Issues Pertaining to Advanced Practice Nurses

¶ … credentialing and regulatory problems encountered by Advanced Practice Nursing professionals (APNs). Further, it will explore the regulatory obstacles they come across, together with historical aspects that played a role in APN development to the level they are, at present.

Regulatory/Credential Issues

The major issues identified are education, specialty practice, practice scope, reimbursement, regulation, credentialing issues, titling, legal status, and prescriptive authority. The similarity between all the above-listed issues is that all are entrenched in regulatory terms, making it hard for advanced practice nurses to take advantage of nursing role development (Knight, 2010). Differences arise if one fails to integrate and deal with the aforementioned issues collectively, and support a collaborative bond with the remaining regulated disciplines in healthcare, at state as well as national levels. Further, these issues remain critical to APN nursing practice. Unlike ever before, APNs' profession has evolved in a new era where several diverse challenges and opportunities present themselves for newcomers. Currently, APNs are found in wide range of settings, from family practice and emergency care, to the cardiology division. For newly graduated APNs, the nursing role may pose numerous difficulties and barriers, particularly when endeavoring to adjust to their role, while simultaneously trying to stick to multiple guidelines in clinical practice (Knight, 2010).

Newly graduated APNs need to be well-acquainted with aspects like different options of payment (e.g., Medicaid, Medicare, third-party paying agencies, etc.), for ensuring proper reimbursement. Another strategy is encouraging institutions all over the nation to integrate this important lesson into mainstream curriculum. The overall nursing profession must continue a strong "equal pay for equal service" campaign; they mustn't be deemed secondary to other healthcare givers, in spite of different caring styles (Knight, 2010). Independent APNs should continue learning up to doctoral stage, for facilitating resolution of unfair prescriptive authority-linked disadvantage in the country. APNs face the following regulatory issues: prescriptive authority, nursing education, titling, practice scope, and reimbursement schemes. Board regulation differences in different states represent one challenge encountered by highly-mobile APNs. Despite the existence and prevalence of prescriptive authority for APNs, requirements continue to differ with state. Advanced practice nurses who enjoy travelling around the country, and are prone to shifting states frequently, need to check their practice scope in every individual state, since it varies considerably (Knight, 2010).

Regulatory Barriers

Care continuity improves when APRNs (advanced practice registered nurses), including NPs (nurse practitioners), charged with primary patient care, are able to follow hospitalized patients and patient families. Despite APRNs having progressed in carrying out their practice to the utmost scope of their training and education, obstacles continue to hinder smooth and uninterrupted care of patients (Brassard and Smolenski, 2011). State and federal rules and laws, together with individual hospital policies and bylaws, may block the access of hospitalized patients to the provider they wish to be treated by, if the provider of their choice is an advanced practice registered nurse.

Depending on information from the latest AANP (American Academy of Nurse Practitioners) survey, just around 43% of American NPs enjoy hospital privileges, while barely more than 50% of these enjoy admitting privileges (i.e., they are authorized to send patients from any outpatient or office setting for being hospitalized). Acute-care nurse practitioners constitute 5.6% of total NP population; NPs form part of hospitalist services' rapid expansion. For primary care NPs, hospital privileges might be essential for being regarded as PCPs (i.e., primary care providers). Normally, private health insurance agencies only allow PCP inclusion on their panel of providers, as well as to bill (in case of office-centered services) if they enjoy hospital privileges (Brassard and Smolenski, 2011). Under Medicare policies, APRNs are allowed membership to medical staff if the law in the state of practice allows it; however, Medicare doesn't mandatorily require APRN membership. Participation conditions (CoP) of Medicare consist of obstacles to APRNs attaining hospital privileges.

A paper by AARP's Public Policy Institute, Creating a 21st Century Nursing Workforce to Care for Older Americans: Modernizing Medicare Support for Nursing Education, expounded the necessity for a greater number of primary healthcare providers, offering studies and approaches to achieve this (Brassard and Smolenski, 2011). Apart from this dearth of primary healthcare providers, health service demand as well as evolving population demographics necessitates a greater quantity of well-prepared APRNs, authorized to practice nursing to the utmost extent of their training and education and easily accessible to any patient in any healthcare setting. Expanding the share of primary healthcare providers (including APRNs) forms one of the solutions to the care access issue, however, another critical element is formulating support processes and procedures for facilitating this care provision.

Profession and Professionalism

Registered Nurses are nursing professionals engaged in 2-7 years of nursing education. Though all states have their own set of regulations and rules, APNs are generally required to possess a master's nursing degree. APNs as well as RNs have to pass a preliminary state licensing test, which accords them practicing rights; this license expires after a span of two years, and needs to be renewed regularly. Education continuance credits are needed for maintaining active RN and APN licenses (Greenwood, n.d). The latter also need to pass certification test in their area of specialization. APNs as well RNs deliver direct care, however, their practice scopes differ. Scope of practice is defined as what nurses are authorized to do in their professional capacity; it is different for different states. One among the key distinctions between APNs and RNs is that the former are allowed to prescribe medical devices and medicines. Furthermore, certified nurse midwives are qualified to deliver prenatal care as well as deliver babies, whereas nurse anesthetists have general anesthesia administration authority.

APNs' responsibility level is greater than that of RNs. Certified NPs, nurse midwives, and nurse anesthetists are directly charged with wholly caring for and managing a patient cluster. For instance, RNs may monitor pregnant women in the process of labor/delivery, administer any requisite medications as well as offer direct care (e.g., back rub). On the other hand, APNs prescribe aforementioned medications and really deliver the child. RNs offer the major part of hospital-based direct care, particularly for patients who are critically ill (Greenwood, n.d). Typically, APNs conduct their practice in localities that are under-served, without sufficient physicians, or they aid physicians in handling a large number of patients, unable to be single-handedly managed by a lone healthcare professional.

Historical Factors and Development

RNs form the basis of all contemporary nursing practice. While the registration campaign isn't addressed here, a crucial point to bear in mind is that education for acquiring elementary nursing skills, and regulation, weren't a requirement since always. Specialist nurses represent the initial product of nursing's professional evolution (Barton, et.al, 2012). The basis of modern-day advanced nurses lay in the specialist nurse's introduction in America. They have been seen in medical practice during the later years of the nineteenth century; moreover, their numbers rose in America in the 30s and 40s. By the sixties, CNSs or clinical nurse specialists could be seen firmly entrenched in the profession of nursing.