In 2011, Barbara Safriet published an article “Federal options for maximizing the value of Advanced Practice Nurses in providing quality, cost-effective health care” from a legal perspective. The article focused on the benefits of utilizing Advance Practice Nurses to the full extent of their abilities as well as the current barriers that APNs encounter in their practice. The aim of this paper is to discuss two regulatory provisions to full deployment of APNs in current health care system, as well as three principle causes of current barriers to removal of the restrictive provisions for the APN. Furthermore, I will discuss the critical knowledge presented in the article and how it relates the APN practice. This article was incorporated into a two-year initiative was launched Institute of Medicine (IOM) and by the Robert Wood Johnson Foundation (RWJF) in 2008 which addressed the urgency to assess and transform the nursing profession.
Credentialing and Privileging
Privileging and credentialing are procedures used by health care systems to evaluate a professional's qualifications. Through these processes, the organizations are able to provide high quality care and avoid malpractice incidences. An APRN can be granted authority to provide care and services in a certain health care facility through the process of privileging. A select committee of ones peers from the institution evaluates a person's education, experience, training, etc. to determine the APRN's capabilities.
The role of Advanced Practice Nursing (APN) has changed dramatically in recent years. Currently, the Unite States (U.S.) health care is focusing on delivering a cost -effective health care to all patients. In the last decades, there were many efforts to control health care over spending in the U.S. One of such efforts is to focus on applying proven principles of evidence-based practice and cost-effectiveness to find the least expensive way to produce a specific clinical service of acceptable quality (Bauer, 2010). The vast changes in health care system, such as cost, need for high productivity, limitation on reimbursement, and the inadequacy on access have made APNs to think in a way where they most fit to provide independent care for children and adults of all ages while focusing on providing high quality and preventative health care services.
In fact, there have been numerous studies supporting the clinical performance and outcomes of NPs. A systematic review covering the literature from 1990-2008 found that patient outcomes of care provided by APRNs in collaboration with physicians were similar to and in some manners, exceeded those of physicians alone (Newhouse et al., 2011) Newhouse, et al’s review added to the available evidence that APRNs provide safe, effective, quality care to specific populations (2011). In their review, they did not separate outcomes of NPs with full practice authority from those with reduced or restricted practice. Due to the patchwork of state regulation and restrictions on NP practice, it may be challenging to compare the outcomes of NPs with full independent practice from those with reduced or restricted practice. Furthermore, the AANP states “there are numerous studies that demonstrate nurse practitioners consistently provided high-quality and safe care” (n.d.). They go on to state “in the more than 100 studies on care provided by both nurse practitioners and physicians, not a single study has found that nurse practitioners provide inferior services” (AANP, n.d.). The Federal Trade Commission (FTC) has also reviewed the literature and determined there is not a significant difference in the outcome of NPs and physicians that would necessitate the anti-competitive nature of scope-of-practice regulations and restrictions on advanced practice nursing (Federal Trade Commission [FTC],
Advanced practice registered nurse (APRN) is an umbrella term given to a registered nurse who has at least a Master’s degree and clinical practice requirements beyond the basic nursing education and the license required of all RNs and also who provides at least some level of care to many number of patients. Under this umbrella fit the principal types of APRNs: Nurse
...addition, the lack of independence to fully make some reasonable decisions in a care of a patient by an NP can make the NP less active in his or her practice. According to Squires ( n.d.), the American Association of Retired Persons (AARP) Public Policy Institute stated to allow Advanced practice registered nurses (APRNs) to certify home health and hospice services, and eliminating the need for physician sign-off to expedite treatment and make care more efficient.
The advanced practice nurse is well positioned to be a leader and catalyst for change. “There is a huge opportunity for nurses to step up, provide leadership and make clear nursing’s unique set of contributions to people who need palliative care” (RWJF, 2010). Working with state boards of nursing and nursing organizations to develop plans and advocate for legislative change. The advanced practice nurse ability to practice to the full scope of practice and training requires the removal of restrictions and barriers.
Ullman, Melanie. "Exploring a Variety of Nurse Practice Settings." EzineArticles Submission - Submit Your Best Quality Original Articles For Massive Exposure, Ezine Publishers Get 25 Free Article Reprints. 12 Aug. 2009. Web. 29 Nov. 2010. .
My plans after obtaining my advanced degree is to acquire licensure to practice as AGNP in the state of Texas. The Texas BON acknowledges that APN education, experiences, and competency levels vary, hence, holds individual APN accountable for knowing and practicing within their own scope of practice and competency always. The APN’s education is the grounds to their scope of practice: however, the APN can expand the scope of practice within the role and population-focus, as long as it remains within limits of the law. The Texas BON restricts the scope of practice for the APNs. The Nurse Practitioner Supervision Laws require¬¬¬¬¬ APN to work under physician supervision within seventy five mile perimeter. In addition, there is the Texas ' Nurse Practitioner Prescribing Laws which require APNs to prescribe medications under physician supervision and APNs are not allowed to prescribe schedule two drugs. All prescriptions written by the NPs must include the supervising physician 's name, address, Drug Enforcement Administration (DEA) number and phone number (Texas BON,
According to Hamric, Spross and Hanson (2005), “advanced practice nursing is the application of the expanded range of practical, theoretical and research based- competencies” to provide patient care in different settings (Pulcini, 2013). Advanced practice registered nurse APRN is a nurse that completed a graduate level program that can practice as a certified nurse practitioner, (NP) certified registered nurse anesthetist (CRNA), clinical nurse midwife (CNM) or clinical nurse specialist (CNS) (Scope and standard, 2010). To be licensed to practice as APRN, they need to pass a national certification exam and maintained their license via recertification through continuous competencies.