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Nursing, Pages: 1, Peer Responses

Nr 506 Week 1 Discussion Barriers to Practice

Nr 506 Week 1 Discussion Barriers to Practice

Peer Response

Hello, great work with your post! Your analysis of barriers to practice for Advanced Practice Registered Nurses (APRNs) in Florida is comprehensive and insightful. I agree with your highlighted specific barriers, such as collaborative practice agreements, prescriptive authority limitations, and limited hospital privileges. In addition, the passage of House Bill 607 was a great step in the right direction as it allowed APRNs to practice to the full extent of their training and education (Rivera et al., 2020).

One area that works well in your post is the identification of key lawmakers and interest groups at both state and national levels. The recognition of Governor Ron DeSantis, Senator Manny Diaz Jr., and Representative Colleen Burton underscores the importance of political advocacy in influencing healthcare policy (Kleinpell et al., 2023). Furthermore, acknowledging interest groups such as the Florida Nurses Association and the American Association of Nurse Practitioners provides a clear picture of the stakeholders involved in advancing APRN practice authority (McMenamin et al., 2023).
I agree that some policies by the Centers for Medicare & Medicaid Services (CMS) are restricting APRN practice. Policies such as 42 CFR § 482.12, requiring that medicare patients admitted must be under the care of a physician, and 42 CFR 483.30, requiring physician visits, have been a barrier to APRN practice (Chiu et al., 2021). It would be a great move to waive these restrictive CMS policies to allow APRNs to practice to the full extent of their education.

One question that remains is about the implementation and effectiveness of public education campaigns in changing public and policymakers’ perceptions of APRNs’ capabilities. Have there been notable successes or challenges in these campaigns that could inform future efforts? (Wheeler et al., 2022). Great post!

References

Chiu, P., Cummings, G. G., Thorne, S., & Makaroff, K. S. (2021). Policy advocacy and nursing organizations: A scoping review. Policy, Politics, & Nursing Practice, 22(4), 276–296. https://doi.org/10.1177/15271544211050611

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9

McMenamin, A., Turi, E., Schlak, A. E., & Lusine Poghosyan. (2023). A Systematic Review of Outcomes Related to Nurse Practitioner-Delivered Primary Care for Multiple Chronic Conditions. Medical Care Research and Review, 80(6). https://doi.org/10.1177/10775587231186720

Rivera, M. P., Katki, H. A., Tanner, N. T., Triplette, M., Sakoda, L. C., Wiener, R. S., Cardarelli, R., Carter-Harris, L., Crothers, K., Fathi, J. T., Ford, M. E., Smith, R., Winn, R. A., Wisnivesky, J. P., Henderson, L. M., & Aldrich, M. C. (2020). Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement. American Journal of Respiratory and Critical Care Medicine, 202(7), e95–e112. https://doi.org/10.1164/rccm.202008-3053ST

Wheeler, K. J., Miller, M., Pulcini, J., Gray, D., Ladd, E., & Rayens, M. K. (2022). Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study. Annals of Global Health, 88(1), 1–21. https://doi.org/10.5334/aogh.3698

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Question 

Nr 506 Week 1 Discussion Barriers to Practice

Respond to your peer’s discussion post.

Nr 506 Week 1 Discussion Barriers to Practice

Nr 506 Week 1 Discussion Barriers to Practice

The scholarly articles used must be less than 5 years old.

Peer Post

Discuss barriers to practice as an APN in one’s state from both a state and national perspective. Research methods to influence policy change from various forms of competition, state legislative and executive branches of government and interest groups.

Florida has historically been a restricted practice state for Advanced Practice Registered Nurses (APRNs), imposing several barriers on all four APRN roles including the nurse midwives, nurse anesthetists, nurse practitioners, and clinical nurse specialists. However, some progress has been made in recent years to reduce these barriers (Boehning and Punsalan, 2023). One of the key barriers for APRNs in Florida is collaborative practice agreements where all APRNs in Florida were required to have a collaborative practice agreement with a supervising physician. There is also prescriptive authority limitation where APRNs are facing restrictions on prescribing certain medications, particularly controlled substances. Limited hospital privileges has also been a barrier in which case many hospitals in Florida have policies that limit APRN privileges, such as admitting patients or being listed as the provider of record.

In 2020, Florida passed House Bill 607, allowing nurse practitioners in primary care to practice autonomously after meeting certain requirements. However, this does not apply to all APRN roles or specialties.

At the national level, the barriers are variation in state regulations in which case there is lack of uniformity in APRN practice regulations across states creates barriers to interstate practice and mobility (Ulit et al., 2020). In addition, the Centers for Medicare & Medicaid Services (CMS) policies can restrict APRN practice even in full practice authority states. Institutional policies has a been a barrier at the national level such that many healthcare organizations have policies that limit APRN roles and authority nationwide.

There are two key forms of competition including physical opposition and scope of practice debates. Physical opposition is whereby the medical associations often oppose expanding APRN practice authority, citing concerns about patient safety and quality of care. For the scope of practice debates, there is ongoing competition between different healthcare professions regarding overlapping scopes of practice (Carranza et al., 2021).

The key Florida Lawmakers whom I think are important is governor Ron DeSantis who is the head of the executive branch, he has significant influence over healthcare policy. Also, Senator Manny Diaz Jr. the Chair of the Health Policy Committee in the Florida Senate. Additionally, Representative Colleen Burton: Chair of the Health & Human Services Committee in the Florida House of Representatives is also important.

At the state level, the interest groups are Florida Nurses Association and Florida Medical Association. At the national level, they are American Association of Nurse Practitioners and American Medical Association.

There are various methods that can be used to influence policy change (Boehning and Punsalan, 2023). The first method is by lobbying where the interest groups engage in direct lobbying of lawmakers and policymakers. Public education campaigns can also be done to raise awareness about the role and capabilities of APRNs. It is also important to have coaling building by forming alliances with other healthcare groups and consumer advocates.

To effectively remove practice barriers for APRNs, a multi-faceted approach involving legislative action, public education, and collaboration with other healthcare stakeholders is necessary. Continued efforts at both the state and national levels are crucial to ensure that APRNs can practice to the full extent of their education and training, ultimately improving access to high-quality healthcare for all patients.

References

Boehning, A. P., & Punsalan, L. D. (2023). Advanced practice nurse roles. StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL).

Carranza, A. N., Munoz, P. J., & Nash, A. J. (2021). Comparing quality of care in medical specialties between nurse practitioners and physicians. Journal of the American Association of Nurse Practitioners, 33(3), 184-193.

Ulit, M. J., Eriksen, M., Warrier, S., Cardenas-Lopez, K., Cenzon, D., Leon, E., & Miller, J. A. (2020). Role of the clinical nurse specialist in supporting a healthy work environment. AACN Advanced Critical Care, 31(1), 80-85.