Advanced practice nursing roles and responsibilities

Advanced practice nursing (APN) is one of the nursing fields that plays a critical role in the promotion of the health and wellbeing of patient populations. APN is regarded as the usage of a wider scope of logical, constructive, and research-based competence relating to patients’ health and wellbeing. This field incorporates knowledge and expertise from a variety of disciplines that are critical in the healthcare sector. Given the acute nursing shortage that characterize the modern healthcare environment, advanced practice nursing has emerged as an important components of the health sector. This is attributable to the key roles that advanced practice nurses play in enhancing health outcomes of diverse patient populations. This paper examines various issues relating to the field of advanced practice nursing in relation to the critical role it plays in the modern healthcare sector.
Regulatory Provisions to Full Deployment of Advanced Practice Nurses
According to Hain & Fleck (2014), advanced practice nurses play an important role in enhancing the health outcomes of diverse patient populations. Consequently, the full deployment of these nurses in the current healthcare setting is considered critical toward enhancing the effectiveness and efficiency of the nursing workforce. However, the full deployment of APNs in current healthcare is governed by various regulatory provisions relating to the nursing profession and nursing practice. Safriet & Clark (2010) suggests that advanced practice nursing is characterized by conflicting and limiting state provisions that govern the prescriptive authority and scope of practice of advanced practice nurses.
One of the regulatory provisions to full deployment of APNs in current healthcare is state-based restrictions on the licensed scope of practice for these professionals. This regulatory provision is a major obstacle to the full deployment of APNs since it limits their ability to practice to the full extent of their capabilities (Safriet & Clark, 2010). State regulations seemingly prevent APNs from practicing to the full extent of their capabilities by imposing limitations on the basis of defining scope of practice. Some states have enacted regulations that determine APNs scope of practice based on their expanding skills, training, education, and abilities. On the other hand, some states rely on outdated regulatory provisions, which limit the total range of professional services provided by APNs. Some of these restrictions on scope of practice imposed by outdated regulatory provisions include limitations on prescription of medications, patient admission to healthcare facilities, and patient assessment. Lugo (2016) argues that limitations on APNs scope of practice in the United States are determined at the state level through rule making or legislation. Therefore, the full deployment of advanced practice nurses in current healthcare is dependent on state regulations on their scope of practice.
The second regulatory provision to full deployment of APNs in today’s health sector is payment or reimbursement policies. Such governmental or private regulatory provisions affect APNs’ full deployment through rendering them ineligible for payment or excluding them from receiving direct payment for their services. In addition, such regulatory provisions limit APNs’ full deployment through offering payments at significantly discounted rates for similar services rendered by physicians. Payment and reimbursement policies are vital in APNs scope of practice and full deployment since they influence their motivation to provide healthcare services to patient populations. States that adopt progressive payment and reimbursement policies for APNs enhance their involvement in the healthcare environment and improve their full deployment. On the contrary, states with outdated policies on payment and reimbursement limit the full deployment and motivation of advanced practice nurses in today’s healthcare. Payment and reimbursement also affect the ability of the health sector to retain APNs.
Principal Causes of Current Barriers to Removal of Restrictive Provisions of APNs
As shown in the previous segment, APNs scope of practice in the modern healthcare environment is characterized by restrictive regulatory provisions. The restrictive provisions are in their scope of practice and payment and reimbursement. Given the restrictive nature of these provisions, advanced practice nursing field requires removal of these limiting provisions in order to enhance its efficiency and effectiveness in the health sector. However, the removal of these restrictive provisions of APNs is hindered by some barriers. These barriers support the existence and protraction of these unnecessary restrictive provisions that limit APNs practice conditions.
Safriet & Clark (2010) states that there are three principal causes of current barriers toward removing these restrictive regulatory provisions. The first principal causes of these barriers is the deliberate or inertial retention of dysfunctions due to the historical evolution of state-based licensure scheme. State-based licensure schemes authorize licensed physicians to undertake nearly all kinds of medical or health interventions. This inadvertently contributes to the retention of dysfunctions that in turn limits the scope of practice of APNs though their competence exceeds their authority. While APNs can legally do more than they are permitted to, deliberate retention of dysfunctions generates complexities in removal of restrictive provisions.
