Barriers to Practice in California and the APN Role
Practice Barriers for APNs Roles in California
Barriers to practice for APNs roles such as nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist may vary from state to state and at the national level. These barriers have determined how APNs can practice to their full potential and training as recommendations of IOM with a negative impact on access to essential care services (Germack, 2020). California has been among the states restricting APNs’ practice requiring them to work under physicans’ supervision. However, such restrictions are selective based on the APNs’ role. For instance, nurse midwives require full physician supervision to practice. On the other hand, Nurse Practitioners will be granted full practice authority to practice independently in California from January 2023; however, they will be required to complete three years in nursing settings with independent practice (Hughes, 2021).
Forms of Competition Interfering with the Ability of APNs to Practice Independently
APNs face a lot of competition at the state and national levels, which interferes with their ability to achieve authorization for full practice authority. APNs and physician assistants perform similar roles, such as carrying out diagnoses, educating and counseling patients, as well as in specialized medicine such as family care, pediatrics, and oncology. APNs may face competition from physician assistants to fill in the roles available in the practice of general or specialized medicine. Besides the competition from physician assistants, physicians also view the recognition of APNs as primary care providers to be a threat to the physician’s role. The physicians have pushed to bar the recognition of nurses as primary care providers and push against the awarding of APNs full practice authority. Physicians through related professional associations such as the American Medical Association (AMA) have openly fought against the expansion of practice authority granting independent practice for APNs, citing patient safety risks (American Medical Association (AMA), 2022). However, policymakers believe that APNs strategically improve the quality-of-care patient experiences (Begley et al., 2014).
Specific Lawmakers
The key members of California’s state executive branch of the government are; Governor Gavin Newsom, a Democrat and the 40th governor of California since 2019, and Eleni Kounalakis, a Democrat who has been the 50th lieutenant governor of California since 2019. She was the first female lieutenant governor of California. Shirley Weber, Democrat and current secretary of the state of California; Rob Bonta, a Democrat and current attorney general of California state; Fiona Ma, a Democrat and the current California State Treasurer; and Betty Yee, a Democrat and current California State Controller. Other key members of the legislative and executive brand of the California State government include Tony Thurmond, the current State Superintendent of Public Instruction, and Ricardo Lara, the current Insurance Commissioner and both Democrats.
Interest Groups that Influence APN Policy
Various interest groups exist in California and the state nationally that are continuously pushing to influence levels of APN policy. These include various stakeholders in support or against policies that grant APNs in California and at the national level to be certified for independent practice and recognized as primary care providers. The major interest groups in California and at the national level lobbying for policies that grant APNs full practice, diagnosing, and prescription authority include the California Association for Nurse Practitioners (CANP), American Association of Nurse Practitioners (AANP), the Federal Trade Commission (FTC), Centers for Medicare & Medicaid Services (CMS), and Veterans Health Administration (VHA). The interest groups lobbying against policies that grant APNs full practice authority include the California Medical Association (CMA), the American College of Physicians (ACP), and the American Medical Association (AMA).
Methods for Influencing Change in Policies
The two major methods interest groups and the government use to change policies are lobbying and participation. Lobbying may include sensitization of the members of the legislature and executive branches on the need for policy change. The interest groups may also lobby for policy changes by targeting relevant members of the policy committee and providing the information needed for policy change or providing the necessary funding to support the policy change. Additionally, interest groups may take advantage of their influence to conduct insider lobbying using their colleagues, making it easy to initiate policy changes. This approach to lobbying creates bias during policy change and leads to a compromised policy change or development process (Wolton, 2019). Participation is another technique that interest groups use to influence policy changes. Interest groups can participate in outreach programs or provide views on policies, and engage in voting to approve policy change or keep the policy’s status quo.
References
American Medical Association (AMA). (2022). AMA successfully fights scope of practice expansions that threaten patient safety. https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten
Begley, C., Murphy, K., Higgins, A., & Cooney, A. (2014). Policy-makers’ views on impact of specialist and advanced practitioner roles in Ireland: the SCAPE study. Journal of Nursing Management, 22(4), 410–422. https://doi.org/10.1111/JONM.12018
Germack, H. D. (2020). States should remove barriers to advanced practice registered nurse prescriptive authority to increase access to treatment for opioid use disorder. Policy, Politics, & Nursing Practice, 22(2), 85–92. https://doi.org/10.1177/1527154420978720
Hughes, K. (2021, November 19). California Nurse Practitioner Full Practice Authority! http://www.nurseallianceca.org/2021/11/19/california-nurse-practitioner-full-practice-authority/
Wolton, S. (2019). Lobbying, Inside and Out: How Special Interest Groups Influence Policy Choices. SSRN Electronic Journal. https://doi.org/10.2139/SSRN.2190685
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Question 
Week 1: Barriers to Practice (Orig Post due Wednesday, Responses due Sunday)
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Purpose
Discuss barriers to practice as an APN in one’s state (CALIFORNIA 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.
Barriers to Practice in California and the APN Role
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)
Due Date: Wednesday by 11:59 pm MT of Week 1
Initial responses to the discussion topic must be posted by Wednesday 11:59 pm MT. Two additional posts to peers and/or faculty are due by Sunday at 11:59 pm MT. Students are expected to submit assignments by the time they are due.
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday of week 1 by 11:59PM MST, regardless of the number of days late. NOTHING will be accepted after 11:59 pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59 pm MT.
Total Points Possible: 100
Requirements:
Using the readings from this week as well as outside reliable resources to:
Identify and describe practice barriers for all four APN 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 APN’s 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 form of competition, state legislative and executive branches of government, and interest groups.
A scholarly resource must be used for EACH discussion question each week.
DISCUSSION CONTENT
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