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Access, Cost, and Quality for APNs

Access, Cost, and Quality for APNs

The roles and responsibilities of advanced practice nurses (APNs) reflect their relevance in healthcare. The autonomy of APNs is dependent on the policies and regulations of the state. For instance, states that acknowledge the autonomy of nurse practitioners include Alaska, Colorado, New Mexico, Hawaii, Massachusetts, South Dakota, and Nebraska (Clarke, 2022). In this context, full autonomy means that APNs are permitted to practice fully without being supervised by physicians (Clarke, 2022). APNs are committed to improving the quality of healthcare services and lowering healthcare costs. To accomplish this, they embrace research to achieve evidence-based practice and apply nursing theories. APNs provide patient-centered care depending on the practitioner’s specialty. For example, nurse practitioners are involved in patient assessment, diagnosis, developing nursing care plans, and patient follow-up, whereas Certified Nurse-Midwives provide holistic gynecological healthcare services (, n.d.). This paper discusses various aspects of APNs’ practice, including quality initiatives, cost, and access.


Wiesen (2022) reports that in 2020, there were more than 220,000 nurse practitioners and other APNs in the USA. Furthermore, this number is projected to exceed 335,000 by 2030 (Wiesen, 2022). The projected growth in employment opportunities for APNs between 2020 and 2030 is approximately 53 percent (Wiesen, 2022). APNs work in various setups such as healthcare facilities, academia (colleges and universities), and physician offices. As such, APNs are key stakeholders that will promote access to healthcare services. (2019) argues that various factors promote the demand for APNs. Firstly, physician shortages have impeded the delivery of primary care to vulnerable populations in rural and urban areas. APNs should be recruited and engaged in addressing this issue. APNs offer comparatively similar primary care services. Secondly, (2022) reports that by 2021, the Affordable Care Act (ACA) had increased healthcare coverage for more than 35 million individuals. An increase in healthcare coverage reflects an increased demand for healthcare services. More APNs should be involved in patient care to avert the possibility of overwhelming healthcare facilities and healthcare providers. Thirdly, findings demonstrate that the elderly population accounts for more than 52 million people in the USA (, 2019). This population is at a high risk of various medical comorbidities and requires patient-centered holistic care. As such, more APNs should be involved to improve access to care.

Access to healthcare services provided by APNs is impeded by various factors. Most states have not granted APNs full practice authority. States with restricted practice require APNs’ actions and decisions to be supervised by physicians (Clarke, 2022). This limits access to healthcare services provided by APNs because all of their decisions have to be approved by a physician. Examples of states with restricted practice include California, Michigan, Oklahoma, Georgia, North Carolina, and Florida (Clarke, 2022). States with reduced practice limit the scope of practice for APNs. For example, these states may limit the ability of APNs to have their practice or prescribe specific medication (Clarke, 2022). This reduces access to healthcare by limiting the services provided by APNs. Examples of states with reduced practice include Wisconsin, Pennsylvania, Louisiana, Alabama, Ohio, and Illinois (Clarke, 2022). To address this problem, nursing organizations should collaborate with other policymakers, such as members of Congress formulate laws advocating full autonomy in the practice of APNs.


APNs play a key role in reducing healthcare costs in the USA. It is approximated that an individual spends $12,000 annually on treatment costs in the USA (, n.d.). These costs range from consultation fees and laboratory tests to medication costs. Findings by Razavi et al. (2021) reveal that APNs play a significant role in lowering treatment costs. According to Razavi et al. (2021), before the enactment of the ACA, APNs offered primary care that cost about 34 percent lower than the services offered by physicians for low-risk patients. Furthermore, regarding medium and high-risk patients, nurses offered primary care services that cost about 28 percent and 21 percent lower than physician-provided services respectively (Razavi et al., 2021). Based on these findings, APNs play an important role in minimizing healthcare costs for patients with various conditions. Notably, low-risk patients benefited significantly from the cost-effective services offered by APNs. Razavi et al. (2021) indicate that the differences in treatment costs are attributed to the observation that physicians order more tests and write more prescriptions than APNs.

Abraham et al. (2021) identify the enablers for cost-effective healthcare services provided by APNs. Firstly, differences in billing and reimbursements may lower the cost of services offered by APNs. For example, in the USA, APNs receive lower reimbursement rates (by about 15 percent) than physicians. As such, APNs are likely to offer cost-effective healthcare services. Secondly, APNs embrace cost-effective resources (such as ordering specific laboratory tests) to address patients’ needs holistically. By so doing, healthcare costs are reduced. Abraham et al. (2019) report that these findings should be used as the basis for expanding the practice of APNs to achieve full autonomy in all states.


