Advance Practice Nurses-The Future of Healthcare Delivery
The globalization of healthcare—the convergence, integration, and collaboration of medical professionals across political and geographical boundaries—has brought together nations with diverse cultures to pursue disease prevention and health promotion. An increasingly interconnected healthcare workforce can respond to epidemics and natural disasters more quickly and efficiently and share information that benefits a large portion of the global population. Globalization, on the other hand, has the adverse side effects of an increase in emerging and reemerging infectious diseases, such as COVID-19 or tuberculosis, which can spread quickly and be difficult to contain, as well as healthcare workforce migration, which results in the movement of trained personnel out of rural areas and into urban centers where they have better working conditions and higher pay. In fact, a shortage of health workers, particularly primary care providers such as nurse practitioners, poses significant and potentially catastrophic barriers to healthcare access in developing countries and rural areas of many industrialized countries such as the United States. Experts predict that by 2035, the global healthcare workforce will be 12.9 million people short (Ng’ang’a & Woods Byrne, 2015). Compounding the problem, demand for health care services is rising alongside the global economy, as is the incidence of chronic diseases, and the population over 60 is expected to reach 56% of the total global population by 2050. (United Nations, 2019).
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Nurse practitioners (NPs) are uniquely positioned to reform health care delivery and increase access to primary care at a lower cost if health care policy supports the global development, recognition, and legitimacy of NPs for them to achieve full practice authority. Patients in underserved areas will have a direct path to primary care if nurse practitioners can practice with their educational preparation (American Association of Nurse Practitioners (AANP), 2015). Individual states in the United States can grant full practice authority. Currently, nurse practitioners can practice and prescribe medications without the involvement of another health discipline in 22 states and territories. Other states and territories require limited or restricted practice, which requires a collaborative agreement with another provider or career-long supervision by a physician (AANP, 2020). Worldwide, the growth rate of practicing NPs is much lower than in the United States, but it has outpaced physician workforce growth in some countries by up to three to nine times since 2005. (Maier et al., 2016). Furthermore, a growing body of research indicates that nurse practitioners provide care comparable in quality to that of primary care physicians. Coupled with recent research indicating that full scope of practice authority is associated with higher NP supply in rural and primary care healthcare provider shortage areas (Xue et al., 2018), international health policies must transition to full practice authority for nurse practitioners to meet care needs in underserved areas of developed and developing countries.
Influencing a change in health policy can be difficult and complex, especially for those with little power and limited resources, because health policy advancement is rare a line (Cullerton et al., 2018). It is developed through communication and negotiations between stakeholders, such as nurse practitioners, physicians, interest groups such as nursing boards, nursing associations, and world health organizations, advisers, and bureaucrats. To begin, it is critical to collect the necessary background intelligence on this issue and provide a unified solution to capture lawmakers’ attention and persuade stakeholders of the benefits associated with granting full practice authority to nurse practitioners: data revealing rural areas and underdeveloped countries where the community lacks primary care resources and the impact of provider shortages on the people, studies revealing patient outcomes and satisfaction. Second, it is critical to establish relationships with people and organizations that support this policy change and have the ability to influence lawmakers, such as the National Academy of Medicine, American Association of Nurse Practitioners, National Council of State Boards of Nursing, Federal Trade Commission, National Governors Association, and the World Health Organization. Third, a policy champion will be needed, perhaps a state representative or senator who is influential in policy creation and understands the significant impact of allowing NPs full scope of practice. Furthermore, the need for policy change can be amplified e, by using media and social platforms and collaborating with citizens willing to put a face and a voice to the overwhelming need for primary care providers in underserved areas. To effect a similar change in countries other than the United States, international organizations with a stake in global health—the World Health Organization, Doctors Without Borders, CARES International, and the World Bank—must support and advocate for allowing nurse practitioners to practice with full authority so that they can speak to the benefits of this healthcare reform in countries around the world.
Kurt Lewin’s Change Theory can be used to create and adapt this policy change effectively. Lewin’s theory is divided into three parts: unfreeze, change, and refreeze. The first step is to unfreeze the current practice or to identify the need for change and prepare for that change. Change agents will plan ahead of time—in this case, rewriting the scope of practice for NPs in areas where it had previously been reduced or restricted—and ensure that others are prepared for the change through education and motivation (Hussain et al., 2018). The following stage is the actual change. Nursing leaders will instruct NPs about the change in their scope of practice and support their new role development in this step.
Furthermore, they will provide feedback and listen to clinician feedback on how the change is progressing and what policy changes may be required. The last stage is to freeze or provide stability and reinforcement to the change. During this stage, hospital systems and physician associations that did not initially support full practice authority for nurse practitioners will adapt to reforttoto provide quality health care to many members of the population who were not adequately served before the policy change.
The design of health care policy should be an essential consideration to promote success, as poor policy design frequently results in policy failure (Liao, 2019). Determining the format in which the policy should be designed is as much a function of the political climate of the crisis being addressed. Liberal policymakers are more likely to use capacity-building tools when crafting policy that addresses issues affecting minority populations, whereas conservatives use these tools when crafting policy aimed at businesses (Liao, 2019). Understanding the policymaker stakeholders and their healthcare objectives will aid in determining which format will be most beneficial. Similarly, the issue at hand—providing equitable healthcare to underserved populations—should be stated clearly and framed so that the government response is adequate and effective. Design tools such as incentive tools, which provide states with federal grants when healthcare desserts are eliminated and NPs with financial incentives to practice in these areas, or learning tools, which educate the public on the qualifications of NPs to provide primary care services, can be used to achieve the desired goal of granting nurse practitioners full practice authority and encouraging them to practice in areas where provider shortages have created a need. The policy should also include instructions for implementing the change and measuring its effectiveness.
