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NUR 740 Discussion 14.1: Contemporary Health Policy Project: Peer Review

Hi Michelle Barry

In the current role play case, I assume the position of a local or a member of the professional nursing society/group or action coalition. As a member of the respective society, my fundamental role entails advocating for policy reform to enhance the overall practice of advanced practice nursing (APRN) as a framework for fostering the health and well-being of the public. The rationale for choosing this role as an APRN member of the professional coalition is prompted by my intrinsic aspiration to champion improved and optimal APRNs practices across the country. Correspondingly, this is an impactful strategy towards guaranteeing equitable healthcare access among the members of the public, not only in my state but also nationwide. I perceive quality health care as a basic privilege and right that should be granted to citizens regardless of their social or economic status. Thus, a viable and conducive healthcare environment should be accorded to every care practitioner to enable them to improve the scope of their care deliveries in a bid to warrant social justice and accessible care in the communities.

Peer Response to Michelle’s Presentation

From my role’s perspective, I believe your proposed policy reform is justifiable and constitutes a relatively strong basis and rationale. As a profound advocate for improved practice policy reform, I can confirm that your proposed policy reform is viable and aims to overcome the pre-existing state barriers to full practice among the nursing practitioners, precisely the advanced practice nursing. I understand that while some states are still considering implementing the FPA regulation, others have enacted restrictive policies that make it relatively challenging for the subsequent APRNs to ultimately achieve full practice certification/status.

As a member of the professional nursing society, I believe the proposed policy reform would foster and improve the medical service deliveries to the members of the public. It will also accord me and the members of my team adequate opportunity to provide full practice in our underlying clinical endeavors. The policy reform advocates for the APRNs to be granted FPA at the time of licensure. This would be a quite crucial milestone in the state’s healthcare practices as it would eliminate the pre-existing complex, lengthy, and tiresome procedures before the APRNs could acquire FPA certifications (American Association of Nurse Practitioners, 2020).  Moreover, the policy would remove barriers limiting APRNs only to primary care settings, thereby allowing them to assume fairly independent and widespread roles in their areas of practice. However, the major drawback or negative impact of the proposed policy reform entails its limiting factor on surgical assisting nursing practitioners. Regardless, this may be understandable at this point as a fundamental measure to protect the safety of patients in the long run.

Needless to say, the policy reform would impact the APNs practice by granting them the inclusive right to full practice. This is crucial as it would allow the APNs to accord independent actions in relation to performing patient diagnosis, recommending treatment, and managing acute and chronic conditions (DePriest et al., 2020). Furthermore, it would lead to the elimination of the current board of nursing’s policy requirement of about 3,000 clinical hours of supervision before the APRNs could be granted the FPA licensure. This would be an integral approach to promoting improved patient health care outcomes among the APRNs.

Ultimately, the proposed policy plays an integral role toward promoting social justice and equity in healthcare. Precisely, the degree of the policy reform in relation to fostering social justice and equitable healthcare access is approximately 8/10. As evident by O’Reilly-Jacob et al. (2022), adopting a less restrictive scope of practice nursing policies, including the implementation of FPA regulations, constitute a substantial framework or role in guaranteeing social justice and equitable health access among the members of the public. However, to enhance the strength of the proposed policy reform, don’t you think the policy should also campaign for other non-physician professionals, including Physician Assistance? According to DePriest et al. (2020), removing obstacles preventing PAs from optimal practice is one of the significant steps to championing improved health access in the communities.

References

American Association of Nurse Practitioners. (2020). 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 (Links to an external site.)

DePriest, K., D’Aoust, R., Samuel, L., Commodore-Mensah, Y., Hanson, G., & Slade, E. P. (2020). Nurse practitioners’ workforce outcomes under implementation of full practice authority. Nursing outlook68(4), 459-467. https://doi.org/10.1016/j.outlook.2020.05.008 (Links to an external site.)

O’Reilly-Jacob, M., Perloff, J., Sherafat-Kazemzadeh, R., & Flanagan, J. (2022). Nurse practitioners’ perception of temporary full practice authority during a COVID-19 surge: A qualitative study. International Journal of Nursing Studies126, 104141. https://doi.org/10.1016/j.ijnurstu.2021.104141

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NUR 740  Discussion 14.1: Contemporary Health Policy Project: Peer Review

NUR 740 Discussion 14.1: Contemporary Health Policy Project: Peer Review

Thank you for choosing my presentation to review, Romina.

To answer your question, I believe we should also campaign for other professions such as physician assistants (PAs) to have policy reform to expand their scope of practice to the full extent their education prepares them for. Similar to advanced practice registered nurses (APRNs), PAs scope of practice is based on education and experience, state-level laws, policies of employers and facilities, and the needs of the patients (American Academy of Physician Assistants [AAPA], 2019). The AAPA (2019) recommends that PA scope of practice be determined at the individual organization or practice level. This would essentially mean that they are in favor of PAs having whatever level of scope of practice their organization deems fit. This would be a strategy that could benefit APRNs. Leaving the scope of practice up to the organization rather than the state would allow for scope of practice expansion in areas that were previously restricted for organizations that support APRNs having full practice authority. This could mean that an APRN could merely switch jobs or companies within their same city to potentially obtain full practice authority rather than having to jump states to obtain this. However, this does not fully expand the profession, nor does it create equality among the profession, but it would be a step in the right direction.