APNs are involved in the delivery of high-quality healthcare services. The scope of service delivery is dependent on their specialty. As aforementioned, APNs work in various settings such as academia, healthcare facilities, nursing homes, and private practice. Their focus is on the provision of patient-centered and holistic services. Clinical nurse specialists are involved in patient assessment, diagnosis, and management (, n.d.). Furthermore, they coordinate registered nurses to improve the quality of healthcare services and achieve a continuum of care. Also, they conduct research and advocate for the implementation of evidence-based practices that improve patient outcomes. Certified registered nurse anesthetists (CRNAs) are key stakeholders involved in the administration of anesthesia (, n.d.). By promoting the safe administration of anesthesia, they achieve patient safety. CRNAs improve the quality of service delivery by collaborating with physicians in surgical and trauma departments. As aforementioned, certified nurse-midwives offer reproductive and gynecological healthcare services. These services aim at availing of quality antenatal and postnatal care. As stated earlier, nurse practitioners provide patient-centered care to patients across all lifespans (, 2019). In their authority as autonomous practitioners, APNs provide quality and cost-effective healthcare services.

Quality Initiatives

Joel (2018) reports that the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services are committed to the delivery of quality healthcare services. For instance, the AHQR conducted an initiative to determine prescription medications that improve patient outcomes and reduce healthcare costs (Joel, 2018). This initiative embodies an evidence practice approach to improve the quality of healthcare services. Findings from this initiative will benefit both APNs and other members of the interdisciplinary team. Secondly, the AHRQ is conducting pilot tests for programs that reward healthcare practitioners based on the quality of healthcare services (Joel, 2018). Also, the AHRQ has availed evidence-based case reports and analyses to guide the decision-making process in the management of community-acquired pneumonia (Joel, 2018). This information enables APNs to make critical decisions and participate actively in the execution of quality initiatives. On the other hand, CMS has developed initiatives to evaluate the quality of care provided by various healthcare facilities (Joel, 2018). To accomplish this, the CMS has formulated standards and guidelines and performed data analysis to provide pertinent information on quality improvement. Other than AHRQ and CMS, private organizations also evaluate and report the quality of healthcare service delivery (Joel, 2018). Thirdly, various organizations are involved in identifying and addressing the community’s healthcare needs (Joel, 2018). This is accomplished by evaluating the quality of performance of children covered by various insurers. These findings enable parents to make informed decisions regarding various healthcare systems.

Quality Measures and Evaluation and Role Development

Quality measures assess the effectiveness of the services provided by APNs. This assesses patient outcomes, organizational structure, and the processes involved (Joel, 2018). Quality measures focus on individuals and groups. Regarding individuals, the focus is channeled to aspects such as interdisciplinary experience, patient-centeredness, and patient safety analytical skills (Joel, 2018). In the context of the group, quality measures evaluate the performance of specific metrics.

Quality measures and evaluation promote role development. Firstly, it enables APNs to conduct introspections and compare their performance with that of other clinicians. This forms the basis for improvement. Secondly, since the evaluation is evidence-based, APNs adopt better practices to improve the quality of service delivery (Joel, 2018). Furthermore, evaluation enables APNs to provide patient-centered holist care that fulfills the needs of the community.

The Role of the APN without Effective Quality Measures

The absence of individual and group quality measures will lower the quality of healthcare services provided by APNs. APNs will be unable to fulfill the needs of the community and holistic patient needs. Additionally, APNs will not track their progress and performance compared to other providers. The absence of quality implies that APNs will not formulate a standard of practice and establish specific core competencies. By so doing, the quality of healthcare services delivered by APNs will be lowered, and their demand will reduce.


Abraham, C. M., Norful, A. A., Stone, P. W., & Poghosyan, L. (2021). Cost-Effectiveness of Advanced Practice Nurses Compared to Physician-Led Care for Chronic Diseases: A Systematic Review. Nursing Economic$, 37(6), 293–305., n.d.). Trends in health care spending.

Clarke, M. E. (2022). Nurse Practitioner Practice Authority: A State-by-State Guide. (2022). New Reports Show Record 35 Million People Enrolled in Coverage Related to the Affordable Care Act, with Historic 21 Million People Enrolled in Medicaid Expansion Coverage.

Joel, L. A. (2018). Advanced practice nursing: Essentials for role development. (5th ed.).FA Davis. (n.d.). Advanced Practice Registered Nurse (APRN). (2019). APRNs Are Critical to Improving Access to Care in the U.S.

Razavi, M., O’Reilly-Jacob, M., Perloff, J., & Buerhaus, P. (2021). Drivers of Cost Differences between Nurse Practitioner and Physician Attributed Medicare Beneficiaries. Medical Care, 59(2), 177–184.

Wiesen, K. (2022). How Many Nurse Practitioners are There in the U.S. – State Wise Data.


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Assignment Prompt

Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1). Student is to reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures.

Access, Cost, and Quality for APNs

Access, Cost, and Quality for APNs


Due: Monday, 11:59 pm PT
Length: 1500 words, double-spaced, excluding title and reference pages (required)
Format: APA 7th Edition
See USU NUR Research Paper Rubric for additional details and point weighting.

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