The number of patients is rising on the state and national level annually. The reason behind this tendency is an increase in the level of aging population, chronic medical diseases and overall lifespan of the US population. As a consequence, there is a tremendous shortage in practitioners and physicians throughout the country. However, Advanced Practice Nurses (APNs) are believed to be a plausible solution to this issue. APNs, which include certified nurse midwives, certified registered nurse anesthetists, certified nurse practitioners and clinical nurse specialist, can be professional enough to assist physicians and provide patients with a qualified level of treatment. However, there are a number of barriers that prevent patients from accessing the health care and negatively impact APN’s work. These barriers include statutory barriers of the joint protocol, regulatory and reimbursement constraints on APN care (Torre & Drake, 2021). Nowadays, the government focuses on reducing the existing barriers for APN practice. According to the New Jersey Collaborating Center for Nursing, the existing barriers for the full-scope of APN practice affect the access, cost and quality of the provided healthcare (NJCCN, 2019). On the national level, a wide range of organization support the removal of these barriers and allowance for the APNs to fully utilize their skill-sets by altering their scope-of-practice statues. They believe that this will lead to the high effectiveness of the health market and better care for the overall population.
The main barriers identified in New Jersey include statutory requirement that requires APNs to prescribe drugs only according to written joint protocol, which should be signed and approved by the physician. This protocol places APNs in dependant position and does not allow them to use their skills and certificates fully. Currently, 10 states including New Jersey use this protocol in primary care setting (Torre & Drake, 2021). The American Medical Association as well as Medicare and Medicaid believe that the APNs should work only in team with physicians and to be led by them as APNs are believed to be not competent enough to perform some procedures without physicians’ supervision, although there is no evidence suggesting that. In addition, the reimbursement system also limits APN practice. In particular, physicians capture reimbursement payment fully, which makes APN’s work and provided services underrepresented.
Apart from the barriers imposed on the state and national level, there are forms of competition within the healthcare system that restrict APNs from providing primary care independently. For example, APNs have to compete with physicians and other physician professional organizations such as American Medical Association and American College of Physicians to prove their competency in offering adequate treatment (Kleinpell et al., 2022). They believe that APNs do not possess enough level of education and training. Thus, in many states APNs have to perform their practice with the physician’s supervision.
In order to impose new policies and remove the existing constrains to APNs practice and independent work, the policymakers on the state and national level should work together to ensure more quality care. The main lawmakers on the state level are represented by key members of executive and legislative branches of government. In New Jersey, they include the governor, who appoint officials and the heads of state agencies like Attorney General; Secretary of State; State Treasurer; Secretary of the Department of Agriculture; Commissioners of the Departments; judges; county prosecutors and others (“About NJ government”, n.d.). The legislative branch consists of the Senate and General Assembly, including 40 and 80 members, respectively (“About NJ government”, n.d.). The idea for a new policy can emerge from the specific interest groups, APNs, for example, citizens concerned with the level of medical care, and the executive branch. For a law or a policy to pass, it should go though a legislative branch as a bill and signed into a law by the governor.
There is a number of interest groups that can initiate the changes and policies related to the APN’s practice on the state and national level. They are usually the main force in the process of the policy decision. In New Jersey, the main interest groups are represented by the New Jersey Collaborating Center for Nursing and New Jersey Association of Nurse Practitioners (NJCCN, 2019). As part of the APN community, people from those organizations may raise the awareness of the government on the issues that the APNs in New Jersey face and suggest solutions to eliminate existing barriers. At the national level, the organizations that can facilitate the policy decision process and propose changes to the APNs practice are Federal Trade Commission, National Governors Association, American Association of Retired Persons, Robert Wood Johnson Foundation, Heritage Foundation. According to the New Jersey Collaborating Center for Nursing, these national organizations feel an urge to eradicate the current APN barriers and support the modification of legislation in improving the access to healthcare (NJCCN, 2019). In addition, consumers can also be a powerful moderator to removing the APN practice barriers. By increasing the public awareness about the lack of health practitioners and existing obstacles in getting the access to the qualified medical care, these interest groups can lobby and influence a policy.
State legislative and executive branches, interest groups as well as national organizations, APNs and physicians can use several methods to influence the change in the existing situation with the barriers with APN’s practice. The report suggests several policy recommendations for eradicating the existing barriers such as provision of APNs with licensure, privileges, and alternative reimbursement system based on their education and training skills (National Academies of Sciences; Engineering; and Medicine et al., 2017). In particular, the recommendations for the Congress consist of expansion of the Medicare program to include the payment for the APNs’ services and amending the Medicare program to authorize APNs to make assessments. Meanwhile, the state legislatures and executives can alter scope-for-practice regulations for APNs to correspond with the National Council of State Boards of Nursing Model Practice Act and Model Nursing Administrative Rules, and encourage third-party payers, i.e. consumers, to provide direct reimbursement to the APNs (National Academies of Sciences; Engineering; and Medicine et al., 2017). Finally, interest groups can use the practices such as lobbying via writing of letters, face-to-face interviews and formal or written testimonies. All those efforts together or separately can impact the policy change and remove the barriers for APNs to fully provide qualified medical care, and saving the America’s healthcare system from the shortage of practitioners.
References
About NJ government. (n.d.). The Official Web Site for The State of New Jersey. Web.
Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N. (2022). Breaking down institutional barriers to advanced practice registered nurse practice. Nursing Administration Quarterly, 46(2), 137-143. Web.
National Academies of Sciences; Engineering; and Medicine, Institute of Medicine, & Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change; Advancing Health. (2017). Removing barriers to practice and care. In Assessing progress on the Institute of Medicine report the future of nursing (pp. 39-56). National Academies Press.
NJCCN. (2019). Policy analysis – Improving access to care for New Jersey. Web.
Torre, C., & Drake, S. (2021). Maximizing access to health care in New Jersey: The case for full practice authority. Advanced Practice Nurses in New Jersey.