Primary care services are an important focus of improving health outcomes in this country. These essential preventive services save lives and improve the quality of life by detecting health problems early. Visits to a primary care provider can help promote health by allowing patients qualified guidance in their decision making, encouraging family involvement, and putting patients in touch with community resources. Since the inception of the first Nurse Practitioner (NP) programs in the 1970’s, these providers have been providing primary care services to patients across the lifespan, typically with an emphasis on underserved populations. Just as long, there has been considerable resistance to NPs being allowed to practice by physician groups …show more content…
Despite this evidence, NPs still face considerable barriers to practice in most states; however, several states currently provide unrestricted independent practice rights to NPs. The purpose of this paper is to examine the available literature about what effect unrestricted NP practice has on accessibility to primary care and health outcomes in the states where independent practice is permitted. Literature Review Kuo, Lorest, Rounds, and James (2013) examined the relationship of the percentage of medicare patients seeing NPs for primary care and the level of restriction placed on NP practice in the state. The authors hypothesized that in states in which there were both fewer primary care physicians per capita and less restrictive NP laws, a higher amount of medicare patients would report NPs as …show more content…
Through a non-experimental design, the authors analyzed data to determine whether full, reduced, or restricted practice rights for NPs affected the health outcomes of medicare and medicaid patients in those states. The type of NP practice allowed was compared to state rankings for avoidable hospitalizations, readmission rates after inpatient rehabilitation, and hospitalizations of residents of long term care facilities, as well as state health outcome rankings provided by the United Health Foundation. The authors performed a quantitative statistical analysis of previous studies done pertaining to outcomes of medicare and medicaid patients. To be included in the analysis, previous studies had to have a national scope but also provide a state ranking system and an explanation of how the ranking was performed. The authors performed two-sampled t tests on all data to determine if there was a correlation between autonomous NP practice and patient outcomes. The results of comparing potentially avoidable hospitalizations, readmission rates of rehabilitation patients, annual hospitalizations of long term care patients and overall state health outcomes between states with full practice and those without, showed that full practice produces more desirable outcomes. Potentially avoidable hospitalizations per 1,000 person-years in
Healthcare is viewed in an unrealistic way by most individuals. Many people view a physician as the only means to find a solution to their problem. Nurses are still seen by some as simply “the person who does what the doctor says.” This is frustrating in today’s time when nurses are required to spend years on their education to help care for their patients. In many situations nurses are the only advocate that some patients’ have.
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 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.
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).
The role of nurse practitioner in the Canadian healthcare system is relatively new compared to the traditional roles of doctors and registered nurses, and as with any new role, there are people who oppose the changes and others who appreciate them. Some members of the public and the healthcare system believe that the addition of the nurse practitioner (NP) role is an unnecessary change and liability to the system because it blurs the line between a doctor and a nurse; this is because nurse practitioners are registered nurses with additional training (usually a masters degree) that allows them to expand their scope of practice into some areas which can be treated by doctors. Other people feel that nurse practitioners can help provide additional primary care services, while bridging communication between nurses and doctors. There are always legitimate challenges to be overcome when changing a system as complicated as healthcare,
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).
Financial implications: Lower overall costs have been associated with NP (nurse practitioner) care. Studies show that the average cost of a nurse practitioner visit is approximately 25-30 percent lower compared to that of a physician visit. For exam...
Over the last few years, I shadowed a Primary Care Adult Nurse Practitioner whose office is located in the underserved urban area of Irvington, NJ. She also takes care of patients from the surrounding areas of Irvington, Newark, and East Orange, all of which have very large underserved populations including African Americans, Latinos, and patients from the Middle East. During my clinical shadowing, I gained a appreciation for the complexity of treating long term chronic conditions such as asthma, diabetes, HIV, and hypertension. In many cases these conditions were exacerbated due to poor nutrition, non-compliance, and lack of education about healthy lifestyle choices. I gained a keen understanding of the importance of patient education and the ability to connect patients with community services to help them with their economic and social challenges.
Much like how US healthcare operates today, there is no Gatekeeper system in place in France where citizen are required to be evaluated by a General Practitioner prior to seeing a specialist(). There is however, an incentive for citizen to first see a GP. If the citizen see a GP and then is refereed to ta specialist insurance will cover seventy percent of the bill where if not only sixty percent is covered (Reid 54). Yet, a key issue with the current US system is the fact that it does not possess a gatekeeper system and thus care is often uncoordinated. According to Thomas Bodenheimer in his textbook, Understanding Health Policy, the key task of primary care (thus GPs) is: one, be the first point of contact, two, to be longitudinal, three, to be comprehensive, and fouth, to coordinate the care of the patient. Therefore, if the United States wished to adopt a system similar to the French then it would be intelligent to alter it by adding a gatekeeper like system to properly coordinate the care of patients and thus reduce the total cost of care in the long
The NHQDR 2012 is a comprehensive report that implies there are changes that need to occur at multiple levels within the health care system and public policy. The report implies that the health care system needs to become more accessible to all populations, and the disparities in quality of care need to decrease. Health care providers need to evaluate access to care, treatment quality and its effectiveness. Meanwhile public policy needs to support funded programs that will improve access to care and support preventative services.
Anderson, A. R., & O’Grady, E. T. (2009). The primary care nurse practitioner. In A. B. Hamric, J. A. Spross, & C. M. Hanson (Ed.), Advance practice nursing and integrative approach (4th ed., pp. 380-402). St. Louis MO: Saunders.
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.
Typically NP’s provide health services in rural areas where they are the only source of medical services and this had n...
In consequence, this will limit poor adults finding the proper treatment since many doctors do not accept Medicaid patients. High rates of uninsured populations were associated with lower primary care capacity (Ku et al., 2011). Thus, expanding insurance coverage can support more primary care practices in rural areas and can help equal the gap in primary care positions. The impact of not expanding affects APRN practice by limiting them to practice in areas where they are needed the most. This not only affects APRNs from practicing without a physician supervision but also limit those that need coverage for basic preventive measures to reduce non-paying visits to the emergency room. Ensuring access to care will be contingent upon the ability to attain progress from insurance coverage and primary
In order for primary care practices to be successful they have to arrange their office setting and scheduling to satisfy their consumers’ needs. Bodenheimer (2003) advocates for improving primary care accessibility by arranging their offices into teams. He explains each team would have “one primary care physician, two non-physicians clinicians (nurse practitioners or physician assistants), three nursing staff, and a receptionist” (p.797). He states patients will be greeted by their team who knows their h...