In the United States, depending upon the state in which they work, nurse practitioners may or may not be required to practice under the supervision of a physician, frequently referred to as a “collaborative practice agreement”. However, in consideration of the shortage of primary care/internal medicine physicians, many states are eliminating or lessening the restrictive authority which allows and nurse practitioners the ability to function more autonomously (AANP 2015).
Since 1989, The American Nurses Association (ANA) had tasked itself to improve the delivery of the health care system in the United States. As one of the major stakeholders of the industry, the ANA had closely monitored and noted “the overwhelming problems of the health care system in the country. In all the reforms that ANA had adopted, “ANA remained committed to the principle that all persons are entitled to ready access to affordable, quality heath care services (ANA, 2008, p. 1). Consequently, in 2008, ANA published an update of the 2005 ANA Health System Reform Agenda that reaffirmed the principle that “health care is a basic human right” (ANA, 2008, p. 1). In addition, ANA also agreed with the
The National Council of State Boards of Nursing (2015) describes an advanced practice nurse as a nurse with a graduate level education in a specific area of study including nurse anesthesia, nurse midwifery, nurse practitioner, and clinical nurse specialist. Advance practice nurses have been crucial to meeting the demands of the growing patient population due to the implementation of the Affordable Care Act. These nurses bridge the gap between physician and patient and are a vital part of the healthcare team. There are a variety of specializations and educational paths nurses may pursue in order to advance their career towards advanced practice nursing.
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],
Access to quality healthcare is a growing concern in the United States especially in light of healthcare reform coverage expansions made possible by the Patient Protection and Affordable Care Act of 2010. It is estimated that 94% of all Americans will acquire healthcare coverage under the law, an increase of nearly 30 million people (King, 2011). This dramatic influx of patients into the healthcare system has projected to cause an immediate increase in added pressure on an already challenged healthcare workforce (King, 2011). Notably, at a time when healthcare demands are growing, graduate rates from medical schools remain unchanged while advanced practice registered nurse (APRN) graduate rates are rising (Cipher, Hooker, Guerra, 2006). The increased availability of APRNs, along with enhanced delivery of healthcare skills, gives the role a unique advantage in the current state of healthcare. These specialized advanced practice nurses provide services often at a patient’s first (and in some cases, primary) point of contact into the healthcare system (Brassard, 2013). Due to this, many states have started to take action to mitigate the increased healthcare system burden by enhancing the APRN’s scope of practice by broadening prescriptive authority. This has been shown to be one of the fundamental ethical avenues of increasing not only access to healthcare, but also efficiency and quality of care (Ross, 2012).
The passing of the Affordable Health Care Act bill on March 23, 2010 places Nurse Practitioners (NPs) at the forefront of health care reform, with the opportunity to be creative and innovative. I envision primary care, preventive care, case management, nurse leaders and educators as critical components of the health care reform. The healthcare reform bill has included provisions through grants for advanced practice, general nurse education and innovative nurse-manage health clinics. This incentive for Nurse Practitioners is timely as the role of Advance practice registered nurse (APRN) continues to evolve. It is a wonderful opportunity as I ...
Nurses have too often in the past not spoken or lobbied with one voice. Name recognition for the advanced practice nurse (APN) was a huge issue in the beginning. Many people question whether APNs are nurses or mini doctors. Decades of APNs struggles with licensing, certification, scope of practice, and recognition by others in the healthcare field added to delaying and expanding prescription authority for all APNs (Berg & Roberts, 2012).
The Affordable Care Act (ACA) was passed in 2010 with the goal of expanding healthcare coverage to all Americans by reforming insurance policies and practices (Tillett, 2011). The ACA upsurges the demand for an increase in primary care providers in order to supply quality care to the much larger population that will have coverage and therefore acquiring healthcare. The Institute of Medicine (IOM) through its report The Future of Nursing: Leading Change, Advancing Health has generated a solution to the shortage of primary care providers by promoting a transformation of the nursing profession to fill the gap.
Nurse practitioners (NPs), one type of advanced practice nurses, are licensed by the states where they practice and certified by private boards. Nurse practitioners hold advanced degrees in clinical practice and function in a wide variety of settings and across the life span. They provide a broad array of healthcare services ranging from managing treatment plans, to prescribing medications, to implementing health promotion services. As of 2014, 205,000 NPs were licensed in the United States with 86% of those prepared to deliver care to patients in primary care settings (NP Facts, 2015). The progression of the Nurse Practitioner movement that occurred in the 1960 and 1970s emerged as a creative and
The primary barrier to nurses being able to practice at their full potential is the states varied legislation (Fairman, Rowe, Hassmiller, & Shalala, 2011). The IOM (2011) report suggests that state scope of practice regulations should model the National Council of State Boards of Nursing Model Nursing Practice act and Administrative rules to provide legal authority to practice to the accomplished level of training. The IOM (2011) report also requested a review of states laws to identify potentially anticompetitive effects that do not protect the health and safety of the public. The new recommendations are to build a common ground with interdisciplinary groups and to include a diverse coalition for the Future of Nursing: Campaign for action (IOM,
This paper will evaluate the local, national and international drivers that have influenced the development of advanced nursing practice. The discussion will include the political, economic, social, and technological influences that have contributed to the transformation from the traditional nursing role to the numerous exciting advanced level career opportunities achievable in nursing today. Dynamics that have shaped my own current advanced nursing role will be discussed and to conclude some thoughts on the future of advanced nursing practice.
It is no secret that the current healthcare reformation is a contentious matter that promises to transform the way Americans view an already complex healthcare system. The newly insured population is expected to increase by an estimated 32 million while facing an expected shortage of up to 44,000 primary care physicians within the next 12 years (Doherty, 2010). Amidst these already overwhelming challenges, healthcare systems are becoming increasingly scrutinized to identify a way to improve cost containment and patient access (Curits & Netten, 2007). “Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal…” (Bailey, Jones & Way, 2006, p. 381). The key to a successful healthcare reformation is interdisciplinary collaboration between Family Nurse Practitioners (FNPs) and physicians. The purpose of this paper is to review the established role of the FNP, appreciate the anticipated paradigm shift in healthcare between FNPs and primary care physicians, and recognize the potential associated benefits and complications that may ensue.
...e crucial change needed in health services delivery, with the aim of transforming the current deteriorated system into a true “health care” system. (ANA, 2010)
The first key message that is discussed is that nurses should practice to the fullest extent of their education and training. Most of the nurses that are in practice are registered nurses. Advanced nurse practitioners are nurses that hold a master’s or doctoral degree and include nurse midwifes, clinical nurse specialists, nurse practitioners, and nurse anesthetists and consist of about two hundred and fifty thousand of the nurses currently working today. Advanced practice nurses are limited to what
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.