party payers
that participate in fee-for-service payment arrangements to provide direct reimbursement to advanced practice registered nurses who are practicing within their scope
of practice under state law. . . . Amend or clarify the requirements for hospital participation in the Medicare program to ensure that advanced practice registered
nurses are eligible for clinical privileges, admitting privileges, and membership on medical staff.  Require insurers participating in the Federal Employees Health
Benefits Program to include coverage of those services of advanced practice registered nurses that are within their scope of practice under applicable state law.Â
Reviewing existing and proposed state regulations concerning advanced practice registered nurses to identify those that have anticompetitive effects without
contributing to the health and safety of the public. States with unduly restrictive regulations should be urged to amend them to allow advanced practice registered
nurses to provide care to patients in all circumstances in which they are qualified to do so. (p. 41). These changes address most of the barriers to practice that NPs
currently face.
Design Strategies
The first step is to get key actors in the administration and in the legislature to be sympathetic to the idea of creating a climate where healthcare professionals can
perform to the full extent of their education and training. There should be goals toward alleviating growing workforce shortages (especially among primary care
physicians) and improving access to care among underserved demographics in the state, many of them have had positive experiences receiving care from practitioners
other than physicians, such as Advanced Practice Registered Nurses and physician assistants.

 Iglehart, J. K. (2013). Expanding the Role of Advanced Nurse Practitioners � Risks and Rewards. New England Journal of Medicine, 368, 1935-1941 .
doi:10.1056/NEJMhpr1301084
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. (2016). Assessing Progress on the Institute of Medicine Report The Future of Nursing.
(A. SH, B. AS, & S. L, Eds.) Washington D.C.: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK350160/

Furlong, E. (2016). Agenda setting. In J. Milstead, Health Policy and Politics: A Nurse’s Guide (5th ed., pp. 45-67). Burlington, MA: Bartlett & Jones Learning.

Hain, D., & Fleck, L. (2014, May 31). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).
doi:10.3912/OJIN.Vol19No02Man02
Iglehart, J. K. (2013). Expanding the Role of Advanced Nurse Practitioners � Risks and Rewards. New England Journal of Medicine, 368, 1935-1941 .
doi:10.1056/NEJMhpr1301084
Lathrop, B., & Hodnicki, D. R. (2014). The Affordable Care Act: Primary Care and the Doctor of Nursing Practice Nurse. Online Journal of Issues in Nursing, 19(2).
Retrieved from https://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Articles-Previous-
Topics/Affordable-Care-Act-Doctor-of-Nursing-Practice.html
Oliver, G. M., Pennington, L., Revelle, S., & Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook,
62(6), 440-447. Retrieved from https://c.ymcdn.com/sites/www.npamonline.org/resource/resmgr/Oliver_Pennington_Revelle_&_.pdf
Von Vleet, A., & Paradise, J. (2015, January 20). Tapping Nurse Practitioners to Meet Rising Demand for Primary Care. Retrieved from Kaiser Family Foundation:
https://www.kff.org/medicaid/issue-brief/tapping-nurse-practitioners-to-meet-rising-demand-for-primary-care/