NURS 8100 Policy Brief
A policy brief serves as a valuable tool for presenting research findings and recommendations to an audience without expertise in the particular policy area. These briefs offer evidence-based policy suggestions to assist lawmakers in making informed decisions (Arnautu & Dagenais, 2021). A well-crafted policy brief should provide research findings that support the proposed policy and clearly establish the links to policy initiatives. Therefore, it must be concise and easy to understand, ensuring that the target audience comprehends the recommendations. This document presents a policy brief based on a recommendation from the Institute of Medicine (IOM) report.
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Selected Recommendation
The chosen IOM recommendation is: “Nurses should practice to the full extent of their education and training.”
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Background
This IOM recommendation underlines the necessity for a transformation in nursing practice. The report encourages legislators to be guided by the Nursing Practice Act and Administrative Rules to amend state nurses’ scope-of-practice laws. Advanced Practice Registered Nurses (APRNs) are highly skilled and competent to provide a wide range of healthcare services. However, they are constrained by various barriers, including federal policies, state laws, outdated insurance reimbursement models, and organizational practices and culture (Sullivan, 2018). State and federal initiatives are required to modernize and standardize APRNs’ scope-of-practice regulations to make the most of their specialized education and full potential. Furthermore, the IOM report states that APRNs should be permitted to practice to their full scope. This would ensure that all citizens can access essential healthcare services, and organizations can maximize the unique contributions of APRNs to the healthcare team.
Insurance providers and states should institute specific policy, regulatory, and financial changes that empower patients to choose from a range of healthcare providers, including APRNs, to best meet their healthcare needs (Sullivan, 2018). Eliminating regulatory, policy, and financial barriers to increase patient choices and patient-centered care is crucial for creating a reformed healthcare system.
Current Characteristics
The scope of APRN practice differs from state to state. The American Association of Nurse Practitioners (AANP) defines three types of practice authority for APRNs: Full, Reduced, and Restricted practice. In states with Full practice authority, APRNs are authorized to practice to their full scope of training, including evaluating, diagnosing, ordering and interpreting diagnostic tests, and prescribing treatments (AANP, n.d.). The state board of nursing grants them exclusive authority to practice to their full scope. Presently, 24 states in the U.S and its territories have adopted Full practice licensure laws. NPs practicing in states with Reduced practice are allowed to participate in at least one element of the NP practice but are regulated by a collaborative agreement with a physician (AANP, n.d.). Physician oversight is needed for NPs to prescribe treatments. Sixteen states currently have Reduced practice, and 11 states have Restricted practice, where the state board of nursing mandates APRN supervision or delegation of duties such as diagnosing and prescribing by a physician. Texas has more restrictive regulations compared to other states regarding the freedom it grants to APRNs. One of the barriers to expanding APRNs’ scope of practice has been opposition from some physicians and physician organizations. Some physicians argue that APRNs are less competent to provide the services outlined in their scope of practice because they do not undergo rigorous training like physicians (Sofer, 2018).
The Impact of the Recommendation
Patients believe that the recommendation for full scope practice for APRNs will enhance their access to essential health services, particularly in rural areas where physicians are scarce, and APRNs often serve as primary care providers. Currently, there is a shortage of primary care physicians in the country, especially in rural and underserved areas (Ortiz et al., 2018). However, there is an ample supply of specialists, which increases healthcare costs, as specialists typically charge higher fees than primary care physicians. Additionally, healthcare consumers perceive that the recommendation will reduce healthcare costs. Full practice authority reduces duplication of services and billing costs caused by outdated physician oversight (Ortiz et al., 2018). It also reduces unnecessary office visits, redundant orders, and treatment services.
Nurses and professional nursing organizations argue that if all states allowed APRNs to practice to the full extent of their education and training, it could help address the country’s primary care needs. APRNs would contribute their specialized knowledge and skills to providing person-centered, community-based healthcare (DePriest et al., 2020). Physicians believe that granting APRNs full practice authority will reduce their workload and increase access to care for patients in underserved urban and rural areas. States with full practice authority have more NPs working in underserved areas, improving healthcare access. Nevertheless, some physicians fear that the recommendation may negatively impact patient care due to APRNs’ less rigorous medical training (Sofer, 2018). Various organizations, like the Kaiser Family Foundation, argue that APRNs could help meet the growing demand for primary care, which is increasing due to an aging population (DePriest et al., 2020). Increased access to healthcare through the Affordable Care Act has increased the demand for care, and APRNs can help bridge the gap.
Current Solutions
The current solution for allowing nurses to practice to their full extent is advocacy. Many professional organizations are lobbying to remove barriers that limit APRNs from working to the full extent of their education and training (Peterson, 2018). NP organizations in various states have engaged lobbyists to help bring advocacy efforts to policymakers’ attention. These lobbyists educate policymakers on what APRN full practice entails, clarifying that it is not a policy against physicians but rather a measure to provide patients with access to quality care (Peterson, 2018). The Future of Nursing Campaign is one approach used to lobby for APRNs to practice to their full scope in states with reduced and restricted practice. Additionally, the National Council of State Boards of Nursing (NCSBN) monitors the practice roles and bills related to APRN practice to keep APRNs informed about their lobbying efforts.
