Running head: UNIFORM REGUALTION AND FULL PRACTICE AUTHORITY Uniform Regulation and Full Practice Authority of the Advanced Practice Nurse Roles Team E Kimberly Bursch-tewalt Kelli Curran Current Circumstances Necessitating Policy Change and Proposed Policy Change Christopher Essex Michelle Faller Jesus Rebolledo Purdue Global University 1 UNIFORM REGULATION AND FULL PRACTICE AUTHORITY 2 Uniform Regulation and Full Practice Authority of the Advanced Practice Nurse Roles The Affordable Care Act (ACA) has extended healthcare coverage to approximately 30 million individuals who were previously uninsured or underinsured. Mandates included in the ACA require that all U.S. citizens and legal immigrants obtain healthcare coverage in order to avoid paying a tax penalty (Aries, Middaugh, & Nickitas, 2016, p. 76). Thus, primary care visits are projected to increase by 15-24 million annually over the next five years (Altares Sarik, Barnes, & Brookes Carthon, 2015, p. 526). This presents a potential problem, as the current physician shortage coupled with an increased demand for primary care could result in an insufficient amount of primary care providers to meet patient need. Advanced practice nurses (APNs) have an intent focus on primary care, wellness, chronic disease management, and care coordination; and their extensive education and training not only qualify APNs to fill the primary care gap, but make them the ideal solution to this problem (Aries, Middaugh, & Nickitas, 2016, pg. 273). In order to successfully transition APNs into this role, legislation that requires uniform regulation and full practice authority of the APN roles must be adopted. By doing so, the educational preparation, clinical training, accreditation and licensure standards, and practice authority regulations of all APNs across the nation will have uniform consensus (National Council of State Boards of Nursing, 2018, APRN Campaign for Consensus pg.). Current Circumstances Necessitating Policy Change According to the U.S. Constitution, the states are responsible for protecting the health, safety, and welfare of its citizens. One way in which states accomplish this, is by establishing the laws that govern professions and occupations. In order to ensure the competency of the UNIFORM REGULATION AND FULL PRACTICE AUTHORITY 3 nursing profession, the state legislatures enact nurse practice acts, which define the laws and regulations of nursing practice and the requirements for nursing licensure and credentialing within each state. The state legislatures also charge an appointed state board of nursing with the responsibility of defining the details associated with the laws and regulations surrounding nursing practice, according to the nurse practice act of each state (Milstead, 2016, p. 101). Thus, the regulatory standards and scope of practice, as well as the requirements for credentialing and licensure for all levels of nursing practice differ in each state (National Council of State Boards of Nursing [NCSBN], 2018, Boards & Regulation pg.). The conditions of each state’s nurse practice act have the greatest impact on the roles of the APN. Currently, there are 23 states that allow APNs to practice autonomously and the remaining states require that APNs work under some degree of supervision or in collaboration with a physician. These stipulations prevent the APN from practicing to the full extent of their education. For instance, restrictions associated with prescriptive authority, medical equipment orders, and admission privileges to skilled nursing facilities are often barriers to practice that consume time, deplete resources, increase medical costs, and decrease patient access to care. Such limitations often have the greatest burden on rural and underserved communities, where there are typically fewer practicing primary care physicians (Mack, 2018, p. 420-421). The Department of Veterans Affairs is currently the only independent entity that has altered practice regulations of APNs. In 2016, all APNs employed by Veterans Affairs were granted the authority to practice to the full extent of their education, training, and certification, regardless of state regulations. State laws pertaining specifically to the APN’s prescriptive authority of narcotics is the only regulation that they’ve continued to enforce (Mack, 2018, p. 420-421). Proposed Policy Change UNIFORM REGULATION AND FULL PRACTICE AUTHORITY 4 An analysis of how the ACA has impacted primary care needs estimates that 44 million Americans live in areas where the expected increase in demand will exceed 5% and 7 million Americans live in areas where the expected increase in demand will exceed 10%. This increase is significant, as it is projected to result in a primary care physician shortage reaching 20,400 by the year 2020 (Brewer, Spetz, Xue, & Ye, 2016, p. 72). In order to meet increased demands for primary care services, APNs must be effectively utilized in healthcare. Policy changes aimed at uniform consensus of the roles of the APN with authorization of full practice authority, are the most effective means of increasing primary care capacity. APNs not only possess the required knowledge and skills, but the growing APN workforce also reflects the potential impact that these proposed policy changes could have on the provision of primary care services in the U.S. According to Brewer et al. (2016), the 30% projected increase in practicing APNs would have an effect equivalent to reducing the primary care physician shortage from 20,400 to 6,400, if APN role consensus with full practice authority was enacted. This represents new availability of primary care services for more than 22 million rural, minority, and low-income patients, which would significantly improve the management of chronic diseases and their symptoms; improve clinical outcomes, health, and functionality; and decrease mortality rates of these vulnerable populations (p. 72). UNIFORM REGULATION AND FULL PRACTICE AUTHORITY 5 References Altares Sarik, D., Barnes, H., & Brookes Carthon, J.M. (2015). Federal polices influence access to primary care and nurse practitioner workforce. The Journal for Nurse Practitioners, 11(5), 526-530. Retrieved from https://search-proquestcom.libauth.purdueglobal.edu/central/docview/1681652429?accountid=34544 Aries, N., Middaugh, D.J., & Nickitas, D.M. (2016). Policy and politics for nurses and other health professionals (2nd ed.). Burlington, MA: Jones & Bartlett Learning. Brewer, C., Spetz, J., Xue, Y., & Ye, Z. (2016). Impact of state nurse practitioner scope-ofpractice regulation on health care deliver: Systematic review. Nursing Outlook, 64(1) 7185. doi:https://www.ncsbn.org/campaign-for-consensus.htm Mack, R. (2018). Increasing access to health care by implementing a consensus model for advanced practice registered nurse practice. The Journal for Nurse Practitioners, 14(5), 419-424. doi:https://doi.org/10.1016/j.nurpra.2018.02.008 National Council of State Boards of Nursing. (2018). APRN campaign for consensus: Moving toward uniformity in state laws. Retrieved from https://www.ncsbn.org/campaign-forconsensus.htm
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