Despite the 2010 report by the National Academy of Medicine (previously Institute of medicine) Advanced Practice Nurses (APNs) continue to struggle against barriers of practice (Schober, 2019). APNs with the same national certification and educational preparation face various restrictions when relocating from one state to another, thus limiting their scope of practice.
Significant barriers to practice for APNs include the requirement to have an oversight agreement with licensed physicians, a hindrance to binding a suicidal patient involuntarily subject to relevant laws, restriction from signing death certificates, and failure to be recognized as primary care providers by insurance providers both governmental and private companies (Grace, 2017). The barrier for oversight requirement by a licensed physician can be classified into:
- Reduced practice: APNs are allowed to engage in at least one component of the practice. However, cases involving patient care and prescribing of medication will require physician oversight.
- Restricted practice: APNs are restricted from engaging in at least one component of practice. Engaging in that component will require full oversight by a physician.
As the push to have APNs granted the licensure for full practice continues, there is a need for policy change in this pursuit. Congress needs to expand Medicare to cover APNs’ services that are within their practice under the relevant state laws like the physician’s services. Secondly, Congress needs to authorize APNs to conduct admission assessments and certification for patients in need of home health care services. Lastly, the state legislature needs to change the scope of practice for APNs to conform to the requirements of the various nursing Boards.
Forms of Competition on the State and National Level
APNs complete diverse tasks characterized by a high level of complexity requiring advanced training. However, these practitioners’ involvement in the provision of care to patients is limited due to rather outdated state and federal regulations (Poghosyan, 2018). For instance, reimbursement rates are inadequate, and NPs’ reimbursement is billed under the name of a physician. Poghosyan (2018) stresses that nurses are reimbursed at 85% of the physicians’ fees for the same services.
A considerable amount of work nursing professionals complete goes unnoticed. At the state level, the situation is often even worse due to various restrictions imposed by state governments. As far as Florida is concerned, nurses working in this state have to provide care in terms of restricted practice as they need to work under physicians’ supervision (Diaz, 2019). These forms of professional and financial competition between nurses and physicians are the major challenges the U.S. healthcare system has to address.
Key Members of the State’s Legislative Branch and Executive Branch of Government
The Florida legislative branch is represented by the Florida Senate and the Florida House of Representatives (The Florida Senate, 2020). The Senate includes forty members who are elected from forty districts throughout the state. This body develops and enacts regulations and laws that address different spheres of the state’s economy, health care, education, and other terrains of social life. The executive branch includes the Governor (Ron DeSantis) and several state agencies (“Florida,” n.d.).
These agencies are Attorney General, Consumer Protection Offices, Corrections Department, Education Department, Emergency Management Agency, Election Office, Lottery Results, Motor Vehicle Offices, Surplus Property Sales, Travel and Tourism, and Social Services. The executive branch executes laws enacted by the legislative branch. The interaction between these two branches ensures proper management of the challenges people of Florida may encounter.
Interest Groups That Exist at the State and National Levels That Influence APN policy
Diverse interest groups affect APN policy at the state and national levels. Federal and state governments are some of these stakeholders as these lawmakers develop regulations that shape the way the healthcare sector evolves (Poghosyan, 2018). Executive power at the federal and state levels also has considerable influence. For instance, the creation of such insurance programs as Medicare or Medicaid became a priority of U.S. presidents.
Healthcare professionals, who are mainly presented by certain associations, are also influential interest groups who articulate the most apparent challenges and issues to be addressed. Insurance companies, hospitals, and various health-related organizations are also involved in the process of developing the healthcare system. These interest groups pay attention to numerous aspects including but not confined to profit, care provision, labor force management, and interaction with other stakeholders. Patients constitute another interest group whose focus is on the quality of provided services, access to care, and other aspects.
Methods Used to Influence Change in Policy
Advocacy and lobbying are often regarded as the central forms of influencing the development of health care. These are potent tools to initiate a wide discussion, as well as the development, enactment, and execution of important regulations that can facilitate the progress of the system (Poghosyan, 2018). Interest groups concentrate on their goals and try to draw the public’s attention to the issue. Research is another instrument often used to change existing practices and policies as researchers unveil specific areas to focus on and potential improvements (Poghosyan, 2018). Different groups often collaborate to achieve certain objectives that can be beneficial for them. For instance, healthcare professionals may encourage patients to raise questions and address policymakers to remove some obstacles to people’s access to care.
References
Diaz, D. (2019). Allowing APRNs to practice independently better serves patients in Florida. Sunshine State News. Web.
Florida. (n.d.). Web.
The Florida Senate. (2020). About the legislature. Web.
Grace, P. J. (Ed.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.
Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioner workforce and practice. Nursing Economics, 36(1), 43-45.
Schober, M. (2019). An international perspective of advanced nursing practice. Advanced Practice in Healthcare: Dynamic Developments in Nursing and Allied Health Professions, 19-38.