NR 506 Week 1: Barriers to Practice

Sample Answer for NR 506 Week 1: Barriers to Practice Included After Question

Preparing the Discussion

Using the readings from this week as well as reliable outside resources to: 

1. Identify and describe practice barriers for all four APNs’ roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
2. Identify forms of competition on the state and national level that interfere with APNs’ ability to practice independently.
3. Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
4. Discuss interest groups that exist at the state and national levels that influence APN policy.
5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
6. A scholarly resource must be used for EACH discussion question each week.

A Sample Answer for the Assignment: NR 506 Week 1: Barriers to Practice

Title: NR 506 Week 1: Barriers to Practice

NR 506 Week 1: Barriers to Practice

The role of Advanced practice nurses (APN) has provided effective and safe care to patients in the United States for many years. But from the initial introduction of APN’s there has been barriers at the state and national level that have been faced. The four different roles of APNs’, nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist face practice barriers that can restrict aspects of patient care and patient access.  

Practice barriers for the nurse midwife in the state of New Jersey includes, working under a physician which impede the midwifes’ ability to work independently with their patients. As delivering better care (2022) mentions “Reimbursement for care in birth centers does not usually cover the actual cost of care provided, and there is currently no Medicaid coverage for midwife-attended home births.” Although New jersey offers many remote educational programs for midwifery, the only in-person degree program resides at Rutgers University, where only a doctorate degree is offered. Lastly, on a national level, restrictive practice regulations appear to remain a barrier for women’s access to maternity and reproductive services from CNMs/CMs.

For the nurse anesthetist a barrier that has been faced is the need for supervision of an anesthesiologist. Priorly nurse anesthetist were able to work under supervision of qualified surgeons and other physicians. There has been 17 states that have lifted restrictions and regulations for nurse anesthetist (Baird, et al., 2020), but in the state of New Jersey  the nurse anesthetist still requires an anesthesiologist to be readily available in order to practice. Although 17 states have opt-out, on a national level it still remains an issue where Medicares condition of participation for healthcare facilities, requires that CRNAs be supervised by operating physician or anesthesiologist (Baird, et al., 2020).

There are many Nurse Practitioner(NP) in New Jersey can work in private practice or in partnership with a physician who is licensed to practice in the state. NP have prescriptive authority but are required to have a joint protocol with a collaborating physician who is licensed in NJ, prior to prescribing any medication or medical device (Nmmra.org, 2018). On a national level, federal regulations place barriers on the NP. The balanced budget act of 1997 allowed for NP’s to bill for services, but would not get 100% reimbursement independently, furthermore placing a barrier of NP’s having their own independent practices and access to healthcare (Bischof, et al., 2021). 

Clinical nurse specialist (CNS) are uniquely qualified to care for patients with complex illness as well as having skills to optimize care for entire populations with complex needs (Tracy, et al., 2020).  A barrier that CNSs are faced with on a state and National level is a lack of standardization in educational programs. This causes and issue of a lack of recognition of the CNS as advanced practice nurses, and prevents the healthcare system from the optimal use of CNS to improve and provide safe and quality care for patients (Tracy, et al., 2020).

 Physician assistants and Doctors are the greatest competitors that APNS are faced with in the state of New Jersey and on a national level. According to Feyereisen et al., (2021) an APRNs autonomy is decided by state laws which means that each state can say under what conditions a APN can practice. The APN faces restrictions along side the misconception that Doctors will provide superior care to that of a NP. This misapprehension leads patients to seek the care of a MD rather that of a NP. Furthermore, Physician groups might be more incline to hire doctors over mid-level provider such as a NP. The other competition lies with physician assistants. While the difference between the two might is that NPs tend to specialize in fields and PAs have a more generalized education, patients might be under the impression that PAs are better qualified to provide care. The notion that doctors and physician associates are better than nurse practitioners make it difficult for the nurse practitioners to gain the publics trust and treat them independently.

The primary function of the Legislature is to enact law.  In the event a law passes it proceeds to the executive branch which is liable to enforce them. The executive branch in New Jersey is led by our governor, Phil Murphy. Sheila Oliver is the Lieutenant Governor. Bob Menendez and Cory Booker are the two United States Senators representing New Jersey. In the legislative branch, Stephen M. Sweeney is the president of the New Jersey Senate, and Craig Coughlin is the Speaker of the General Assembly. (New Jersey Office of Information Technology, n/d).

Interest groups represent the fundamentals and set the tone for the APRNs scope of practice. At the state level, The New Jersey State Nurses Association (NJSNA) is advocating for APNs to practice to the fullest extent of their license. At the international level, the American Association of Nurse Practitioners (AANP), the National Council of State Boards of Nursing (NCSBN), Institute of Medicine (IOM), Robert Wood Johnson Foundation, National Governors Association (NGA), and FTC have come together in support of APNs practicing to the fullest extent of their education and licensure. (Brom et al., 2018). Furthermore, the American Nurses Association (ANA), traces interrelated nursing legislature in every state and examines health sector allied bills presented into the state council (American Nurses Association, n.d.).

