NURS 8100 Policy Brief
NURS 8100 Policy Brief
A policy brief is a vital tool used to present research findings and recommendations to an audience with no specialization in the policy matter. Policy briefs offer evidence-based policy recommendations to help legislators make informed decisions (Arnautu & Dagenais, 2021). A strong policy brief incorporates research findings supporting the recommended policy and draws clear connections to policy initiatives. Therefore, it should be clear and concise to ensure the target audience adequately understands the recommendations. This paper presents a policy brief on the recommendation from the Institute of Medicine (IOM) report.
The selected IOM recommendation is: “Nurses should practice to the full extent of their education and training.”
The IOM recommendation emphasizes the need to transform nursing practice. The report encourages lawmakers to be guided by the Nursing Practice Act and Administrative Rules to amend state nurses’ scope-of-practice laws. Advanced Practice Registered Nurses (APRNs) are highly trained and competent to provide a wide range of healthcare services. However, they are limited by barriers, such as federal policies, state laws, obsolete insurance reimbursement models, and organizational practices and culture (Sullivan, 2018). State and federal initiatives are needed to update and standardize APRNs’ scope-of-practice regulations to capitalize on their specialized education and full capacity. Furthermore, the IOM report states that APRNs need to be allowed to practice to the full scope of practice. This will ensure that all citizens can access essential healthcare services and that organizations make the best use of the APRNs’ unique contributions to the healthcare team.
Insurance providers and States should create specific policy, regulatory, and financial changes that offer patients the freedom to choose from a range of health providers, including APRNs, to best, meet their healthcare needs (Sullivan, 2018). Eradicating regulatory, policy, and financial barriers to increase patient choices and patient-centered care is critical in creating a reformed health care system.
The scope of APRN practice varies with the state. The American Association of Nurse Practitioners (AANP) defines three types of practice authority for APRNs: Full, Reduced, and Restricted practice. APRNs practicing in states with Full practice authority are authorized to practice to their full scope of training, including evaluating, diagnosing, ordering and interpreting diagnostic tests, and prescribing treatments (AANP, n.d.). The state board of nursing gives them exclusive authority to practice to their full scope. Currently, 24 states in the U.S and its territories have adopted Full practice licensure laws. NPs practicing in states with a reduced practice are allowed to participate in at least one element of the NP practice. However, they are regulated by a collaborative agreement with a physician (AANP, n.d.). Physician oversight is needed for the NP to prescribe treatment. Sixteen states currently have the reduced practice.
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There are 11 states with a restricted practice whereby the state board of nursing mandates APRN supervision or delegation of duties such as diagnosing and prescribing by a physician. Texas lies at the lower end of the spectrum with regards to the freedom it offers APRNs. One of the barriers to expanding APRNs’ scope of practice has been opposed by some physicians and physician organizations. Some physicians argue that APRNs are less competent to provide the services outlined in their scope of practice since they do not undergo rigorous training like physicians (Sofer, 2018).
The Impact of the Recommendation
Patients perceive that the recommendation on the full scope for APRNs will increase their access to essential health services, especially in rural areas where there are few physicians and APRNs are usually the primary care providers. Currently, the country faces a shortage of primary care physicians, especially in rural and underserved areas (Ortiz et al., 2018). However, there is also an ample supply of specialists, which increase health care expenditures since specialist charge more expensively than primary care physicians. In addition, healthcare consumers perceive that the recommendation will lower the cost of healthcare. This is because full practice authority lowers duplication of services and billing costs caused by the outdated physician oversight (Ortiz et al., 2018). Besides, full practice decreases the unnecessary office visits, repetition of orders, and treatment services.
Nurses and professional nursing organizations argue that if all states allowed APRNs to practice to the full scope of their education and training, it could increase the workforce needed to meet the country’s primary care needs. APRNs would also contribute their specialized knowledge and skills to delivering person-centered, community-based health care (DePriest et al., 2020). Physicians believe that granting APRNs full practice will reduce their workload and increase access to care for patients living in underserved urban and rural areas. This is because states with full practice authority have many NPs working in the rural and underserved areas, which increases access to healthcare. Nevertheless, some physicians perceive that the recommendation will negatively impact patient care due to the lack of rigorous medical training for APRNs (Sofer, 2018). Various organizations, such as the Kaiser Family Foundation, argue that APRNs could help meet the demand for primary care. They argue that APRNs’ full practice can help meet the demand for primary health care, which is increasing due to a growing aging population (DePriest et al., 2020). Besides, increased access to health care through the Affordable Care Act increases the population in demand for care, and APRNs can help bridge the gap.
The current solution to having nurses to their full extent is advocacy. Many professional organizations are lobbying to remove barriers that limit APRNs from working to the full extent of their education and training (Peterson, 2018). NP organizations in various states have engaged lobbyists to help bring the advocacy efforts to the front line of policymakers. The lobbyists are educating policymakers on what APRN full practice entails. They clarify that it is not a policy against physicians but rather one that seeks to provide patients with access to quality care (Peterson, 2018). The Campaign by the Future of Nursing is one approach taken to lobby for APRNs to practice to their full scope in states with reduced and restricted practice. Furthermore, the National Council of State Boards of Nursing (NCSBN) monitors the practice roles and bills related to APRN practice to keep APRNs informed of their lobbying efforts.
