Chamberlain College of Nursing NR 506 NP Week 1 Discussion Already Passed

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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 a... nd executive branches of government and interest groups. 1. Identify and describe practice barriers for APNs in your state and discuss these barriers on a state and national level. 2. Identify forms of competition on the state and national levels that interfere with the APN’s ability to practice independently. 3. Identify the lawmakers at the state level (i.e., key members of the state’s legislative branch and the executive branch of government) 4. Discuss interest groups that exist at the state and national levels that influence APN policy. 5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government and interest groups. Dr. Sibel and fellow classmates, There have always been barriers for advanced practice nurses (APN) on the state and national level. Family nurse practitioners (FNP) are faced with challenges involving licensure, prescription privileges, and payment from insurance companies. Each state varies when it comes to practicing guidelines and prescribing privileges. In my home state of Kentucky, FNPs can practice fully but must have an agreement with an overseeing physician before being able to prescribe narcotics (Kentucky Board of Nursing, 2020). From what I gather from fellow nurses from different states, a few other states are not so lax. On the state level and nationally, family nurse practitioners also get reimbursed less by insurance companies than that of a doctor. In fact, nurse practitioners receive an average of 29% less reimbursement than that of a doctor for the same exact procedure when reimbursed by Medicare (Perloff, DesRoches, & Buerhaus, 2016). Within the state and national level, nurse practitioners must compete with doctors and physician assistants. Despite millions in need of healthcare, there seems to be a misconception that doctors provide better care than that of an FNP. Because of this public belief, some healthcare offices only hire doctors and do not rely on mid-levels to see patients. Nurse practitioners must also compete against physician assistants who apply for many of the same mid-level positions available to APNs. My whole life I have heard people say that they would rather see a doctor or physician assistant over an FNP. While I never understood this, it became apparent to me that nurse practitioners may have a harder time finding employment and locating providers to oversee them in order to have privileges to write narcotics. While FNPs may practice independently, in Kentucky I have noticed that many chose to work in offices with large client bases that also have a doctor on staff because many patients prefer to go to a practice where a physician is available. Wyoming received backlash for introducing emergency nurse practitioner certification in 2017 due to individual’s perceptions that FNPs are not properly educated to work in the emergency care setting (Davis, 2019). Davis (2019) states that instead of defending the nurse practitioners and educating the public on the roles of APNs, some hospitals simply replaced emergency care nurse practitioners with physician assistants and physicians. Instead of promoting the use of FNPs, many complied with the suggestions of the public and reinforced the misconception that physicians and physician assistants provide better care than nurse practitioners, making it hard for FNPs to practice independently. Lawmakers in Kentucky that play key roles in healthcare legislation include the legislative and executive branches of government. According to the Commonwealth of Kentucky (2020), Kentucky’s This study source was downloaded by 100000831988016 from CourseHero.com on 04-18-2022 13:42:54 GMT -05:00 https://www.coursehero.com/file/62662123/NR-506-NP-Week-1-Discussiondocx/ executive branch is led by our governor Andy Beshear and under this branch, the Cabinet for Health and Family Services falls. They ensure that Kentucky families have access to human services and healthcare programs and advocate for low-income families. The legislative branch has a non-partisan group responsible for Kentucky Medicaid and are liable for making the state’s laws and determining the duties and services of government (Commonwealth of Kentucky, 2020). These lawmakers all help influence healthcare in Kentucky and ensure that its residents have access to healthcare. There are interest groups within the state and national level that influence APN policy. In Kentucky, one of the largest is the Kentucky Nurses Association. The Kentucky Nurses Association has representatives at the state capitol during hearings and advocates for nurses and nurse practitioners within the state. Not only do they push for safe working conditions, they also advocate for laws giving nurse practitioners the ability to practice with autonomy. Nationally, the American Association of Nurse Practitioners (AANP) aids in influencing APN policy. They also have an influence on the state level. The AANP has legislative teams that represent FNPs and their patients. In recent years, they have aided in bills passed on full practice authority, signature recognition and other essential NP/patient care issues (Kopanos, 2020). Methods used to influence change in policy involve advocacy and education. Showing support for healthcare change can encourage others to learn about the issue at hand. Educating the public about healthcare concerns can not only help gain the support of fellow clinicians but can also encourage the community to support FNPs and favor improved legislation as well. Community support can aid in showing state legislative and executive branches that changes need to be made and show potential competition that APNs are competent when providing patient care. With the help of interest groups at the state and national level, family nurse practitioners can show the positive impact of FNPs in medicine and continue to demonstrate how beneficial APNs are to the healthcare system. Amber References Commonwealth of Kentucky. (2020). General government. Retrieved from https://transparency.ky.gov/accountability/gengov/Pages/default.aspx Davis, W. D. (2019). Moving the emergency nurse practitioner specialty from resistance to acceptance: The Wyoming experience. Advanced Emergency Nursing Journal 41(4), 279. Kentucky Board of Nursing. (2020). APRN prescriptive authority. Retrieved from https://kbn.ky.gov/practice/Pages/APRNPresAuth.aspx Kopanos, T. (2020). AANP forum. Journal for Nurse Practitioners, 16(2), A13–A15. Perloff, J., DesRoches, C. M., & Buerhaus, P. (2016). Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians. Health Services Research, 51(4), 1407–1423. Dr. Sibel, I believe that barriers for practice stem from misconceptions. People are familiar with nurses at the bedside taking orders from doctors but are not use to nurses practicing with autonomy. While working in the emergency department, I worked alongside many great nurse practitioners, but despite them providing This study source was downloaded by 100000831988016 from CourseHero.com on 04-18-2022 13:42:54 GMT -05:00 https://www.coursehero.com/file/62662123/NR-506-NP-Week-1-Discussiondocx/ the very best care, some people still requested to see the “real doctor”. This is not only frustrating to the clinicians, but also to those of us who hope to become family nurse practitioners (FNP). It just goes to show that many individuals feel that FNPs provide inferior care compared to that of a physician. Lawmakers may also have these same misconceptions, and therefore vote against giving FNPs the chance to provide optimal care. I hope that with upcoming bill proposals, nurse practitioners finally receive the chance they deserve. According to Corso, Dorrance, and LaRochelle (2018), the existing size of the physician workforce is failing to meet the pressures of treating our current unhealthy and aging population and by 2025, America will face a shortage of approximately 61,700–94,700 physicians. This is a daunting thought but could easily be solved by giving nurse practitioners more practicing privileges and educating the public on the roles of an FNP. Together through education and advocacy, I hope we can open America’s eyes to the benefits of having family nurse practitioners in practice. Amber Reference Corso, K. A., Dorrance, K. A., & LaRochelle, J. (2018). The physician shortage: A red herring in American health care reform. Military Medicine, 183, 220–224 Courtney, You made many valid points in your discussion. FNPs are greatly hindered in their practice by having to have an agreement with a physician to write narcotics. This ensures that nurse practitioners cannot practice independently and continues to oppress the FNP by not letting them practice to their full capability. I do agree that narcotic limits are not a bad thing, but I personally feel that those should be more restricted to all clinicians given the curr [Show More]

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