Identify and describe practice barriers for all four APNs roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner and clinical nurse specialist.
Nurse practitioners significantly contribute to disease prevention, disease management and health promotion. APNs have faced barriers to practice at both the state and national perspective since the beginning. The four roles of the APN include the nurse midwife, nurse anesthetist, nurse practitioner and clinical nurse specialist. There are various rules and regulations based on the scope of practice. Advanced practice nurses face challenges including policy restrictions on practice, poor physician relationships, prescription privileges, licensure, payment and insurance company problems and restrictive practice settings. Each state varies when it comes to rules, regulations, practicing guidelines and prescribing privileges.
The nurse practitioner in the state of Florida is permitted to perform medical diagnosis and treatment, prescribe medications, and operate with authorization of an established protocol supervision. The Florida law requires that NPs enter into a supervisory agreement with a physician to practice which allows the nurse practitioner to diagnose, dispense, prescribe, and administer medications (Weissing, 2019). Nurse practitioners in Florida can prescribe controlled substances that are scheduled II-IV. “An advanced registered nurse practitioner may prescribe or dispense a controlled substance as defined in s. 893.03 only if the advanced registered nurse practitioner has graduated from a program leading to a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills” (Bushy, 2019, p.6). “The American Association of Nurse Practitioners (AANP) classifies state laws and regulations impacting APRN practice and identifies the practice environment within the state as full, restricted, or reduced” (Kleinpell et al., 2022, p.137).
A certified nurse midwife has advanced education in both family practice and midwifery. A midwife provides care for women and newborns including gynecological and prenatal care. A barrier to practice for the nurse midwife is the lack of clarity regarding the nature and scope of practice of the nurse midwife. The Certified Registered Nurse Anesthetist is a licensed practitioner who administers anesthesia to a wide range of patients in collaboration with surgeons, anesthesiologists, and other healthcare providers. The CRNA does not prescribe medications or diagnose patients. A practice barrier the CRNA faces is being able to perform their duties with or without a supervising anesthesiologist. In the state of Florida, a physician’s supervision is required for a CRNA to practice.
The clinical nurse specialists (CNS) focus on educating patients and their families on how to manage their symptoms and disease prevention through the most up-to-date evidence-based practice. The Clinical Nurse Specialist faces prescriptive barriers on the state and national level. In the state of Florida, the CNS works under established protocols and may plan for disease prevention and diagnose human responses to actual or potential health problems. The CNS has no prescribing authority in the state of Florida. On the national level it also varies, some states allow the CNS to have independent prescriptive authority, some have no prescriptive authority at all and other require a collaborative agreement with a physician.
Identify forms of competition on the state and national level that interfere with APNs ability to practice independently
Nurse practitioners have various forms of competition at the state and national level. There are other medical professionals that deliver the same type of care to patients including physicians and physicians’ assistants (PA). A physician assistant is considered a mid-level provider, just like the nurse practitioner. Throughout the years, there has been an increase in the number of nurse practitioners. A major form of competition on the state and national level is over saturation. Outdated and restrictive regulations that are still in the scope of practice for the NP inhibit competition among health care providers and can limit access to healthcare services and decrease innovation in health care delivery (Moore et al., 2020). The American Medical Association has expressed concerns in letting APN’s practice independently and outside the supervision of a physician because they believe that physicians have more extensive and specialized training (JUCM,2020). Imposition of laws and regulations through state regulators of the medical board also cause competition for the NP (Peterson, 2017).
Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
In the state of Florida, where I plan on practicing, there are three branches that include the Executive, Legislative, and judicial branch. The governor, lieutenant governor, and cabinet are the lawmakers who serve on Florida’s executive branch. The executive branch’s purpose is to implement and enforce laws. In the state of Florida, the executive branch is currently run by governor, Ron DeSantis. The legislative branch consists of the Senate and the House of Representatives and are responsible for passing or carrying out laws for the state of Florida. Florida’s judicial branch is comprised of the supreme court, which is the highest court in Florida. The judicial branch interprets the laws. “The intent of the Legislature is that persons desiring to engage in any lawful profession regulated by the department shall be entitled to do so as a matter of right if otherwise qualified” (Toney-Butler, 2020, p. 38).
Discuss interest groups that exist at the state and national levels that influence APN policy.
Interest groups are individuals, organizations or institutions that attempt to influence public policy and are essential to regulate the NP’s scope of practice (Brom et al., 2018). Interest groups play a major role in influencing the regulation of NPs’ scope of practice and work together to initiate change. There are several interest groups on both the state and national level that influence APN policy. In the state of Florida, the Florida Association of Nurse Practitioners is major interest group and nationally the American Associates of Nurse Practitioners (AANP) is a major interest group. The Florida Association of Nurse Practitioners promotes patient-centered healthcare and increases knowledge on health care policy for the nurse practitioner’s practice. The objective of the FLANP is to utilize strong lobbying and grassroot efforts in combination with medica to inform and educate the public on issues in Florida’s health care system and how Nurse Practitioners can change these problems if outdated laws are changed (FLANP,2020). The American Association of Nurse Practitioners provide support to nurse practitioners nationwide, educational opportunities, scholarly journals, and other forms of support to benefit the NP.
Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government and interest groups.
There are multiple methods that can influence change in healthcare policy. Participating and allowing your voice to be heard is one of the most powerful ways to produce change in my opinion. The only way to be heard is by speaking up and becoming involved. An important step in influencing change is understanding the policy process. It is essential for the NP to be knowledgeable about the policy process and knowing who the policy makers are. Reviewing proposed health care legislations is important to help promote best practices and determine changes to see if they will be beneficial or not. Interest groups heavily influence the regulation of NP’s scope of practice are one of the key methods to influence change (Brom et al., 2018).
