Nurses in some parts of the world have been prescribing for decades. Why has this been such an elusive privilege in the United States? 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). Doctors have traditionally had the domain of prescribing medications. Advanced practice nurses have had some prescription authority in the United States since 1969, yet this has varied from state to state. The American Medical Association (AMA) has lobbied for years to limit the scope of practice of the APN (Kuntz, 2011). In 2009, the AMA disseminated scare tactics around the country, concerning the health and safety concerns of allowing APNs to expand their scope of practice. Finally, in 2014, the APN role is being expanded to include more autonomy and expanded prescription authority in all states. As discussed in Joel (2013), how can APNs best educate legislators and regulators about prescriptive authority? Educating legislators and regulators about prescriptive authority has been an ongoing battle for APNs. Developing curriculum guidelines for APNs to follow in pharmacotherapy has alleviated some of the fear of allowing APNs to practice with prescriptive authority (Klein, 2012). The American Medical Association can no longer use the fear that APNs do not have education in pharmacotherapy as a scare tactic. Advanced practice nurses should foll... ... middle of paper ... ...e be teaching nurse prescribers today? Journal of the American Academy of Nurse Practitioners, 24(5), 297-302. doi:10.1111/j.1745- 7599.2011.00687.x Kuntz, K. (2011). 'Deadly spin' on nurse practitioner practice. Journal of the American Academy of Nurse Practitioners, 23(11), 573-576. doi:10.1111/j.1745-7599.2011.00667.x Pearlman, S. A. (2013). The Patient Protection and Affordable Care Act: Impact on mental health services demand and provider availability. Journal of the American Psychiatric Nurses Association, 19(6), 327-334. doi:10.1177/1078390313511852 Reinhard, S. C. (2012). Money Follows the Person: Un-burning bridges and facilitating a return to the community. Generations, 36(1), 52-58. Shaffer, E. R. (2013). The Affordable Care Act: The value of systemic disruption. American Journal of Public Health, 103(6), 969-972. doi:10.2105/AJPH.2012.301180
Click here to unlock this and over one million essaysShow More
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.
The model discusses the impact of new regulations on education for APRN, Licensure Accreditation, Certification & Education Document, certification and practice. The model is implemented to grasp the general understanding and definition of advance practice registered nurse APRN role, inconsistencies with state by state recognition of APRN roles, and determining eligibility for APRN licensure (Consensus Model for APRN Regulation, 2015). The consensus model definition of APRN is a nurse who is educationally rounded to assume the responsibility of assessing, diagnosis, treating, teaching health promotion and disease maintenance, acquired advanced clinical knowledge and skills to provide direct patient care, has passed a national certification examination, and licensed to practice in one of the four roles (Consensus Model for APRN Regulation, 2015).
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).
APRNs lead staff with professionalism and provide education to patients and family members designed to engage them in patient care. Providing education to staff, patients, and family members ensures a high level of quality of care is delivered. Maintaining a balance between the patient’s autonomy and the duty to do no harm can result in an ethical dilemma at times. As patients continue to be fully involved in their care, staff must remain patient advocates and maintain professional responsibility.
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,
The medical field is among the largest and ever growing career fields, especially when dealing with Physician Assistants (PAs) and Nurse Practitioners (NPs). In the 1960’s when the physician shortage began, the medical field created the PA and NP positions to fill in the gaps (Curren, 2007, p. 404). This matter has opened up numerous questions as more and more PAs and NPs begin practicing, especially concerning their education level. Many patients are concerned that they will not get the proper care. PAs/NPs are beneficial to everyday life by providing patients with the necessary skills needed to successfully treat them.
Sullivan-Marx, E. M., McGivern, D. O., Fairman, J. A., & Greenberg, S. A. (2010). Nurse practitioners: The evolution and future of advanced practice. (5th ed.). New York: Springer Publishing Company.
Currently, there are multiple challenges to the US healthcare system like the nation’s aging population and the staggering reports of alarming rates of increase in chronic diseases in both pediatrics and adults (Stanley, 2012). While the need for more healthcare providers who can take care of these populations increases, a study by Peterson et al. (2012) states that there is a foreseen shortage primary care physician due to new physicians opting to specialize. Coincidentally, the availability of Advanced Practice Registered Nurses (APRNs) has been increasing throughout the years. APRNs, specifically Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs), can fill in the shortage of primary care providers (Stanley, 2012).
Advanced practice registered nurses play a significant part in extending access to health care by providing primary care and specialty care services to clients. Advanced practices registered are mentors, educators, researchers, and administrators. According to Health Resources and Services Administration, “Ninety-six percent of the NP workforce reported being in clinical practice, providing direct patient care” (Health Resources and Services Administration 2016). Furthermore, “Nearly three percentages were in faculty positions and approximately one percent was in administrative positions”(Health Resources and Services Administration 2016).
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 laws and regulations of the practice and prescribing privileges of Advanced Practice Register Nurse Practitioner (APRN) in North Carolina is jointly regulated by North Carolina Board of Nursing and North Carolina Board of Medicine (NC Board of Nursing, 2016). These privileges can only be granted under a collaborative practice agreement (CPA) with a licensed physician. The CPA provides ongoing supervision and collaboration between the APRN and physician, however the APRN can practice independently, without direct supervision, under the CPA (NC Board of Nursing, 2016).
Nursing is a knowledge-based profession within the health care sector that focuses on the overall care of individuals. According to The American College of Nurse Practitioners (ACNP), “defines nurse practitioners as registered nursed who have received graduate-leveling nursing education and clinical training, which enables them to provide a wide range of preventative and acute health care services to individuals of all ages. They deliver high-quality, cost effective care, often performing physical examinations, ordering tests, making diagnoses, and prescribing and managing medication and therapies”. Nurse Practitioners are able to specialize in a particular area, such as family and adult practice, pediatrics, and women’s health; and refer patients to other specialist when necessary. Some Nurse practitioners work under the supervision of a physician; while others run their own practices.
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.