Today people are living longer than ever. The discovery of new technology, innovative medicines, science, and research all play apart of that. An increase in aging population is one of the most dramatic demographic trends in the world today. Many elders present many complex diseases and require complex care and disease management. The challenge also presents many opportunities in the healthcare field and a shortage of providers in rural areas. The roles for advanced practice nursing (APN) have been introduced since the late nineteenth century till the present (Hamric, Spross, and Hanson, 2009, p. 3). These roles include certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), and nurse practitioners (NPs) (Hamric, Spross, and Hanson, 2009, p. 3). Building credibility and defining practice of APN roles did not firmly establish until in late 1970s (Hamric, Spross, and Hanson, 2009, p. 17).
In 1992, the American Nurse Association (ANA) established Healthcare Reform which focused on restructuring the United States healthcare system to reduce costs and improve access to care (Hamric, Spross, and Hanson, 2009, p. 23). Today APNs face many challenges as they strive to be recognized by members of the society. The current issues faced by APNs are discussed below and this information is based on Advanced Practice Nursing: An Integrative Approach (4th ed.).
The Key Issues
The identified key issues are education, scope of practice, specialty practice, reimbursement, titling, prescriptive authority, legal status, regulation, and credentialing issues. The similarities among these issues are all embedded in regulatory languages which make it difficult for APNs to benefit from development of nursing role. The differences occur when one failed to collaborate and to address these above issues as a whole and to promote collaborative relationships with other regulated health disciplines both at the national and state level. And, indeed these issues are still importance to the practice of advanced practice nurses.
Three Chosen Issues
The three chosen issues are scope of practice/specialty practice, reimbursement, and prescriptive authority. Like never before, the profession for APNs has emerged into different era which presents many different opportunities and challenges for newcomers. Today APNs can be found working anywhere from the family practice, cardiology office, urgent care always to emergency medicine. As a new graduate APN, the role can present many challenges and obstacles especially when she or he tries to adjust to the new role while attempting to comply with several clinical practice guidelines.
Even though the title of APN is recognized as a valuable asset to the community and other healthcare team member, many of them are still struggled to get reimbursed properly. The holistic caring approach provided by APNs is not inferior to the medical model provided by physicians. The education requirement for both professions will be soon about the same especially with the new requirement of a doctoral degree for APNs. This is the reason APNs still debate for equal pay for equal service when care is compared between both health providers.
After reading Advanced Practice Nursing: An Integrative Approach (4th ed.) page 606 and 607, the reality becomes clear that APNs have to prove so much in order to gain sole authority in scope of practice. The Board of Medicine continues to find ways to limit the scope of practice for APNs. According to Lugo, O’Grady, Hodnicki, & Hanson (2007), 23 states possess sole authority from the board of nursing; whereas other states possess joint authority with the board of medicine, the board of pharmacy, or both (Hamric, Spross, and Hanson, 2009, p. 606). The outcome of this disagreement affects the role and practice of APNs greatly especially when they attempt to provide the best care possible in a timely manner.
Top Two Issues
The chosen top two issues are reimbursement and prescriptive authority. As a new graduate APN, she or he must get educated well about different payment options such Medicare and Medicaid, third party payers, and more to ensure proper reimbursement. The second strategy is to encourage schools throughout the country to incorporate this valuable lesson as part of the standard curriculum. The nursing profession as a whole should continue to flight aggressively for equal service for equal pay because nursing profession should not be assumed as inferior to other independent health providers despite different styles of caring approach. As an individual APN, one must continue the education to doctorial level in order to try to resolve the unfair disadvantage of prescriptive authority across the nation. The second strategy is APNs should continue to promote the recognition of APN as safe and cost-effective alternative provider throughout the healthcare systems.
The current regulatory barriers for APNs are prescriptive authority, reimbursement schemes, nursing education, and scope of practice and titling. The variance in board regulations from state to state is a problem facing APNs who highly mobile (Hamric, Spross, and Hanson, 2009, p. 610). Even though prescriptive authority exists over the years and becomes fairly standard for APN prescribers, but the requirements still vary from state to state (Hamric, Spross, and Hanson, 2009, p. 607). For those APNs who love to travel and work at another state to make sure to check the scope of practice for that state as it varies significantly (Hamric, Spross, and Hanson, 2009, p. 607). The professional nursing organizations and the National Council of State Boards of Nursing (NCSBN) have been working on a new regulatory model for APNs in order to promote some uniformity on credentialing and licensure (Hamric, Spross, and Hanson, 2009, p. 610). A system of mutual regulatory recognition between states is needed and remains to be done.
Even though most of the hard work was done to promote the path to independency and uniformity for advanced practice nursing, but several issues remain to be solved especially in the areas of credentialing and regulation. Many nursing organization is working aggressively to put a new regulatory model in place to promote a system of mutual regulatory recognition. The field in advanced practice nursing is evolving and changing rapidly, especially in the areas of advanced practice nursing specialties. As a result of this complex change, policymakers and regulators face many challenges and obstacles to ensure development of broad-based practice standards. At the same time this challenge also presents many new opportunities for advancing practice nursing; thus APNs continue to prove themselves as safe and cost-effective providers to the members of society and to move forward to a better professional future.
Hamric, A. B., Spross, J. A., & Hanson, C. M. (2009). Advanced practice nursing: An integrative approach (4th ed.). St. Louis, MO: Elsevier.