Current Status in the Health Policy Arena
A report from The Campaign shows that APRN practice authority has expanded significantly since the release of the IOM recommendation report. After the release of the IOM report, 44 state Action Coalitions worked to eliminate barriers in APRN scope of practice. Thirteen states have passed laws granting APRNs full practice authority (Sullivan, 2018). Since the Campaign’s inception, eight states have amended their laws to grant APRNs full practice and prescriptive authority. Furthermore, some states with reduced and restrictive practices have improved their laws to be less restrictive (Sullivan, 2018). For instance, Florida, which had reduced practice regulations, passed a bill that requires Psychiatric Mental Health Nurse Practitioners to practice with supervision for the first two years and then practice to the full scope of their licensure.
Conclusion
The IOM recommendation to allow APRNs to practice to the full extent of their education and training will increase healthcare accessibility and reduce costs. The healthcare landscape is constantly evolving, with a growing demand for healthcare services driven by an aging population. Therefore, APRNs’ full contribution to the healthcare team is vital. Tremendous progress has been made in reducing restrictions on APRN scope of practice across the U.S. States with restrictive and reduced APRN practice are increasingly recognizing the potential of APRNs to make substantial contributions to healthcare. However, more efforts are needed to expedite the amendment of outdated policies. More states need to grant full practice authority to APRNs as primary care providers.
References
AANP. (n.d.). Issues at a glance: Full practice authority. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief
Arnautu, D., & Dagenais, C. (2021). Use and effectiveness of policy briefs as a knowledge transfer tool: a scoping review. Humanities and Social Sciences Communications, 8(1), 1-14. https://doi.org/10.1057/s41599-021-00885-9
DePriest, K., D’Aoust, R., Samuel, L., Commodore-Mensah, Y., Hanson, G., & Slade, E. P. (2020). Nurse practitioners’ workforce outcomes under the implementation of full practice authority. Nursing Outlook, 68(4), 459–467. https://doi.org/10.1016/j.outlook.2020.05.008
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare6020065
Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.
Sofer, D. (2018). AMA Resolution Opposes Independent Practice by APRNs. AJN The American Journal of Nursing, 118(3), 12. doi: 10.1097/01.NAJ.0000530922.33715.46
Sullivan, T. (2018). Institute of Medicine Report, The future of nursing: leading change, advancing health. Policy and Medicine.
The Institute of Medicine (IOM) has put forward a policy proposal: “Nurses should practice to the full extent of their education and training.” This recommendation is aimed at addressing the current disparities in licensing and practice rules for Advanced Practice Registered Nurses (APRNs) across states. In many states, these rules do not align with the education and training levels of APRNs. The proposal emphasizes the need to allow APRNs to practice to the full extent of their education and licenses with full practice authority in all states. This would help alleviate the shortage of primary care providers in both rural and urban areas, a pressing issue in today’s healthcare system.
The IOM’s message of “nurses should practice to the full extent of their education and training” is rooted in the idea that nurses should adapt their practice to ensure that all Americans receive healthcare services. This message also emphasizes the importance of nurses maximizing their contributions to the healthcare team. To make this vision a reality, it’s essential for insurance companies and federal agencies to align their regulations and policies with the goal of protecting patients’ rights.
However, there are various barriers preventing nurses from practicing to the full extent of their education and training. These barriers include state laws, federal policies, outdated insurance models, and institutional practices and cultures. The healthcare system has undergone significant changes over the years, transitioning from simple home remedies to complex technological systems. To promote patient safety and implement nursing recommendations effectively, there are several actions that federal and state authorities should take. These actions include regulating healthcare markets, supporting nurses in acquiring knowledge, and ensuring the provision of healthcare services to vulnerable populations.
The unpredictability of scope-of-practice regulations across states can hinder advanced practice nurses from delivering care that aligns with their training and qualifications. While a substantial number of nurses are registered nurses, a significant portion, more than a quarter million, are advanced practice registered nurses (APRNs) with advanced degrees and national certifications. APRNs, including nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives, often face varying regulations across states, with some allowing them to see patients and prescribe medications independently, while others require physician supervision.
The federal government is in a position to drive reform in state scope-of-practice laws by encouraging the sharing of best practices and providing incentives for their adoption. The primary recommendation is to eliminate Scope of Practice Barriers, allowing APRNs to practice to the full extent of their education and training. The responsibility to achieve this goal extends to state legislatures, Congress, Centers for Medicare and Medicaid Services, Office of Personnel Management, Antitrust Division of the Department of Justice, and the Federal Trade Commission, which has a history of challenging anticompetitive practices in the healthcare industry.
In conclusion, the transformation of the healthcare system is a collective effort, and nurses play a pivotal role in this process. However, the responsibility for improving the regulatory, business, and organizational conditions does not fall solely on nurses but also on various stakeholders, including government, corporations, healthcare organizations, professional associations, and the insurance industry. The IOM’s recommendations provide a path to address these issues and enhance the healthcare system.
References
Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine
Report The Future of Nursing: Leading Change, Advancing Health; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine; Altman SH, Butler AS, Shern L, editors.
Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington (DC): National Academies Press (US); 2016 Feb 22. 2,
Removing Barriers to Practice and Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK350160/
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future
of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health.
Washington (DC): National Academies Press (US); 2011. 1, Key Messages of the Report.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK209881/
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