NURS 8100 Health Policy Proposal Analysis (Policy Brief)
A policy brief is a crucial tool used to present research findings and recommendations to an audience without expertise in the policy field. It offers evidence-based policy suggestions to help lawmakers make informed decisions (Arnautu & Dagenais, 2021). An effective policy brief should include research findings supporting the recommended policy and establish clear links to policy initiatives. It needs to be concise and easily understood by the target audience. In this paper, we present a policy brief based on the recommendation from the Institute of Medicine (IOM) report.
Selected Recommendation
The chosen IOM recommendation is: “Nurses should practice to the full extent of their education and training.”
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Supportive and interpersonal Psychotherapies
Background
The IOM recommendation underscores the need to transform nursing practice. It calls on legislators to use the Nursing Practice Act and Administrative Rules as guidance to amend state nurses’ scope-of-practice laws. Advanced Practice Registered Nurses (APRNs) possess high levels of training and competence, enabling them to provide a wide range of healthcare services. However, they face constraints due to barriers such as federal policies, state laws, outdated insurance reimbursement models, and organizational practices (Sullivan, 2018). State and federal initiatives are required to update and standardize APRNs’ scope-of-practice regulations, allowing them to utilize their specialized education to the fullest. Furthermore, the IOM report emphasizes that APRNs should be permitted to practice to the full extent of their training. This will ensure that all citizens can access essential healthcare services, and organizations can make the best use of APRNs’ unique contributions to the healthcare team.
Insurance providers and states should implement specific policy, regulatory, and financial changes that grant patients the freedom to choose from a variety of healthcare providers, including APRNs, to best meet their healthcare needs (Sullivan, 2018). Removing regulatory, policy, and financial barriers to enhance patient choices and patient-centered care is critical to creating a reformed healthcare system.
Current Characteristics
The scope of APRN practice varies by 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.). Currently, 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 required for prescribing treatment. Sixteen states currently have Reduced practice.
There are 11 states with Restricted practice, where APRN supervision or delegation of duties such as diagnosing and prescribing by a physician is mandated by the state board of nursing. Texas falls on the more restrictive end of the spectrum regarding the freedom it grants to APRNs. Opposition to expanding APRNs’ scope of practice has come from some physicians and physician organizations. They argue that APRNs are less competent to provide the services outlined in their scope of practice since they do not undergo the rigorous training of physicians (Sofer, 2018).
The Impact of the Recommendation
Patients anticipate that the recommendation for APRNs to practice to their full extent will improve their access to essential healthcare services, particularly in rural areas with few physicians, where APRNs often serve as primary care providers. The United States currently faces a shortage of primary care physicians, especially in rural and underserved areas (Ortiz et al., 2018). However, there is an abundant supply of specialists, which leads to higher healthcare costs since specialists charge more than primary care physicians. Healthcare consumers also believe that the recommendation will reduce healthcare costs. Full practice authority minimizes duplication of services and billing costs associated with outdated physician oversight (Ortiz et al., 2018). Additionally, it reduces unnecessary office visits and the repetition of orders and treatment services.
Nurses and professional nursing organizations argue that allowing APRNs in all states to practice to the full extent of their education and training could help meet the country’s primary care needs. APRNs could also contribute their specialized knowledge and skills to delivering person-centered, community-based healthcare (DePriest et al., 2020). Physicians believe that granting APRNs full practice authority will reduce their workload and improve access to care for patients in underserved urban and rural areas. States with full practice authority have more NPs working in rural and underserved areas, increasing access to healthcare. However, some physicians believe that the recommendation may have a negative impact on patient care due to the perceived lack of rigorous medical training for APRNs (Sofer, 2018). Various organizations, such as the Kaiser Family Foundation, argue that APRNs could help meet the growing demand for primary care. They suggest that APRNs’ full practice could address the increasing need for primary healthcare due to the growing aging population (DePriest et al., 2020). Additionally, the increased access to healthcare through the Affordable Care Act has expanded the population in need of care, and APRNs can help bridge the gap.
Current Solutions
Advocacy is the current solution for nurses to practice to the full extent of their education. Many professional organizations are actively lobbying to remove barriers that restrict APRNs from working to their full extent (Peterson, 2018). Nurse Practitioner organizations in various states have engaged lobbyists to advocate for changes in state policies. These lobbyists educate policymakers about what full APRN practice entails. They clarify that it is not a policy against physicians but rather an effort to provide patients with access to quality care (Peterson, 2018). The Campaign by the Future of Nursing is one such initiative that advocates 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 practice roles and bills related to APRN practice to keep APRNs informed of their advocacy efforts.
Current Status in the Health Policy Arena
A report from The Campaign reveals that APRN practice authority has expanded significantly since the release of the IOM recommendation report. After the IOM report’s release, 44 state Action Coalitions worked to eliminate barriers in the APRN scope of practice. Furthermore, 13 states have passed laws granting APRNs full practice authority (Sullivan, 2018). Since the inception of The Campaign, eight states have amended their laws to grant APRNs full practice and prescriptive authority. Moreover, some states with reduced and restricted practices have made their laws less restrictive (Sullivan, 2018). For example, Florida, which previously had reduced practice, passed a bill requiring Psychiatric Mental Health Nurse Practitioners (PMHNPs) to practice under supervision for the first two years and then practice to the full extent of their licensure.
Conclusion
The IOM recommendation to allow APRNs to practice to the full extent of their education and training will enhance healthcare accessibility and reduce costs. The healthcare landscape is continually evolving, with increasing demand for healthcare services driven by an aging population. Therefore, the full contribution of APRNs to the healthcare team is essential. Substantial progress has been made in reducing restrictions on the scope of APRN practice across the United States. States with restrictive and reduced APRN practice are expanding APRNs’ potential to contribute fully to healthcare. However, further efforts are required to expedite the amendment of outdated policies. More states should 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.
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