There are many methods used to induce change in policy in forms of competition, state legislative and executive branches of government, and interest groups. As Future Nurse leaders it is very important to be engaged in health policies, procedures, and guidelines. NPs’ have the ability to guide quality improvement ventures within their work atmosphere and translate those findings to cultivate new policies (Chilton, 2019). Continuing education and staying up to date with the most current policies is imperative. Becoming members of organizations that support APNs’ roles and professional advancement such as the American Association of Nurse Practitioner (AANP) gives the  APN a voice to approach and stand up for their concerns. These organizations provide educational and informative resources to keep their members up to date with crucial policies. 

Apn Rules and Regulations: New Jersey and Pennsylvania. (2018, August 10). Nmmra.org. https://nmmra.org/apn-rules-and-regulations-new-jersey-and-pennsylvania/Links to an external site.

Baird, O’Donnell, J. M., & Martsolf, G. R. (2020). Effects of opting out from federal nurse-anesthetists’ supervision requirements on anesthesiologist work patterns. Health Services Research, 55(1), 54-62. http://doi.org/10.1111/1475-6773.13245Links to an external site.

Bischof, A., Greenberg, S.A., ( 2021) “Post COVID-19 Reimbursement Parity for Nurse Practitioners” OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 2, Manuscript 3. https://doi.org/10.3912/OJIN.Vol26No02Man03Links to an external site.

Chilton, L. (2019). Nurse Practitioners Have an Essential Role in Health Policy. The Journal for Nurse Practitioners, 11 (2), PA19. http://www.npjournal.org/article/S1555-4155(14)00687-4fulltextLinks to an external site.

Delivering Better Care: Midwifery Practice in New Jersey J U N E 2 0 2 2. (n.d.). https://www.njhcqi.org/wp-content/uploads/2022/06/Delivering-Better-Care-Midwifery-Practice-in-New-Jersey-Report_2022.pdfLinks to an external site.

Feyereisen, S., McConnell, W., Thomas, C., & Puro, N. (2021). Physician dominance in the 21st
century: Examining the rise of non-physician autonomy through prevailing theoretical
lenses. Sociology of Health & Illness, 43(8), 1867-1886. https://doi.org/10.1111/1467-9566.13366Links to an external site.

New Jersey Office of Information Technology. (n.d.). Official site of the state of new jersey. Office of the Governor Senior Staff. https://www.nj.gov/governor/admin/staff/Links to an external site.

Tracy, M. F., Oerther, S., Arslanian-Engoren, C., Girouard, S., Minarik, P., Patrician, P., Vollman, K., Sanders, N., McCausland, M., Antai-Otong, D., & Talsma, A. (2020). Improving the care and health of populations through optimal use of clinical nurse specialists. Nursing outlook, 68(4), 523–527. https://doi.org/10.1016/j.outlook.2020.06.004Links to an external site.

5. Grading Rubric

Discussion Criteria	A (100%) Outstanding or highest level of performance	B (87%) Very good or high level of performance	C (76%) Competent or satisfactory level of performance	F (0) Poor or failing or unsatisfactory level of performance
Answers the initial graded threaded discussion question(s)/topic(s), demonstrating knowledge and understanding of concepts for the week. 16 points	Addresses all aspects of the initial discussion question(s) applying experiences, knowledge, and understanding regarding all weekly concepts.16 points	Addresses most aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of most of the weekly concepts.14 points	Addresses some aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of some of the weekly concepts.12 points	Minimally addresses the initial discussion question(s) or does not address the initial question(s).0 points
Integrates evidence to support discussion. Sources are credited.* ( APA format not required) 12 points	Integrates evidence to support your discussion from:assigned readings** OR online lessons, ANDat least one outside scholarly source.***Sources are credited.*12 points	Integrates evidence to support discussion from:assigned readings OR online lesson.Sources are credited.*10 points	Integrates evidence to support discussion only from an outside source with no mention of assigned reading or lesson.Sources are credited.*9 points	Does not integrate any evidence.0 points
Engages in meaningful dialogue with classmates or instructor before the end of the week. 14 points	Responds to a classmate and/or instructor’s post furthering the dialogue by providing more information and clarification, thereby adding much depth to the discussion.14 points	Responds to a classmate and/or instructor furthering the dialogue by adding some depth to the discussion.12 points	Responds to a classmate and/or instructor but does not further the discussion.10 points	No response post to another student or instructor.0 points
Communicates in a professional manner. 8 points	Presents information using clear and concise language in an organized manner (minimal errors in English grammar, spelling, syntax, and punctuation).8 points	Presents information in an organized manner (few errors in English grammar, spelling, syntax, and punctuation).7 points	Presents information using understandable language but is somewhat disorganized (some errors in English grammar, spelling, syntax, and punctuation).6 points	Presents information that is not clear, logical, professional or organized to the point that the reader has difficulty understanding the message (numerous errors in English grammar, spelling, syntax, and/or punctuation).0 points
PARTICIPATION: Response to initial question: Responds to initial discussion question(s) by Wednesday, 11:59 p.m. M.T.	0 points lostStudent posts an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.		-5 pointsStudent does not post an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.
PARTICIPATION Total posts: Participates in the discussion thread at least three times on at least two different days.	0 points lostPosts in the discussion at least three times AND on two different days.		-5 pointsPosts fewer than three times OR does not participate on at least two different days.