This paper examines the evolving status of advanced practice nurses (APNs) in the United States, focusing on expanding scopes of practice, key stakeholders, and legislative strategies. It identifies all Americans as stakeholders given APNs' role in improving healthcare access and reducing costs. The paper outlines advocacy efforts by major nursing organizations — including the AACN, ANA, and AANP — and highlights a proposed federal policy that would grant full practice authority to APNs working in Department of Veterans Affairs facilities nationwide, regardless of individual state laws, as a significant step toward broader healthcare reform.
The status of advanced practice nurses (APNs) in the United States has changed significantly in recent years, and the scope of their practice now extends into areas that were previously unavailable to them. The American Association of Colleges of Nursing (AACN) reports that APNs can now prescribe medications in at least 45 states. An additional 16 states — including Alaska, Arizona, Colorado, Hawaii, Idaho, Iowa, Maine, Montana, Oregon, New Hampshire, New Mexico, North Dakota, Rhode Island, Vermont, Washington, Wyoming, and the District of Columbia — have authorized APNs to practice independently without any physician collaboration or supervision (Expanded role for advanced practice nurses, 2016).
From a broad perspective, the stakeholders involved in the debate over the precise role of APNs extend to all Americans. The extent to which APNs are authorized to provide healthcare services comparable to physicians will likely determine the extent to which all Americans enjoy better medical care at lower costs (Expanded role for advanced practice nurses, 2016).
For instance, the AACN points out that "Americans will never realize greater access to care and lower costs if policymakers continue to define health care according to the needs and interests of only one profession" (Expanded role for advanced practice nurses, 2016, para. 2). Likewise, the American Nurses Association (ANA) emphasizes that "[advanced practice nurses] are often primary care providers and are at the forefront of providing preventative care to the public" (Advanced practice nurses, 2016, para. 2). Taken together, it is therefore reasonable to conclude that all Americans are stakeholders in this situation.
There have been organized letter-writing, networking, and lobbying efforts at the national, state, and local levels by prominent nursing organizations, including the AACN, the ANA, and the American Association of Nurse Practitioners (AANP), among others.
Perhaps the most important additional health policy strategy currently under consideration in the United States would be to provide APNs practicing in U.S. Department of Veterans Affairs (VA) healthcare facilities with the same level of expanded full practice authority authorized by other states, irrespective of the state in which the VA facility is located. At present, state-level laws prescribe practice authority for APNs, while legislation under consideration by the U.S. Senate would extend this authority to all VA APNs regardless of state laws.
Because the VA is the nation's largest healthcare provider, extending full practice authority to APNs working in VA facilities would represent a valuable strategy for improving healthcare services at reduced costs.
"Access, efficiency, cost, and patient choice benefits"
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