References

American Academy of Physician Assistants. (2019). PA scope of practice [PDF]. https://www.aapa.org/wp-content/uploads/2017/01/Issue-brief_Scope-of-Practice_0117-1.pdf

Contemporary Health Policy Project: Peer Review of Romina Gujic

          The person’s presentation I chose to review was Romina Gujic. The role I have selected for the conduction of the review is the advanced practice nurse (APN).

An APN is a masters or doctoral-prepared nurse who is properly equipped and ready to accept the duty of and accountability for health promotion and the assessment, diagnosis, and management of patient conditions, including the use and prescription of pharmacologic and nonpharmacologic interventions (Ott, 2022). APNs come in many forms such as certified nurse practitioners (CNPs) in the areas of family practice, pediatrics, psychiatric mental health, acute care, women’s health, and geriatrics (National Council of State Boards of Nursing [NCSBN], n.d.). Additionally, there are the roles of certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), and clinical nurse specialist (CNS) (NCSBN, n.d.). I chose this role as it is the most pertinent to the subject matter of Nevada State Board of Nursing Bill No. 327 as it directly impacts the APN role.

Romina’s presentation was very informative and insightful about the differences in licensure renewal between states. As a Florida APN, I can say that the requirements for licensure renewal sound far stricter in Nevada. Nevada State Board of Nursing Bill No. 327 impacts licensure renewals by requiring two continuing education (CE) contact hours to be obtained in the area of cultural competency. 60 minutes of participation equates to one CE contact hour (Nevada State Board of Nursing [NSBN], n.d.). I do not see this as being too difficult or too taxing of a requirement to complete with each licensure renewal. However, I am not sure as to why courses are taking nurses three to four days to complete just for this one CE requirement.

The proposed policy reform is viable from my perspective as an APN. The proposed policy reform focuses on providing monetary assistance to all nurses for going out of their way to obtain the required CE contact hours. This would require compensation for taking the required courses, or that the courses be offered free of charge. As an APN, I feel that if nurses are required to obtain these courses with every licensure renewal, they should at least be cost-effective. Additionally, the two hours of required CE should take an actual two hours’ worth of time to complete as opposed to three to four days just to obtain two CE contact hours. The duration of completion does not align with the NSBN’s description of how participation equates to contact hours. Positive impacts of the proposed policy reform include lessening the financial burden of APNs and other nurses while maintaining their licensure and ability to practice. It also positively impacts the APN role by ensuring APNs are not taking too much time away from work to complete the CE courses and allowing more time with their patients. I do not feel the proposed reform has any negative impact on the APN role itself. The proposed policy reform would impact APN practice by ensuring all APNs are culturally competent in addressing and managing the care of persons of different backgrounds. The proposed policy reform promotes social justice and equity by ensuring that APNs are properly educated regarding cultural competency, diversity, equity, and inclusion. The proposed policy reform also requires that the policy aligns with the legislation of other states. This ensures Nevada APNs are prepared to appropriately manage the care of all persons from many backgrounds and locations. It also ensures Nevada nurses will be prepared to work in other states if they so choose. As an APN, a suggestion I have to strengthen the proposed policy reform includes standardizing the course to one singular provider for the entire state of Nevada that is overseen by the NSBN. The course should be a self-paced online course for all nurses to complete at their leisure. Allowing the course to be completed in a self-paced format would eliminate nurses having to miss work to complete the course. They could start the course well before the expiration of their license, and take their time working to complete it when they have free time. The format of the online course should allow for the nurses to save their spot within the course and resume it at any point. At the completion of the course, the nurses would be awarded the two CE contact hours required to renew their license. This would ensure all nurses, including APNs, are trained and well versed in explicit and implicit bias, indirect discrimination, race and ethnicity, religion and spirituality, gender bias, gender identity, microaggressions, and cultural humility.

 

References

National Council of State Boards of Nursing. (n.d.). APRNs in the U.S. NCSBN. https://www.ncsbn.org/aprn.htm

Nevada State Board of Nursing. (n.d.). Continuing education. https://nevadanursingboard.org/continuing-education/

Ott, K. M. (2022). Health policy effect on health systems. In K. A. Goudreau & M. C. Smolenski (Eds.), Health policy and advanced practice nursing: Impact and implications (3rd ed., pp. 13–24). Springer.

Hi Michelle

I concur with your indications in your role play post regarding the Nevada State Board of Nursing relatively stricter license renewal policy for nursing practitioners. In addition to the implementation of the proposed policy amendment for the NSBN’s Bill no. 327, there is also an imminent need for the NSBN to enact adequate regulations that would attract nurses from other states to practice in Nevada. Thus, it is true to say that in order to foster a moderately homogenous work environment for nurses, it is necessary for the NSBN to implement favorable policy reforms that coincide with those of other states. Your suggested ideas/strategies for strengthening the proposed policy reform are effective and worth considering. For instance, standardization of the course to a single provider throughout the state would ensure that all course programs can be centrally accessed by nurses in the region, regardless of their physical locations. Also, providing the course programs via a designated online platform would reduce the overall costs and amount of time required by nurses to complete the respective course (Geng et al., 2021).

Reference

Geng, Y., Huang, P. S., & Huang, Y. M. (2021). Crowdsourcing in nursing education: A possibility of creating a personalized online learning environment for student nurses in the post-COVID era. Sustainability13(6), 3413. https://doi.org/10.3390/su13063413

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