Introduction One of the main objectives of the Office of Disease Prevention and Health Promotion’s Healthy People 2020 campaign is to increase access to care for patients (ODPHP, 2018). However, with more and more primary care physicians leaving primary care for specialized medicine, there is a gap in care coverage. That gap could be filled if advanced practice registered nurses (APRNs) were permitted to practice to the full extent of their education and training—but they are not. The Institute of Medicine (IOM, 2010) recommends that they should and gives explicit steps on how that recommendation can come about.

Selected Recommendation

Recommendation #1: “Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training. To achieve this goal, the committee recommends the following actions” (IOM, 2010, p. 1).

Background

The field of nursing was originally promoted to help fill the gap created by the demand for services and the lack of providers in the latter half of the 20th century when more and more people began using health care. Throughout the ‘50s and ‘60s, physicians collaborated with and trained nurses so that the latter would be able to give primary care to patients (O’Brien, 2003). However, there was no adequate channel for credentialing these nurses, and their education and training was never quite put to use in the way it was intended. The IOM (2010) has stressed that now is the time to make that happen.

Current Characteristics

Some states are beginning to listen to what the IOM (2010) has urged. The Robert Wood Johnson Foundation (2015) reports that “in March, Nebraska granted nurse practitioners (NPs) the ability to provide the full complement of services they are educated and trained to deliver. In May, Maryland enacted its own ‘full-practice authority’ law. And similar legislation is pending in many other states.” However, many other states are still behind the curve and old laws preventing nurses achieving the full scope of their practice remain on the books.

Impact of the Recommendation

From the Perspective of Consumers

Consumers would benefit because they would have increased access to care.

From the Perspective of Nurses

Nurses would benefit because they would finally be free from all scope-of-practice barriers.

From the Perspective of Other Health Professionals

Other health professionals such as primary care physicians would benefit because there would be less pressure and stress placed on them to provide all the access points to care.

From the Perspective of Additional Stakeholders

Legislators and the communities they represent would benefit because the former would enjoy the appreciation and support of their constituents, who would benefit because their communities would now have greater freedom to gain access to care.

Current Solutions

The current solution, recommended by the IOM is to eliminate scope-of-practice barriers by expanding and amending the Medicare program to cover services provided by APRNs in the same manner that they cover the services provided by physicians.

Other solutions include (IOM, 2010):

· Extend the increase in Medicaid reimbursement rates for primary care physicians included in the ACA to advanced practice registered nurses providing similar primary care services.

· Limit federal funding for nursing education programs to only those programs in states that have adopted the National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules (Article XVIII, Chapter 18).

· Require insurers participating in the Federal Employees Health Benefits Program to include coverage of those services of advanced practice registered nurses that are within their scope of practice under applicable state law.

· Review existing and proposed state regulations concerning advanced practice registered nurses to identify those that have anticompetitive effects without contributing to the health and safety of the public. States with unduly restrictive regulations should be urged to amend them to allow advanced practice registered nurses to provide care to patients in all circumstances in which they are qualified to do so

Final Conclusions

The IOM’s (2010) recommended solutions would help to bring about more equity in the health care industry by granting APRNs the freedom to practice to the fullest extent of their education and training. The Office of Disease Prevention and Health is calling for greater access to care for patients all over the U.S.—and nothing could make...

(2010). The future of nursing. Retrieved from http://nacns.org/wp-content/uploads/2016/11/5-IOM-Report.pdf
O’Brien, J. (2003). How nurse practitioners obtained provider status: Lessons for pharmacists. American Journal of Health-System Pharmacy, 60(22), 2301-2307.

ODPHP. (2018). Access to health services. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

Robert Wood Johnson Foundation. (2015). More states removing barriers to nurses’ scope of practice. Retrieved from https://www.rwjf.org/en/library/articles-and-news/2015/07/more-states-removing-barriers.html

2: Policy Analysis

Part 1: Defining the Policy Issue

As the Institute of Medicine (IOM, 2010) has recommended, advanced practice registered nurses (APRNs) must be able to practice to the fullest extent of their education and training. The IOM (2010) asserts that states must “remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training” (p. 1). This policy issue is an important one because it addresses a serious issue in today’s health care environment—the lack of access to care for many patient.

One of the main objectives of the Office of Disease Prevention and Health Promotion’s Healthy People 2020 campaign is to increase access to care for patients (ODPHP, 2018). However, with more and more primary care physicians leaving primary care for specialized medicine, there is a gap in care coverage. That gap could be filled if APRNs were permitted to practice to the full extent of their education and training—but they are not. The Institute of Medicine (IOM, 2010) recommends that they should and gives explicit steps on how that recommendation can come about.

How the Issue Affects the Policy Arena

The field of nursing was originally promoted to help fill the gap created by the demand for services and the lack of providers in the latter half of the 20th century when more and more people began using health care. Throughout the ‘50s and ‘60s, physicians collaborated with and trained nurses so that the latter would be able to give primary care to patients (O’Brien, 2003). However, there was no adequate channel for credentialing these nurses, and their education and training was never quite put to use in the way it was intended. The IOM (2010) has stressed that now is the time to make that happen. This policy affects the policy arena because it calls for a change in the laws and legal framework regarding the practice of medicine, reimbursements, coverage, etc.

Current Politics of the Issue

Some states are beginning to listen to what the IOM (2010) has urged. The Robert Wood Johnson Foundation (2015) reports that “in March, Nebraska granted nurse practitioners (NPs) the ability to provide the full complement of services they are educated and trained to deliver. In May, Maryland enacted its own ‘full-practice authority’ law. And similar legislation is pending in many other states.” However, many other states are still behind the curve and old laws preventing nurses achieving the full scope of their practice remain on the books, and federal law has not budged regarding allowing APRNs to be reimbursed under Medicare.

Level in the Policy Making Process of This Issue

At this time, this issue is being addressed at the state government level. Federal level policy would also have to be addressed in order to meet the recommendations of the IOM (2010) regarding expanding and amending the Medicare program.

Part 2: Applying a Policy Analysis Framework to Explore the Issues

Social Context

American physicians began working closely with clinically-experienced nurses as the need arose in the 20th century. The growing demand for specialized services had caused a number of physicians to leave primary care service behind and focus more exclusively on providing specialized care. This exodus had produced a gap in primary care in many regions of the country. As a result, many patients were not receiving the kind of care they required and desired. Throughout the 1950s and 1960s, doctors collaborated with and trained nurses to offer primary care to these patients (O’Brien, 2003). By 1965, the U.S. provided Medicare and Medicaid to health care patients whose low income meant they were unable to pay for health care. By subsidizing health care costs, the government increased demand for primary care. As physicians had already been moving into specialized care services, nurses…