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Despite making considerable progress in the areas of nursing practice, nursing education, advocacy, policymaking, and expanding the influence of professional nursing organizations and associations, the nursing profession still has areas where the progress and development are not as significant as many professional nurses would like it to be. In particular, there are barriers limiting the progress of Advanced Practice Nursing and the contribution that Advanced Practice Nurses (APNs) can make to improving the health care system and access to care. Back in 2011, The Institute of Medicine (IOM) (2011) published a landmark report called “The Future of Nursing: Leading Change, Advancing Health”. In this report, IOM (2011) identified several barriers to undermining the ability of APNs to contribute to the health care delivery to the full extent of their training and education. The three of those barriers include (1) federal and state-level regulations limiting nurses’ scope of practice (SOP), including state laws, (2) institutional culture and practice, and (3) outdated reimbursement models (IOM, 2011).
SOP regulations present a considerable barrier to the progress of advanced practice nursing. For example, nearly half of the U.S. states have reduced or restricted SOP. In the states with reduced SOP, APNs do not have the author to engage in at least one element of advanced practice (Martin & Alexander, 2019). In those states, APNs are required to have a collaborative agreement with physicians to provide primary care, diagnose patients, and prescribe treatments including controlled substances. In the states with restricted SOP, APNs practice under supervision, perform delegated tasks or work as a part of the teams managed by the physicians (Martin & Alexander, 2019). In other words, SOP regulations limiting APNs’ professional autonomy and the ability to practice independently to the full extent of their education and training present a significant barrier to the progress of advanced nursing practice.
As was mentioned earlier, one more barrier is institutional culture and practice. For example, many health care organizations hire APNs that completed programs that equipped them with exceptional skills and educational background necessary to manage complex patients, work in fast-paced settings, perform complex monitoring, develop evidence-based treatment plans, and order and interpret diagnostic studies (Vanderbilt School of Nursing, n.d.). Moreover, many graduates of the MSN programs possess advanced expertise in clinical care, interprofessional collaboration, quality improvement, and organizational leadership (American Association of Colleges of Nursing, 2011). However, APNs may find it challenging to realize their full potential and make a greater contribution to their organizations when the latter have an organizational culture where the role of APNs is viewed as a managing or supervising type of position. Apparently, such organizational culture makes it more challenging for APNs to make a more valuable contribution to improving organizational outcomes.
Finally, an outdated reimbursement model for the services provided by nurses is another barrier slowing down the progress of advanced practice nursing. As Sarzynski & Barry (2019) explain, a revenue stream may need to be developed in order for the APN role to survive in different settings. However, APNs do not receive reimbursement equal to physicians for providing the same services (Sarzynski & Barry, 2019). Further disparities in reimbursement are exacerbated by the fact that ANpss are more likely to practice in rural settings and treat vulnerable populations and Medicaid beneficiaries compared with physicians (Sarzynski & Barry, 2019). Thus, reimbursement issues should be regulated to ensure that APNs can generate adequate revue for their organizations and in independent practice as well. Therefore, regulations limiting nurses’ SOP, organizational culture and practice, and outdated reimbursement models are the three barriers blocking the way to the progress of advanced nursing practice. Addressing these barriers through policy and practice change should be one of the priorities of nurses’ policymaking and policy advocacy efforts.
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