APNs as Healthcare Policy Leaders
Impact of Healthcare Policy on the Advanced Practice Nurse Profession
Healthcare policies, which are the guiding principles for how healthcare is delivered, heavily impact the advanced practice nurse (APN) profession at the state and federal levels. At the state level, the APN scope of practice (SOP) is defined by either state laws or the state board of nursing (BON). States with full practice authority allow the APN to utilize all education, training, and experience to provide the patient with safe, high-quality care, while states with reduced or restricted practice authority require physician supervision to practice and limit the actions and procedures the APN can perform. Unfortunately, state-regulated APN SOP policies are not consistent across states, and sometimes, the policies do not clearly define APN roles, which causes confusion amongst other healthcare professionals about what the APN can and cannot do (Moore, 2017). Healthcare administrators who are confused by inconsistent state practice standards and poorly defined roles are unlikely to give APNs more independence and responsibility in clinical practice (Woo et al., 2017). Therefore, not allowing qualified APRNs to provide healthcare services to the full extent of their scope inhibits the delivery of accessible, competent, low-cost primary care to everyone (Moore, 2017).
Furthermore, federal laws and policies from Medicare and Medicaid also affect the APN profession. Initially, the Social Security Act did not include nurse practitioners (NPs) when referring to the health care provider, only physicians; and while the Act has been revised over the years to include NPs, there are still some aspects of providing care that only physicians are authorized to perform (Buppert, 2018). Failure to recognize nurse practitioners (NPs) as healthcare providers who are equal to physicians negatively impact APN reputation and finances. When large insurance companies such as Medicare and Medicaid do not view the nurse practitioner as equal to the physician, the APN reputation suffers because physicians, healthcare administrators, and other healthcare professionals do not take the APN role seriously. Moreover, the Medicare policy states that when billing healthcare services under APRN, the APRN will receive only 85% of what the physician would receive for the same healthcare service (Buppert, 2020). Confusion about roles and responsibilities, not being taken seriously by colleagues, and low reimbursement rates further contribute to APN’s financial burden.
Advocacy in the Advanced Practice Nurse Role
Advocacy is an essential component of the advanced practice nurse’s role. The importance of advocacy is emphasized by the American Nurses Association (ANA) in provision three of the Code of Ethics for Nurses, which states that nurses encourage, advocate for, and aim to protect the patient’s health, safety, and rights (Haddad and Geiger, 2021). Advanced practice nurses are in an incredibly unique position to advocate for patients and families since APNs have more direct interaction with patients, which creates additional opportunities to build trusting relationships (Abbasinia et al., 2019). For patients and families, the healthcare system can be
Complicated and overwhelming, which is where the APN can step in to help as a patient advocate. APNs, as advocates, act on behalf of the patient, ensure the patient’s voice is heard, and support the needs of the patient. The APN supports the patient by lending a listening ear and a shoulder to cry on when things get frustrating or by communicating patient preferences and concerns to the care team. As an advocate, the APN empowers patients and families by providing the knowledge and resources necessary to make cognizant healthcare decisions (Nsiah et al., 2019). Effective advocacy positively impacts patient care by maintaining patient autonomy, improving communication between patients and providers, and increasing safety, self-discipline, and quality of life (Abbasinia et al., 2019).
Four Pillars of Transformational Leadership
Transformational leadership is a relationship-oriented approach to leadership that is founded on motivating and inspiring followers to be ethical and aim for excellence through role modeling (M’Lingera and Guantai, 2020; Sayyadi, 2020). To be effective in creating change, transformational leaders must follow the four pillars of transformational leadership, which are idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation.
First, idealized influence means leading by example or being a good role model to followers. The idea behind idealized influence is that the leader uses good character and ethical behavior to build trusting relationships with followers, who admire the leader and will mimic the leader’s personality and behaviors (M’Lingera and Guantai, 2020). Second, inspirational motivation is how the leader influences followers to work towards mutual goals. This is accomplished by instilling a sense of purpose in followers, communicating expectations, and encouraging followers to step outside of their comfort zone and engage in new activities (M’Lingera and Guantai, 2020). Third, individualized consideration is when the leader recognizes that each follower is unique, pays attention to individual needs, and listens to concerns (M’Lingera and Guantai, 2020). Understanding followers as individuals allows the leader to better motivate followers to grow and develop. Finally, intellectual stimulation is when the leader provides opportunities for followers to be creative, independent, and have shared responsibilities with other followers (M’Lingera and Guantai, 2020). This encourages originality and innovation amongst the team and promotes different ways of approaching things.
Abbasinia, M., Ahmadi, F., & Kazemnejad, A. (2019). Patient advocacy in nursing: A concept analysis. Nursing ethics, 27(1), 141-151. https://doi.org/10.1177/0969733019832950
Buppert, C. (2018). Nurse practitioner’s business practice and legal guide (6th ed.). Jones & Bartlett.
Buppert, C. (2020). How to bill for nurse practitioner services: The basics. Medscape business of medicine. Retrieved from https://www.medscape.com/viewarticle/926845_1
Haddad, L. M. & Geiger, R. A. (2021). Nursing ethical considerations. StatPearls [Internet].
Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK526054/
Moore, C. (2017). Policies that restrict the full utilization of nurse practitioners in primary care. Nursing economics, 35(2), 70-99. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx? direct=true&db=a9h&AN=122315786&site=ehost-live&scope=site
M’Lingera, M. J. & Guantai, K. H. (2020). Nexus between pillars of transformational leadership and organizational effectiveness: A case of 21st century organizations. Journal of Business and Management, 22(3). https://doi.org/10.9790/487X-2203050113
Nsiah, C., Siakwa, M., & Ninnoni, J. (2019). Registered nurses’ description of patient advocacy in the clinical setting. Nursing open, 6(3), 1124–1132. https://doi.org/10.1002/nop2.307
Sayyadi, M. (2020). The four aspects of transformational leadership. Society for Human Resource Management. Retrieved from https://blog.shrm.org/blog/the-four-aspects-of- transformational-leadership
Woo, B. F., Lee, J. X., & Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review. Human resources for health, 15(63). https://doi.org/10.1186/s12960-017-0237-9
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APNs as Healthcare Policy Leaders
The purpose of this assignment is to discuss the healthcare policy of the APN profession and how Transformational Leadership can help to influence policy changes. This week’s assignment focuses on the APN as a Health Policy Leader, one of the nine NONPF NP competencies. Students will analyze how health policy may affect NP practice and how Transformational Leadership can help to influence policy changes.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
1. Critically analyze how healthcare systems and APRN practice are organized and influenced by ethical, legal, economic, and political factors (CO2)
2. Demonstrate professional and personal growth concerning the advocacy role of advanced practice nursing in fostering policy within diverse healthcare settings (CO3)
3. Advocate for institutional, local, national, and international policies that fosters person-centered healthcare and nursing practice (CO4)
Preparing the Discussion
Criteria for Content
· Explanation of how healthcare policy can impact the advanced practice nurse profession
· Explanation of why advocacy is considered an essential component of the advance practice nurse’s role
· Discuss the four pillars of Transformational leadership and the effect they may have on influencing policy change
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