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NUR 740 Discussion 11.1: Advocacy for APN Practice

As the demand for health care workers surged with the coronavirus case count, many states lifted restrictions on nurse practitioners, who provide much of the same care as doctors do. But California did not allow nurse practitioners to work without the supervision of a doctor, and most limitations on their practice stayed the same amidst pandemic.

In a March 2020 Gov. Gavin Newsom directed the state Department of Consumer Affairs, which controls professional licensing, the power to change or temporarily waive regulations to let the health care workforce respond to the crisis (Brusie, 2020). That opened the door for nurse practitioners to ask the department to kill the supervision requirements without actually lifting them. It temporarily lifted the cap on how many nurse practitioners each physician could supervise, though it left in place the oversight requirement (Brusie, 2020). Instead of one physician supervising four nurse practitioners, physicians can supervise an unlimited number of nurse practitioners (Brusie, 2020). In addition, on September 29, 2020, AB890 was signed into law by Gavin Newsom and Assembly member Jim Wood (Brusie, 2020). With the passage of AB 890 the Nurse Practitioner may be able to practice independently once certain provisions have been met. This law will come into effect in January 2022. Per AB890, the transition to practice must include a minimum of three full-time equivalent years of practice or 4600 hours (California Board of Nursing, 2021). Upon completion of the transition to practice, a nurse practitioner may practice in limited settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures (California Board of Nursing, 2021).

A restrictive environment of imposed state laws and regulations reduces nurse practitioners’ level of autonomy in prescribing medications and acts as a barrier to their practicing to full potential. The restrictive practice scope adversely impacts APNs’ ethical practices. For example, the restrictive-level policy is associated with reduced access to care, which goes against the ethical principle of justice. This ethical principle requires nurses to fairly and equitably distribute care to patients. Nevertheless, with the scope of practice limits, APNs might not be in a position to adhere to this policy. According to Patel et al. (2019), restrictive policies inhibit using nurse practitioners’ workforce strategically at their full capacity to improve access to care. As such, it might be challenging for APNs to offer equal care, particularly among patients from low-resource regions. Neff et al. (2018) added that in restrictive nursing practitioner policy states, APNs face restraints to practice to their full capacity and ability to offer the expected care. As a result, it becomes challenging for nurse practitioners to always adhere to the code of ethical practice requiring them to ensure fair and equitable care to all patients regardless of their socioeconomic status.


Brusie, Chaunie (2020). California Grants Nurse Practitioners Full Practice Authority by 2023. Nurse.org. Retrieved June 13, 2022, from https://nurse.org/articles/california-nurse-practitioners-full-practice/

California Board of Nursing (2021). Assembly bill 890. California Board of Registered Nursing. Retrieved June 13, 2022, from https://www.rn.ca.gov/practice/ab890.shtml

Patel, E. Y., Petermann, V., & Mark, B. A. (2019). Does state-level nurse practitioner scope-of-practice policy affect access to care? Western Journal of Nursing Research41(4), 488-518. https://doi.org/10.1177/0193945918795168 (Links to an external site.)

Peterson M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology8(1), 74–81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/

Hello Kaur

The prevailing changes in the context of healthcare practices throughout the world have imposed direct implications on the overall scope of practices among distinct medical providers. Most of the respective changes have led to the substantial evolutions, especially regarding the traditional roles and mandates of nursing practitioners and other non-physicians medical professionals. In this respect, I concur with your indications about the recent significant advancements in the scope of practices and educational frameworks for nursing practitioners, thereby according them sufficient level of expertise to provide almost similar care as typical doctors (Rosa et al., 2020). It is also true that recent COVID-19 pandemic prompted notable changes in the general scope of practice for healthcare providers in certain states, including the policy provision allowing nurses to work independently without the supervision of physicians.

Regardless, some states are yet to realize the emerging evolutions in the sphere of nursing practitioners and their integral roles toward fostering healthcare access among individuals through the implementation of relevant health policy reform. I agree with you that lack of effective policy reforms in some states, enabling nursing practitioners to practice up to their full potential have been a limiting factor and barriers to enhancing improved care access among the  members of public (Rosa et al., 2022).  It is logical that critical policy changes should be implemented countrywide to recognize the current advancements in the scope of practice for nurses in order to ensure enhanced accessible care among individuals.

However, don’t you think much emphasis should be conducted to determine whether the nurses’ pre-existing levels of healthcare expertise could not only warrant accessible care, but also quality patient care? According to Poortaghi et al. (2021), one of the notable factors that has been dwarfing the adoption of adequate regulations to allow nurses practice at the top of their licenses in certain states includes the risk of patient safety. From this perspective, health policy makers in the region have attempted to overcome the respective challenge through proposing the introduction of patient safety education in the context of nursing undergraduate curriculum, in a bid to ensure quality patient outcomes among future nurses (Mansour et al., 2018).


