expanding role & autonomy of nurse...
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B A R R I E R S T O F U L L S C O P E O F P R A C T I C E
EXPANDING ROLE & AUTONOMY OF NURSE PRACTITIONERS
Dana Leigh Knoll
OBJECTIVES
• Define APRN • Current state of regulation • Identify barriers facing NP’s ability to practice • Discuss the changing landscape and needs of
healthcare populations • Identify how NPs may improve quality and safety of
healthcare • Address changes to support progress
THE ISSUE
• APRNs • CNP, CRNA, CNS, CNM • Post-graduate education
• State Regulation • Fragmented Regulatory Requirements • National Council of State Boards of Nursing
• Full vs. Reduced vs. Restricted Practice • Full practice - 18 states • Reduced Practice – 20 states • Restricted practice – 12 states
State-by-State Scope of Practice
THE RESEARCH
• Cost reduction • Decreased wait times
• Patient satisfaction • Consistent quality care
NURSING THEORY THE THREE C’S OF LYDIA HALL
• The Core • The Care • The Cure
The Core patient
The Care nurse
The Cure medicine
SOCIOLOGY THEORY PROFESSIONAL SOCIALIZATION
• Professional Socialization • Adopting characteristics of
the group in which you seek membership
• Changing Roles & Titles
HEALTHCARE ENVIRONMENT
“Physician-led team approach to care helps ensure high quality patient care and value for health care spending” AMA, 2010
“Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States” IOM, 2010
“Based on our extensive knowledge of health care markets, economic principles, and competition theory, we reach the same conclusion: expanded APRN scope of practice is good for competition and American consumers” FTC, 2014
ROOT CAUSE ANALYSIS
APRNs do not
practice to the full extent of
their scope &
education
Colleague Opposition
Public Knowledge
Fragmented Regulation
Legislative Change
Competition
“Patient Safety”
State-by-State Consistent with Physician Coverage
Enforce ACA
Role of APRN
Image of Nurses
Inconsistent Educational Requirements
INFERENCES & IMPLICATIONS
• Primary Care Practitioners Supply & Demand • Estimates anywhere from 20,000 – 65,000
• Medically Underserved Areas & Populations • Correlation with restricted practice? • Fragmented regulation preventing NPs from covering MUAs? • Migration to areas of independent practice
Health Resources and Services Administration (2013). Projecting the Supply and Demand for Primary Care Practitioners Through 2020. U.S. Department of Health and Human Services.
QSEN COMPETENCIES
• Quality of Practice • Resource Utilization • Leadership
ANA STANDARDS
• Teamwork & Collaboration • Patient-Centered Care • Evidence Based Practice
RECOMMENDATIONS
• Collaboration (Teamwork & Collaboration, Resource Utilization, Patient-Centered Care)
• Physician familiarity correlated with increased support
• Regulation (Evidence Based Practice, Quality of Practice)
• State à National or otherwise uniform regulation
• Education (Leadership, Quality of Practice)
• Public • Self • Image of Nursing
• Research (Evidence Based Practice, Leadership)
• Evidence-based practice • Continue to support claims with rigorous scientific evidence
REFERENCES American Association of Nurse Practitioners. (2013). State practice environment. Retrieved from http://www.aanp.org/legislation-regulation/state-legislation-regulation/
state-practice-environment American Medical Association. (2010). AMA responds to IOM report on future of nursing. Retrieved from http://www.ama-assn.org/ama/pub/news/news/nursing-future-
workforce.page Biddle, B. (1986). Recent developments in role theory. Annual Review of Sociology, (12). doi: 10.1146/annurev.so.12.080186.000435 Black, A. & Dawood, M. (2013). A comparison in independent nurse prescribing and patient group directions by nurse practitioners in the emergency department: A cross
sectional review. International Emergency Nursing. doi: 10.1016/j.ienj.2013.03.009 Creech, C., Filter, M. & Bowman, S. (2011). Comparing patient satisfaction with nurse practitioner and physician delivered care. Poster presented at 26th Annual American
Academy of Nurse Practitioners Conference, Las Vegas, NV. Dulisse, B. & Cromwell, J. (2010). No harm found when nurse anesthetists work without supervision by physicians. Health Affairs, 29(8), 1469-1475. Federal Trade Commission. (2014). Competition and the regulation of advanced practice nurses. Policy Perspectives. Retrieved from www.nacns.org/docs/
FTC140307aprnpolicy.pdf Fund, M. & Swanson-Hill, A. (2014). Cost-effectiveness of nurse practitioner care. The Kansas Nurse, 89(1), 12-15. Health Resources and Services Administration (2013). Projecting the Supply and Demand for Primary Care Practitioners Through 2020. U.S. Department of Health and
Human Services. Retrieved from http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/ Institute of Medicine. (2010). Report recommendations. The Future of Nursing: Leading Change, Advancing Health. Retrieved from http://www.iom.edu/~/media/Files/
Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf National Council of State Boards of Nursing. (2008). Consensus model for APRN regulation, licensure, accreditation, certification, and education. APRN Joint Dialogue Group
Report. Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf Nursing Library. (2010). Lydia Eloise Hall: Care, Cure, Core Nursing Theory. Retrieved from http//nursinglibrary.info/lydia-eloise-hall-care-cure-core-nursing-theory/ Odell, E., Kippenbrock, T., Buron, W. & Narcisse, M. (2013). Gaps in the primary care of rural and underserved populations: The impact of nurse practitioners in four
Mississippi Delta states. Journal of the American Association of Nurse Practitioners. doi: 10.1111/1745-7599.12023 Shuval, J. & Adler, I. (1980). The role of models in professional socialization. Social Science & Medicine, 14(1), 5-14. Steiner, I., Nichols, D., Blitz, S, Tapper, L, Stagg, A., Sharma, L. & Policicchio, C. (2009). Impact of a nurse practitioner on patient care in a Canadian emergency department.
Canadian Journal of Emergency Medical Care, 11(3), 207-214. Street, D. & Cossman, J. (2010). Does familiarity breed respect? Physician attitudes towards nurse practitioners in a medically underserved state. Journal of the American
Academy of Nurse Practitioners. doi: 10.1111/j.1745-7599.2010.00531.x