Secondly, the removal of restrictive provisions of APNs is hindered by lack of awareness regarding the role and abilities of APNs. Carter et al. (2013) contend that the implementation of APNs in the modern healthcare setting has the potential of generating improvements in patient and health system outcomes. However, this implementation or deployment process is affected by the lack of awareness of the roles and abilities of APNs in relation to enhancing patient and health system outcomes. As a result, this acts as a major impediment toward the removal of restrictive provisions that affect the work of APNs in current healthcare. This lack of awareness of the roles and abilities of APNs is not within the health sector alone, but is more amorphous in the general public (Safriet & Clark, 2010).
The third principal cause of the failure to remove restrictive provisions of APNs is the continued opposition to expansion of the authority of other healthcare providers by organized medicine. In this case, organized medicine has supported the maintenance of the status quo on the authority of other healthcare providers in the healthcare delivery processes. Additionally, the status quo has also been preserved in the direct payment of services provided by other healthcare providers. Even though many physicians have acknowledged and supported the full APNs’ scope of practice, the lack of support for full deployment of these practitioners perpetuate the maintenance of restrictive provisions of APNs (Chesney, 2015). While some states have undertaken legislative reforms to remove regulatory inertia on this issue, such measures are yet to be implemented in all states.
Proposed Strategies for Change
Given the restrictive nature of these regulatory provisions on the work and contributions of APNs to modern healthcare practice, the nursing field requires changes. The removal of the restrictive regulatory provisions would play a critical role toward the full practices of APNs in today’s healthcare field. This would help enhance their contributions toward improved patient and health systems outcomes as they practice to their full extent. Professional associations, administrators, and legislators are aware of the difficulties associated with attempts to reconcile regulatory authority with growing clinical abilities. However, these stakeholders have been slow to develop an awareness for the need of change in public and policymaking areas.
Safriet & Clark (2010) proposes several strategies that can be utilized to promote change in the full deployment and practice of advanced practice nurses in today’s healthcare environment. They contend that the change process should be implemented at the federal level. In this case, one of the proposed strategies for change is rationalizing education, licensure, and compensation. This would require developing a rational and effective educational and regulatory framework for the nursing workforce, particularly APNs. Secondly, the desired change can be achieved through articulating national priorities and generating public awareness. Using an Executive Order or other suitable mechanism, the federal government can declare that the highest and optimum utilization of APNs and other healthcare providers is a national priority. As part of the objective of promoting wider access to affordable quality care, the federal government should declare that unnecessary limitations on the scope of practice of healthcare providers hinder the creation of innovative and efficient healthcare delivery systems. Public awareness on this issue could be achieved through launching a public information campaign.
The third proposed strategy is identification, integration, and publicizing best practices in a framework of preferred scope of practice. This would entail the creation of a Healthcare Workforce Commission with various responsibilities that focus on identifying problems in the current system and establishment of attainable, preferred practices. The other strategies include: incentivizing the states to adopt the framework of preferred scope of practice, ensuring the visibility of APNs and consideration of their roles, monitoring anti-competitive behavior, rationalizing professional education and training opportunities and associated payment schemes for APNS, promoting parity in the recognition and payment of APNs, and using available measures to enhance APNs’ practice context (Safriet & Clark, 2010).
The most suitable strategy for change is to promote parity in the recognition and payment for services of all healthcare providers. This strategy would help create change since APNs full extent of abilities is not fully acknowledged in the modern healthcare sector and legislative framework. The lack of recognition of the full extent of abilities of APNs, particularly in relation to enhancing patient and health system outcomes has contributed to the enactment of restrictive regulatory provisions. These provisions also extend to the payment and reimbursement of services rendered by these nursing practitioners. Therefore, the change process in APNs scope of practice commences with promoting parity in their recognition and payment services in relation to those offered by other healthcare providers. Safriet & Clark (2010) contends that this would require making changes in state regulations to permit APNs to function independently without supervision by any other healthcare provider. Additionally, states should change current legislation that promotes optional recognition of nurse practitioners and certified nurse midwives as Medicaid Primary Care Case Managers.