Current Status in the Health Policy Arena
A report from The Campaign shows that APRN practice authority has expanded significantly since the release of the IOM recommendation report. After the release of the IOM report, 44 state Action Coalitions worked on the recommendation to get rid of barriers in the APRN scope of practice. Besides, 13 states have passed laws granting APRNs full practice authority (Sullivan, 2018). Since the Campaign’s commencement, eight states amended their laws to grant APRNs full practice and prescriptive authority. Furthermore, some states with reduced and restrictive practices have improved their laws to be less restrictive (Sullivan, 2018). For instance, Florida (reduced practice) passed a bill that requires PMHNPs to practice for the first two years with supervision and then practice to the full scope of their licensure.
The IOM recommendation on allowing APRNs to practice to the full scope of their education and training will increase accessibility to healthcare and lower costs. The health care environment is continuously evolving with an increasing demand for healthcare services from the aging population. Thus APRNs’ full contribution to the health care team is essential. Tremendous progress has been made toward decreasing restrictions on the APRN scope of practice across the U.S. States. The states with restrictive and reduced APRN practice are increasing APRNs’ potential to contribute fully to health care. However, more efforts are needed to hasten the amendments of the obsolete policies. We need more states to grant full practice authority to APRNs as primary care providers.
AANP. (n.d.). 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
Arnautu, D., & Dagenais, C. (2021). Use and effectiveness of policy briefs as a knowledge transfer tool: a scoping review. Humanities and Social Sciences Communications, 8(1), 1-14. https://doi.org/10.1057/s41599-021-00885-9
DePriest, K., D’Aoust, R., Samuel, L., Commodore-Mensah, Y., Hanson, G., & Slade, E. P. (2020). Nurse practitioners’ workforce outcomes under the implementation of full practice authority. Nursing Outlook, 68(4), 459–467. https://doi.org/10.1016/j.outlook.2020.05.008
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare6020065
Peterson, M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.
Sofer, D. (2018). AMA Resolution Opposes Independent Practice by APRNs. AJN The American Journal of Nursing, 118(3), 12. doi: 10.1097/01.NAJ.0000530922.33715.46
Sullivan, T. (2018). Institute of Medicine Report, The future of nursing: leading change, advancing health. Policy and Medicine.
The policy proposal the Institute of Medicine (IOM) recommends for furthering healthcare is “Nurses should practice to the full extent of their education and training.” Licensing and practice rules for Advanced Practice Registered Nurses (APRNs) scope of practice varies in each state and is determined not by their education and training but by the state laws. APRNs are essential in today’s healthcare system to solve the increasing shortages of primary care providers in rural and urban areas. Therefore, policy and regulatory changes recommend that all states allow APRNs to practice to the full extent of their education and license with full practice authority. According to the article written by Hudspeth and Klein (2019), IOM got it right in proposing that state legislators, Centers for Medicare & Medicaid Services, and Congress allow APRNs can practice to the full extent of their education and training; therefore,, decreasing the primary care provider shortage.
One of the IOM report messages is that “nurses should practice to the full extent of their education and training.” This message is driven by the need for nurses to transform practice to ensure that all Americans receive healthcare services ( Kershaw, 2019). In addition, nurses should maximize their contribution to the healthcare team. Also, insurance companies and federals should ensure they follow regulations and policies that protect patients’ rights. Several barriers prevent nurses from practicing to the full extent of their education and training. Some obstacles include state laws, federal policies, out-of-date insurance models, and institutional practices and cultures. The healthcare system is evolving. Between the years 1750 and 2000, there have been drastic changes in healthcare. There has been a shift from simple home remedies to complex technological systems. There are actions that the federal state should undertake to ensure the promotion of patient safety and the implementation of nursing recommendations. It provides provision of healthcare services to vulnerable populations. It should ensure the regulation of healthcare markets and support the acquisition of knowledge by nurses(Kershaw, 2019).
Hudspeth, R. S., & Klein, T. A. (2019). Understanding nurse practitioner scope of practice: Regulatory, practice, and employment perspectives now and for the future. Journal of the American Association of Nurse Practitioners, 31(8), 468-473.
Kershaw, B. (2011). The future of nursing – leading change, advancing Health. The future of nursing – Leading change, advancing health. Nursing Standard, 26(7), 31- 31. https://doi.org/10.7748/ns2011.10.26.7.31.b1274
The unpredictability of scope-of-practice regulations across states may hinder advanced practice nurses from giving care they were trained to provide and contribute to innovative health care delivery solutions. Though most nurses are registered nurses, over a quarter million are advanced practice registered nurses (APRNs), who hold master’s or doctoral degrees and have passed national certification examinations. APRNs include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. Although some states have regulations that allow nurse practitioners to see patients and prescribe medications without a physician’s supervision, most states do not. The federal government is well suited to promote reform of states’ scope-of-practice laws by sharing and providing incentives for the adoption of best practices (IOM, 2010).
First recommendation is to remove Scope of Practice Barriers. Advanced practice registered nurses should be able to practice to the full extent of their education and training. To achieve this goal, the committee recommends actions for the following entities: State Legislatures, Congress, Centers for Medicare and Medicaid Services, Office of Personnel Management, Antitrust Division of the Department of Justice, Federal Trade Commission, which has long sought to eliminate anticompetitive behavior in the health care industry, including restrictions on health care providers’ business practices and policies that could operate as a barrier to entry for new competitors (IOM, 2010).
In conclusion, the country has an opportunity to transform its health care system, and nurses are in the forefront and should play a critical role. However, the ability to improve current regulatory, business, and organizational conditions does not rest only with nurses; government, corporations, health care organizations, professional associations, and the insurance industry all have a role to play (IOM, 2010).
Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine
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Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington (DC): National Academies Press (US); 2016 Feb 22. 2,
Removing Barriers to Practice and Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK350160/
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future
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Available from: https://www.ncbi.nlm.nih.gov/books/NBK209881/