However, enacting the policy will not guarantee its success. To increase the likelihood that more people in underserved areas will benefit from NP full practice authority, it is critical to educate those affected by the new policy, change administrative operations or systems as needed for implementation, monitor for both intended and unintended consequences of the change, and enforce the policy as needed (CDC, 2019). Furthermore, stakeholders should identify and coordinate resources to support NP autonomy, aor policy, program, and fiscal sustainabiliplans ty should be developed. Most importantly, the policy’s goals, as well as the roles and responsibilities of all those involved in its implementation, should be clear, and the timeline for policy change should be adequate to address pre-implementation needs while also ensuring that people who have suffered from a lack of healthcare access have greater access to quality, equitable care as soon as possible.
Evaluating the impact of NP full practice authority in developed and developing countries requires stakeholders to participate in credible data collection that corresponds with policy expectations and reflects the reality of the people served by the policy change. In addition to program process measures such as the number of patients served in a given area, health outcomes associated with NP care, and reimbursement costs for services rendered, participant data such as demographics, insurance coverage, and health status should be included. Evaluations should be transparent and provide accountability that will encourage public support and inform future policy decisions if changes are required to improve access to care in underserved areas.
Expanding the scope of practice for nurse practitioners is a global solution to the growing physician shortage. Despite objections from the American Medical Association and the American Academy of Family Physicians, which cite patient safety as the primary reason for opposing full practice authority for NPs, extensive scientific evidence suggests that the quality of care provided by nurse practitioners is equivalent to and often exceeds, that provided by physicians (Cassidy, 2013). Nonetheless, legal barriers limit NP practice, and vulnerable populations continue to face access to care. Enacting a global policy change that allows nurse practitioners autonomy will aid in providing necessary health care reform, bridging the gap between rural, underserved populations and the quality health services they deserve.
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References
American Association of Nurse Practitioners. (2015). Quality of nurse practitioner practice. AANP.org. https://www.aanp.org/advocacy/advocacy-resource/position- statements/quality-of-nurse-practitioner-practice
American Association of Nurse Practitioners (2020, October 20). State practice environment. AANP.org. https://www.aanp.org/advocacy/state/state-practice-environment
Cassidy, A. (2013, May 15). Nurse practitioners and primary care (updated). Health Affairs. https://www.healthaffairs.org/do/10.1377/hpb20130515.65357/full/
Centers for Disease Control and Prevention (2019, January 2). Polaris: Policy implementation. CDC: Office of the Associate Director for Policy and Strategy. https://www.cdc.gov/policy/polaris/policyprocess/policy_implementation.html
Cullerton, K., Donnet, T., Lee, A. & Gallegos, D. (2018). Effective advocacy strategies for influencing government nutrition policy: a conceptual model. International Journal of Behavioral Nutrition and Physical Activity, 15(1), 1–11. https://doi.org/10.1186/s12966- 018-0716-y
Hussain, S., Tavvaba, S., Muhammad, A., Haider-Sved, J. Hussain, H. & Ali, M. (2018, September-December). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge. 3(3), 123–127. https://www.sciencedirect.com/science/article/pii/S2444569X16300087
Liao, C. (2019). Public Policy Design. In J. Milstead & N. Shorts (eds.), Health policy and politics: A nurse’s guide (pp. 87–99). Jones & Bartlett Learning.
Maier, C. B., Barnes, H., Aiken, L. H., & Busse, R. (2016). Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential. BMJ Open, 6(9), e011901. https://doi.org/10.1136/bmjopen-2016-011901
Ng’ang’a, N., & Woods Byrne, M. (2015). Professional practice models for nurses in low-income countries: an integrative review. BMC Nursing, 14(1), 1–15. https://doi.org/10.1186/s12912-015-0095-5
United Nations (2019). World Population Ageing 2019: Highlights. United Nations Publications. https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopul ationAgeing2019-Highlights.pdf
Xue, Y., Kannan, V., Greener, E., Smith, J., Johnson, A., & Spetz, J. (2018, January). Full scope-of-practice regulation is associated withmoref nurse practitioners in rural and primary care health professional shortage counties. Journal of Nursing Regulation. 8(4), 5–13. https://doi.org/10.1016/S2155-8256(17)30176-X
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Directions:
Main post:
Technology in healthcare continues to advance. You have learned about technologies to facilitate communication, Clinical Information Systems, and Electronic Medical Records.
The Future of Health Care Delivery
- What impact will communication technology, Clinical Information Systems, and Electronic Medical Records have on the future of healthcare?
- Provide an example of how you see the above technologies advancing to improve the provision of safe, quality care to clients,
- How will it positively impact nursing staff?
Peer replies:
- Evaluate how the recommended technology chart on the nurse’s workload and staff satisfaction
- Provide a viable solution to the potential problem.
Please make your initial post by midweek, and respond to at least two other student posts by the week’s end. All posts require references AND in-text citations in full APA format. The information must be paraphrased and not quoted. Please check the Course Calendar for specific due dates. NOTE: Deadlines must submit finalized postings. Any edits after the deadline will be counted as late submissions and deducted accordingly. If you need to make any corrections for clarity’s sake only, you can write a supplement as a reply to yourself. The initial post will still be the one receiving ng entire grade.