Mansour, M. J., Al Shadafan, S. F., Abu-Sneineh, F. T., & AlAmer, M. M. (2018). Integrating patient safety education in the undergraduate nursing curriculum: A discussion paper. The Open Nursing Journal12, 125. https://doi.org/10.2174%2F1874434601812010125 (Links to an external site.)

Poortaghi, S., Shahmari, M., & Ghobadi, A. (2021). Exploring nursing managers’ perceptions of nursing workforce management during the outbreak of COVID-19: A content analysis study. BMC Nursing20(1), 1-10. https://doi.org/10.1186/s12912-021-00546-x (Links to an external site.)

Rosa, W. E., de Campos, A. P., Abedini, N. C., Gray, T. F., Huijer, H. A. S., Bhadelia, A., & Downing, J. (2022). Optimizing the global nursing workforce to ensure universal palliative care access and alleviate serious health-related suffering worldwide. Journal of Pain and Symptom Management63(2), e224-e236. https://doi.org/10.1016/j.jpainsymman.2021.07.014 (Links to an external site.)

Rosa, W. E., Binagwaho, A., Catton, H., Davis, S., Farmer, P. E., Iro, E., & Aiken, L. H. (2020). Rapid investment in nursing to strengthen the global COVID-19 response. International Journal of Nursing Studies109, 103668. https://doi.org/10.1016%2Fj.ijnurstu.2020.103668

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NUR 740 Discussion 11.1: Advocacy for APN Practice

NUR 740 Discussion 11.1: Advocacy for APN Practice

Hi Husnaldeep,
The COVID-19 pandemic required all healthcare workers to be flexible. It also required laws and policies to shift to combat the high patient volume. You mentioned California did not allow APNs full practice authority but allowed physicians to supervise an unlimited number of APNs. It would be worthwhile to explore how involved supervision was with the restriction and what supervision looked like after the restriction was lifted. Physician supervision entails the physician to be legally responsible for the APNs work (Spetz, 2018). Exact details of supervision are decided between physician and nurse practitioner (Spetz, 2018). The variation between physician standards for supervision makes it hard to determine what pre and post pandemic supervision entailed. Do you think allowing physicians to supervise an unlimited number of APNs changed patient care? Did it change APNs practice at all? AB890 sounds like a step forward in the right direction toward full practice authority for APNs. APNs complete clinical rotations while in school before becoming licensed APNs. However, they do not go through a residency position like medical doctors do. Three years before independent practice can be seen as a “residency” period where APNs are still new to their position and learning the ropes. AB890 is a bill that may appease both physicians and APNs.

Spetz, J. (2018, September). California’s nurse practitioners: How scope of practice laws impact care. California Health Care Foundation. https://www.chcf.org/wp-content/uploads/2018/09/NursePractitionerScopePracticeLaws.pdf

Hello Kaur

Indeed, the restrictive environment imposed by state laws and regulations reduces nurse practitioners’ autonomy in prescribing medications and acts as a barrier to practice to their full potential. Do you think that the difference in educational requirements warrants physician supervision? Perhaps you could explore the argument that physicians go through lengthier and more cumbersome training hence justified in supervising nurses. According to Peacock & Hernandez (2020), nurses are not required to undergo years of medical residency training and get only 500 to 720 hours of clinical training compared to the 10,000 to 16,000 hours physicians receive. When you said that restrictive-level policy is associated with reduced access to care, did you mean that allowing nurses to practice independently can increase access to healthcare? Some evidence shows that states like Oregon, which allow for independent practice, have not witnessed any significant shift of nurses to rural areas (Feyereisen & Puro, 2020). However, I agree that restrictive practice prevents nurses from exploring their full potential. My discussion established that decisions to restore restrictive practices after the pandemic could seriously damage relationships with APRNs who perceive a lack of reciprocity from institutions for which they have risked their health and sacrificed their personal needs. If the practice restrictions are suddenly or even gradually reversed, when the pandemic declines, many APRNs, for instance, may feel that they were treated unfairly. You had an excellent discussion. 


Feyereisen, S., & Puro, N. (2020). Seventeen states enacted executive orders expanding advanced practice nurses’ scopes of practice during the first 21 days of the COVID-19 pandemic.  Rural and Remote Health20(4). DOI:10.22605/RRH6068

Peacock, M., & Hernandez, S. (2020). A concept analysis of nurse practitioner autonomy.  Journal of the American Association of Nurse Practitioners32(2), 113-119. doi: 10.1097/JXX.0000000000000374

Hi Husnaldeep,

I agree with you that the surge of COVID-19 triggered the demand for healthcare providers. Therefore, healthcare organizations lifted restrictions on nurse practitioners. The decision was reached as the best strategy of ensuring that there are enough nurses to attend to patients (Bolt et al., 2021).  Thus, most nurses were allowed to work at the same capacity as doctors without licensing. Unfortunately, some states such as California did not lift the restrictions on nurses. As a result, nurses were expected to perform their nursing roles without interfering with doctor’s obligations. The decision was a surprise to many people given that California was among states with surging cases of COVID-19 (Minissian et al., 2021). However, the state was clear on not allowing nurses to execute new roles since some healthcare providers were doubted to have the right skills to operate as nurses.  Despite of the crisis, California healthcare sector wanted nurses to operate under supervision from certified doctors. Restricted environment amidst the pandemic interferes with response. However, California wanted to maintain professionalism.



