Discussion – Barriers to Practice

Discussion – Barriers to Practice

The healthcare field has evolved over the past decade leading to the rise of new healthcare professions. One of the healthcare professions that have been embraced in many healthcare facilities, especially in developed countries is Advanced Nursing Practice (ANP). This report discusses the practice barriers faced by ANPs, forms of competition faced by the ANPs, influence groups that influence APN policy, and methods used to influence policy change. The report will also mention the lawmakers who may influence healthcare laws in Maryland.

Practice Barriers

According to Kleinpell et al. (2023), Maryland is among the states that offer full practice for APNs. However, the APNs may still face some barriers that limit their practice. For instance, in Maryland, APNs face institutional barriers because the hospitals and healthcare systems in the state have the full authority to make decisions on patient admission and set the APN’s credentialing requirements. Nurse midwives and nurse anesthetists in Maryland are also required to work under physician collaboration or supervision, which could limit their authority in the provision of healthcare services. Further, Maryland has particular laws that restrict CNSs’ scope of practice, necessitating physician supervision in specific care-related areas.

Forms of Competition

APNs in Maryland encounter practice hurdles as a result of many types of competition that obstruct their capacity for independent practice. For example, in Maryland, advanced practice nurses must draft collaborative practice agreements requiring them to work together with physicians to provide healthcare services, limiting their autonomy. Due to reimbursement rules, APNs’ scope of practice may be restricted nationally by Medicaid and Medicare policies. State licensing boards may also establish rules that limit APNs’ participation in healthcare delivery, therefore limiting their scope of practice. According to McMullen & Howie (2020), State licensing boards may also dictate credentialing requirements, thus limiting APNs’ ability to practice at a nationally approved standard of care. Limitations on APNs’ autonomy to practice autonomously to improve patient safety may also come from organizations like the National Medical Association.

Specific Lawmakers

Maryland’s legislative branch of government includes the Senate and the House of Delegates (Maryland State Archives, 2024). The key members of the Senate include Bill Ferguson, who is the president of the Senate, Nancy King, the majority leader, and Steve Hershe,y the minority leader. The key members in the House of Delegates include Adrienne A. Jones, who is the speaker of the House, Jazz Lewis, the majority leader, and Jason Buckel, the minority leader. The key members in the executive branch of government include Wes Moore, who is the governor of Maryland, Anthony G. Brown, the attorney general, Aruna Miller, the lieutenant governor, Susan C. Lee, secretary of state, and Laura Herrera Scott, secretary of health.

Interest Groups that Influence APN Policy

According to Mark (2023), APN policy is influenced by the need to increase access to healthcare services and improve patient outcomes. The main interest groups that influence APN policy at national levels include the American Medical Association, the Physician for Patient Protection, the National Council of State Boards of Nursing, the National Association of Clinical Nurse Specialists, the American College of Nurse-Midwives, the Healthcare Leadership Council, the American Association of Nurse Practitioners and the American Nurses Association. The interest groups that influence APN policy at the state level include the Maryland Coalition of Nurse Practitioners, the Maryland Association of Nurse Anesthetists, the Maryland Hospital Association, and the Maryland Nurse Association.

Methods Used to Influence Change in Policy

APNs create a conducive environment for practice by influencing change in APN policy. According to Mark (2023), the methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups include contributing to campaigns that create favorable APN policies, lobbying, filing lawsuits to challenge regulations that restrict APN practice, mobilizing APNs to participate in advocacy and increasing public awareness of the role of APNs and their importance in the healthcare delivery.

 References

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

Mark, D. (2023). Advocating for Policy Change: The Role of Advanced Practice Nurses in Healthcare Reform. Journal of Advanced Practices in Nursing, 8(4).

Maryland State Archives. (2024). Maryland government, state, local & federal. https://msa.maryland.gov/msa/mdmanual/01glance/html/govern.html

McMullen, P. C., & Howie, W. O. (2020). Credentialing and privileging: A primer for nurse practitioners. The Journal for Nurse Practitioners, 16(2), 91-95.  

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I’m in the State of Maryland

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.

Discussion – Barriers to Practice

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Discuss the history of policy development and policy-making in nursing (CO1)
Examine different types of policy and their relationships to healthcare policy (CO1)
Explain current barriers to practice for advanced practice nurses (CO2)
Discuss health policy and methods of lifting barriers to practice (CO2)

Preparing the Discussion

Using the readings from this week as well as reliable outside resources to:

Identify and describe practice barriers for all four APNs’ roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
Identify forms of competition on the state and national level that interfere with APNs’ ability to practice independently.
Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
Discuss interest groups that exist at the state and national levels that influence APN policy.
Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
A scholarly resource must be used for EACH discussion question each week.