Week 1 Discussion Barriers to Practice
Peer Response
Hello, great work with your post. Notably, this is an informative discussion about the concerns affecting advanced practice nurses (APNs) at the federal and state levels. The breakdown of the barriers to practice, especially the restrictions to license transfer and restrictive scope of practice due to state regulation, is noteworthy. For example, in Georgia, stipulations such as the collaborative practice agreement with a physician significantly hinder APNs’ autonomy and their capacity to practice independently (Kleinpell et al., 2023). Challenges, such as restrictions on prescriptive authority, are undeniable barriers to providing quality healthcare.
However, the information relating to national-level issues, including the issue of insurance reimbursement rates for APNs being lower than for physicians and the role played by professional associations in the formulation of legislation, highlights systematic barriers that require consideration (Schorn et al., 2022). The rivalry between NPs, MDs, and PAs adds to the complexity of the professional field, resulting in unnecessary rivalry and a possible negative effect on the quality of patient care, as suggested by Morgan et al. (2019).
The details given about the difficulties faced by nurse midwives and clinical nurse specialists are perhaps the most striking. Required partnership and physician oversight for certified nurse midwives limit practice independence, and CNSs encounter challenges with payment and limited recognition of healthcare professionals and consumers (Wheeler et al., 2022). These barriers are not only restrictive of the capacity to practice but also of the capability to fully acculturate into healthcare networks.
Lastly, while using the examples of the legislative structure in Georgia and the roles of different representatives, the study demonstrates how APNs can advance policies. Therefore, to address these challenges, there is a need to interact with elected officials, attend legislature hearings, and develop interest groups. As supported by Chiu et al. (2021), the assertion that political processes and advocacy for APNs are crucial serves as a strong message about further enhancing practice environments and healthcare outcomes.
References
Chiu, P., Cummings, G. G., Thorne, S., & Makaroff, K. S. (2021). Policy advocacy and nursing organizations: A scoping review. Policy, Politics, & Nursing Practice, 22(4), 276–296. https://doi.org/10.1177/15271544211050611
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
Morgan, P. A., Smith, V. A., Berkowitz, T. S. Z., Edelman, D., Van Houtven, C. H., Woolson, S. L., Hendrix, C. C., Everett, C. M., White, B. S., & Jackson, G. L. (2019). Impact of physicians, nurse practitioners, and physician assistants on utilization and costs for complex patients. Health Affairs, 38(6), 1028–1036. https://doi.org/10.1377/hlthaff.2019.00014
Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a national survey: Ongoing barriers to APRN practice in the United States. Policy, Politics, & Nursing Practice, 23(2), 118–129. https://doi.org/10.1177/15271544221076524
Wheeler, K. J., Miller, M., Pulcini, J., Gray, D., Ladd, E., & Rayens, M. K. (2022). Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study. Annals of Global Health, 88(1), 1–21. https://doi.org/10.5334/aogh.3698
ORDER A PLAGIARISM-FREE PAPER HERE
We’ll write everything from scratch
Question 
Week 1 Discussion Barriers to Practice
Respond to your peer’s discussion post.
Week 1 Discussion Barriers to Practice
Peer’s Post
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.
Professor & Class,
Advanced practice nurses (APN), including nurse midwives, nurse anesthetists, nurse practitioners, and clinical nurse specialists unfortunately will all run into barriers to practice at the federal and state levels. A significant obstacle encountered by all four APNs is the mobility of their licenses. APNs’ scope of practice is restricted by state-level constraints, such as limitations on their ability to conduct certain procedures, prescribe, and have practice autonomy. APNs’ capacity to offer autonomous care is restricted in several places by laws requiring them to collaborate with physicians or operate under their supervision. APNs can only operate standalone clinics or work in specific healthcare institutions due to rigorous laws in these areas. I will be practicing in the state of Georgia and reviewing their precise laws and regulations. Due to Georgia’s ban on full practice authority, all four APN responsibilities encounter difficulties. Rather, the state has limited practice under Georgian law, which necessitates that a nurse practitioner must establish a collaborative practice agreement with a physician to engage in the profession. These limitations cover teamwork, career monitoring, delegating, and physician management. The prescription authority is limited to a nurse’s agreement with a physician or by a physician’s delegation. To acquire prescriptive authority, the nurse practitioner must first secure a nursing protocol agreement. Before becoming an APN, this agreement needs to be filed to and authorized by the Georgia Composite Medical Board. Only scheduled III–V medications may be prescribed by nurse practitioners. At the national level, a lot of nurse practitioners go unnoticed since a lot of people think they aren’t doctors and can’t offer high-quality patient care. On a federal level, an APN is limited by set policies that affect their practice authority and pay (American Association of Nurse Practitioners [AANP], 2021b). For example, current federal laws limit nurse practitioners from making patient diagnoses related to workplace injuries (AANP, 2021b).
The same obstacles that face nurse practitioners also affect registered nurse anesthetists. Practice restrictions, doctor supervision, and getting paid for services rendered. All things considered, Georgia’s limitations on APN practice impede the APNs’ capacity to deliver high-quality treatment as a whole. On a federal level, the APN is limited by set policies that affect their practice authority and pay (American Association of Nurse Practitioners [AANP], 2021b).
Obstacles for nurse midwives include lack of integration, restricted practice environments, and regulatory concerns. For instance, mandated collaboration and physician supervision, which restrict or limit their practice autonomy and impede their ability to make decisions. Not to mention how restricted laws limit their capacity to practice in hospitals and birth centers. Finally, because midwives find it difficult to fully integrate into many health care systems, they have less access to networks for referrals and collaborative opportunities.