Al Maaitah & AbuAlRub (2017) contends that expansion of APNs role and scope of practice requires a solid regulatory framework. Such regulatory framework would promote parity in recognition and payment services of APNs through ensuring and sustaining a legal status for expansion of APNs’ role. Heale & Buckley (2015) support such measures by arguing that the role and deployment of APNs in today’s healthcare is supported through clear, solid legislation and regulation. Therefore, solid regulatory framework is the premise for promoting change on this issue through establishing parity in recognition and payment services.
Importance of this Knowledge to a Prospective APN
This knowledge is important to prospective APNs since their nursing practice will be affected by existing state regulatory or legislative provisions. Prospective APNs need to examine the regulatory provisions of their specific state to determine their scope of practice and identify any existing barriers that limit their deployment in the health sector. Through this knowledge, a prospective APN will understand what is required of him/her in the clinical setting from a regulatory perspective. The prospective nurse will then determine the extent with which he/she can practice and apply his/her knowledge and skills in enhancing patient and health system outcomes. This implies that having this knowledge enables the prospective APN to avoid future confusion that could emerge in his/her scope of practice.
Application of this Knowledge by Prospective APNs
A prospective APN could apply this knowledge in implementing of his/her advance practice role through conducting a research on existing state laws regarding scope of practice and payment and reimbursement policies. In addition, the prospective APN should conduct research and integrate research findings into his/her specific practice. Integration of research findings into nursing practice would help enhance the effectiveness of the prospective APN in enhancing patient and health system outcomes (Pepler et al., 2006). The prospective APN could use information regarding regulatory provisions to advocate for changes in the healthcare setting or environment. Through advocacy, the prospective APN would play a critical role in the recognition of APNs full extent of abilities and their integration into nursing practice.
In conclusion, advanced practice nursing is a critical component of nursing practice in relation to enhancing patient and health system outcomes. However, APNs full scope of practice and payment and reimbursement services is affected by restrictive regulatory provisions. These provisions limit the abilities of APNs to practice to the full extent of their abilities. While the need for change is recognized by various stakeholders in the health sector, the removal of restrictive provisions of APNs is limited by some barriers. The principal causes of these barriers include deliberate or inertial retention of dysfunctions, lack of awareness of APNs roles and abilities, and ongoing opposition to expansion APNs authority. Prospective APNs need to understand this knowledge to help avoid confusion in their future advance practice.
References
Al Maaitah, R. & AbuAlRub, R.F. (2017, January 30). Exploration of Priority Actions for Strengthening the Role of Nurses in Achieving Universal Health Coverage. Revista Latino-Americana de Enfermagem, 25. Doi: 10.1590/1518-8345.1696.2819
Carter, N., Dobbins, M., Ireland, S. & Hoxby, H. (2013, December). Knowledge Gaps Regarding APN Roles: What Hospital Decision-Makers Tell Us. Nursing Leadership, 26(4), 60-75.
Chesney, M.L. (2015, May/June). Increasing Families’ Health Care Access and Choice Through Full Practice Authority. Journal of Pediatric Health Care, 29, 219-221.
Hain, D. & Fleck, L.M. (2014, May). Barriers to NP Practice that Impact Healthcare Redesign. The Online Journal of Issues in Nursing, 19(2). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html
Heale, R. & Buckley, C.R. (2015, June). An International Perspective of Advanced Practice Nursing Regulation: APN Regulation. International Nursing Review, 62(3), 421-429.
Lugo, N.R. (2016, May). Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue. The Online Journal of Issues in Nursing, 21(2). Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No2-May-2016/Articles-Previous-Topics/Full-Practice-Authority-for-APRN.html
Safriet, B.J. (2010). Federal Options for Maximizing the Value of Advanced Practice Nurse in Providing Quality, Cost-Effective Health Care. In The future of nursing: leading change, advancing health (H1-H29, Washington, DC: National Academy of Sciences).
Pepler, C., Edgar, L., Frisch, S. & Rennick, J.E., Swidzinski, M., White, C., Brown, T. & Gross, J. (2006, January). Strategies to Increase Research-based Practice. Clinical Nurse Specialist, 20(1), 23-31.