Barriers that Slow Down the Progress of Advance Practice Nursing and Strategies to Overcome Them (Solved)

Introduction: Despite nurse practitioners being highly trained and equipped with competent skills for quality healthcare delivery, they are prohibited from delivering these services by state laws and federal policies restricting their scope of practice, institutional practices and obsolete insurance reimbursement models (Wakefield et al., 2021). This essay discusses these barriers and outlines strategies to overcome them.

Barriers slowing down the progress of advanced practice nursing

The scope-of-practice regulations variations in different states present a significant barrier in advanced nursing practice. In some states, the challenges of limiting one’s practice to within the scope of practice are further worsened by traditional hospital laws and policies Paterson, 2017). The different scopes of practice and rules across states significantly affect patient care as nurses relocate from one state to another. Additionally, introducing the Affordable Care Act (ACA) in 2010 created a healthcare system that is more patient-centred with a special emphasis on primary care. Strong evidence suggests that nurse practitioners are more likely than physicians to work in primary health care settings (Paterson, 2017). However, with restrictive laws that limit NP’s practice and require a physician’s oversight to treat patients, NPs cannot utilize their knowledge and skills to the full extent to achieve positive patient outcomes.

Institutional practices such as mandatory overtime and inadequate staffing impede the progress and development of NPs at professional and individual levels. While a shortage of staff is common in most professions and is considered a minor inconvenience, there are serious and almost fatal implications associated with short-staffing in nursing. The shortage affects patient health and safety and the NP’s too through increased fatigue, burnout, injury rate, and reduced ability to provide quality care (ANA, n.d). The use of mandatory overtime as a staffing tool impairs NP’s progress in professional and personal development since it is associated with poorer patient outcomes, increased medical errors, and nurses turning away from the bedside.

Some insurance reimbursement models present a significant barrier to the progress of NP practice. For instance, Medicare has a system that strictly reimburses APRNs for services outlined in their scope of practice as per the state’s regulations. Some services have been traditionally adopted as nursing services, even though they are ideally physician services; therefore, insurers do not reimburse NPs for such services. These services include rounding, patient transfers, documenting transfer orders, and documenting orders to change intravenous fluids and medications (Wakefield et al., 2021).

Strategies to overcome the barriers

Building a common ground regarding the scope of practice and institutional policies and reimbursement models is key to addressing these barriers. Nongovernmental organizations that advocate for nursing should widen their coalitions to include more stakeholders from different disciplines. Working with other healthcare professionals, policymakers, and the community can have an impact on eliminating scope-of-practice restrictions, improving collaborations across different disciplines, and addressing relevant issues aimed at improving healthcare delivery (Wakefield et al., 2021).

Conclusion

While there are numerous significant barriers that slow down nursing practice, the most fundamental ones are state laws and policies, institutional practices, and reimbursement models that do not consider the professional roles of NPs. To overcome these barriers, it is vital to incorporate diverse stakeholders and the community in the policymaking process and eliminate scope-of-practice restrictions, which do not serve to improve patient care delivery.

References

American Nurses Association (ANA). (n.d). Nurses Staffing. Retrieved from https://www.nursingworld.org/practice-policy/nurse-staffing/

Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.

Wakefield, M., Williams, D. R., & Le Menestrel, S. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. National Academy of Sciences.

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