Lastly, the obstacles that clinical nurse specialists (CNS) must overcome include limitations on their scope of practice and difficulties with reimbursement. As an example, the clinical nurse specialist (CNS) has restricted prescribing authority, just as the nurse practitioner. Similarly, the clinical nurse specialist function may be hindered by the lack of understanding among many healthcare workers, administrators, and patients. In terms of government reimbursement and coverage denials from insurance providers, the CNS, like other APNs, faces numerous obstacles.
Barriers at the national level encompass differences and imbalances between various categories of healthcare providers. For example, APN insurance reimbursement rates are lower at the Centers for Medicare and Medicaid Services (CMS) than physician insurance rates. The ability of an APN to offer care services to Medicare enrollees may be impacted by these variations in compensation. APNs’ scope of practice may also be restricted by professional associations that represent doctors or other healthcare practitioners. The practice of APNs may be hampered by this opposition’s ability to affect legislative and regulatory decision-making.
Nurse practitioners compete with physicians, physician assistants, and other nurses in the healthcare industry. Because they have invested so much in their careers, doctors may see nurse practitioners as competitors. In a similar vein, physician assistants could view nurse practitioners as rivals and strive for respect and acknowledgement for their work. Since I live in Georgia, I am not allowed to practice law fully. Rather, the state has limited the practices under its jurisdiction. These limitations include collaboration, career supervision, delegating, and management by another healthcare professional. As a result, in order to work in the state, a nurse practitioner and a physician must sign a collaborative practice agreement. This leads to competition by limiting the options for APN’s to work under which in turn causes competition for employment.
The Georgia General Assembly consist of the Georgia State Senate and the House of Representatives. The Georgia General Assembly holds the power in the state to create, change, or remove current laws. They are the voices for the residents in the state of Georgia. There are 56 state senators in Georgia. The Georgia State Senate is led by the Lieutenant Governor Burt Jones (U.S. Senate: States in The Senate | Georgia, 2023b). Jon Ossoff and Raphael G. Warnock are 2 state senators at the national level (U.S. Senate: States in The Senate | Georgia, 2023b). Likewise, there are 180 elected members of the House, one for each district. The speaker of the House is Jon Burns (R-Newington) he represents the 159th legislative district of Georgia but, also serves as the presiding officer of the legislative body (Georgia.gov, 2022). Dar’shun Kendrick is a member of the House of Representatives that represents the 95 th district where I reside. Georgia is considered the 13th congressional district and is represented by David Scott at the national level (U.S. Senate: States in The Senate | Georgia, 2023b).
The Advance Practice Nurse policies are influenced by a number of state and national organizations. An interest group known as the Georgia Board of Nursing was established on August 22, 1907, and it is responsible for regulating advanced practice registered nurses as well as registered professional nurses. Among their duties is formulating policies and guidelines that establish the benchmarks for nursing practice and instruction. Additionally, the Georgia Board of Nursing sets the requirements for licensure and makes sure that the disciplinary procedure is carried out in a way that protects the public interest and due process (Georgia Board of Nursing | Georgia Secretary of State, n.d.). Similarly, the American Association of Nurse Practitioners (AANP) counts Georgia Board of Nursing as a member. Moreover, the national interest group is the American Association of Nurse Practitioners (AANP). At the state and federal levels, AANP speaks for and represents nurse practitioners (NP) in healthcare policy and legislation. The American Association of Nurse Practitioners (2023) states that the objective of AANP is to enable all nurse practitioners (NPs) to promote equitable, person-centered, accessible, and high-quality healthcare for a variety of communities through practice, education, advocacy, research, and leadership.
Advanced Practice Nurses (APNs) have the option to support or enter politics as a candidate advocating for their particular topic. bringing attention to the special contributions made by APNs as well as the difficulties they face every day. For instance, supporting, among other things, the availability of healthcare services, greater scopes of practice, and reimbursement reforms. By fostering a relationship with their elected official and sharing their evidence-based concerns for policy reform, APNs can interact with lawmakers and executives at the Georgia state legislative and executive branches in order to influence policy change. APNs can also serve as expert witnesses, take part in legislative hearings, and work with organizations like the America Association of Nurse Practitioners (AANP). Another successful tactic is to start an interest group dedicated to the APNs agenda. One way to advocate for improvements in nursing policies is by starting a support organization, like the America Association of Nurse Practitioners (AANP). I receive a weekly bulletin outlining current legislative topics and requesting my cooperation as a current student member of the AANP.
References
American Association of Nurse Practitioners. (2024, July 07). AANP | The American Association of Nurse Practitioners. https://www.aanp.org/Links to an external site.
American Association of Nurse Practitioners. (2021b). Federal policy priorities. https://www.aanp.org/advocacy/federal/federal-issuebriefs/aanpfederalpolicy-prioritiesLinks to an external site.
Georgia Board of Nursing | Georgia Secretary of State. (n.d.). https://www.sos.ga.gov/georgia-board-nursingLinks to an external site.
Georgia.Gov. (2022). Who Represents You. Georgia.gov. https://georgia.gov/who-represents-youLinks to an external site.
Georgia Secretary of State. (2023). PLB: Licensing. Plb | Licensing. Retrieved July 08, 2024, from https://sos.ga.gov/index.php/licensing/plb/45/authorization_as_an_aprnLinks to an external site.
How to Guide: APRN / NP | Georgia Secretary of State. (2023). Georgia Secretary of State. Retrieved July 08, 2024, from https://sos.ga.gov/how-to-guide/how-guide-aprn-npLinks to an external site.
U.S. Senate: States in the Senate | Georgia. (2024, July 07). https://www.senate.gov/states/GA/intro.htmLinks to an external site.