Bolt, S. R., van der Steen, J. T., Mujezinović, I., Janssen, D. J., Schols, J. M., Zwakhalen, S. M., … & Meijers, J. M. (2021). Practical nursing recommendations for palliative care for people with dementia living in long-term care facilities during the COVID-19 pandemic: A rapid scoping review. International journal of nursing studies113, 103781. https://doi.org/10.1016/j.ijnurstu.2020.103781 (Links to an external site.)

Minissian, M. B., Ballard-Hernandez, J., Coleman, B., Chavez, J., Sheffield, L., Joung, S., … & Marshall, D. (2021). Multispecialty Nursing During COVID-19:: Lessons Learned in Southern California. Nurse leader19(2), 170-178. https://doi.org/10.1016/j.mnl.2020.08.013


The recent COVID-19 pandemic demanded flexibility from every healthcare professional. To tackle the increased patient load, changing the laws and regulatory practices of the state was necessary. You said that California enabled doctors to oversee an endless amount of Advanced practice nurses, but they did not give APNs complete practice power. Investigating how active and involved supervision was with the limitation and how supervision seemed once the restriction was withdrawn would be helpful. Under medical supervision, the doctor is held accountable for the APNs’ performance on a legal level. It is challenging to ascertain what pre- and post-pandemic monitoring include due to differences in physician criteria for supervision. Do you believe that changing MD/DO supervision to allow for an infinite number of APNs affected patient care? Did it alter APNs’ methods in any way?   Before becoming licensed APNs, APNs must undergo clinical rotations while still in school. They do not, however, complete a residency program as physicians do. APNs might be said to be in their “residency” stage when they get practice experience in the field after obtaining licensure. Thank you for such a thorough discussion post this week!



The beginning of the COVID-19 pandemic was an unprecedented time for all institutions, but especially for healthcare. The rapid spread of the virus created more patients than hospitals were equipped to handle. Non-essential units were shut down to focus on critical and emergent care. Hospital staff members were redistributed to areas of greatest need including emergency department, intensive care units, and medical surgical inpatient units. All nurses were called upon to practice at the top of their scope. For example, certified nurse anesthetists were transferred out of the operating room to be the lead nurse for COVID patients on ventilators. The federal and state government lifted restrictions for advanced practice nurses (APNs) to have full practice authority. Illinois was not a state to suspend or lift restrictions in response to the pandemic (American Association of Nurse Practitioners, n.d.). Each state varied in type of restriction lifted, but there were some common requirements waived. For example, there was less, or no physician supervision required, APNs had more prescribing freedom, and APNs could practice at the top of their scope in facilities where they previously could not (American Association of Nurse Practitioners, n.d.) With the COVID-19 pandemic more under control, state and federal legislation have let these prior orders expire. The scope of practice for APNs is largely returning to what it was pre-pandemic. The removal of practice restrictions during a national emergency and the subsequent reinstatement is an exploitation of APNs. The state, hospital administration, and healthcare colleagues are willing to accept the full scope of practice and services offered by APNs when they have little to no other resources available. Management at Emory healthcare gathered APNs, surveyed their current skill set, gave a brief competency training, and deployed them to new areas of the hospital to practice (Proulx, 2020). APNs were entrusted to navigate new practice environments while providing exemplary care to patients. The restriction of full practice authority for APNs stems from physician-led organizations wanting to keep traditional roles and hierarchy in medicine (Stucky et al., 2020). It is not ethical to restrict the ability of a trained and educated nurse practitioner to bolster physician only care. Patients ultimately suffer the consequences when there is a shortage or lack of available providers. Studies have found APNs provide equivalent care as physicians with increased patient satisfaction (Stucky et al., 2020). The COVID-19 pandemic has shown APNs are capable of practicing at the top of their scope. Healthcare policy can grant full practice authority throughout the United States to standardize the role of the NP across state lines (Stucky et al., 2020). Nurses should continue to advocate for their right to full practice authority.

American Association of Nurse Practitioners. (n.d.). COVID-19 state emergency response: Temporarily suspended and waived practice agreement requirementshttps://www.aanp.org/advocacy/state/covid-19-state-emergency-response-temporarily-suspended-and-waived-practice-agreement-requirements (Links to an external site.)

Proulx, B. (2020). Impacts and innovations. COVID-19 care model: leveraging advanced practice providers. Nursing Economic$, 38(3), 149-151.

Stucky, C. H., Brown, W. J., & Stucky, M. G. (2020). COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority. Nursing Forum56(1), 222–227. https://doi.org/10.1111/nuf.12515

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