The advance practice nurse and Doctor of Nursing Practice roles have developed substantially recently, gaining increasing recognition in educational institutions and working environments. Nevertheless, barriers remain in place, particularly concerning letting members of these new roles use their competencies to facilitate change. The first, per Chism (2017), is the lack of formal authority on the part of the clinician. As such, before putting their initiatives up for consideration by management, they have to secure the agreement of other stakeholders. As such, the process of them creating meaningful change is impeded, though the framework also provides a useful safeguard.
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Legal barriers are another issue that inhibits the work of APNs and DNPs in proposing and implementing improvements. Many states place stringent restrictions on these roles that inhibit their practice, and bodies such as the American Medical Association often support these restrictive policies (Ahmed & Wolf, 2018). As a result, the new nursing positions’ superior competencies are not recognized, and their role in proposing and facilitating changes is diminished. With that said, as APNs and DNPs achieve increased recognition in law, these concerns should be alleviated.
Concerns about APN and DNP competencies inform many of the laws that restrict their ability to practice and facilitate change. Legislators that pass such policies are often concerned about the quality of their education because of the limited resources available for the training of these roles (Tracy & O’Grady, 2018). The education standards for APNs and DNPs are often not standardized across institutions, and the practical experience that is critical in the education of these roles is lacking due to a lack of time on the part of existing professionals. With that said, as the positions develop further and more people attain these specifications, these problems should be gradually alleviated.
Ahmed, S. W., & Wolf, A. K. (2018). Evolution to revolution: Positioning advanced practice to influence contemporary healthcare arenas. In S. W. Ahmed, L. C. Andrist, S. M. Davis, & V. J. Fuller (Eds.), DNP education, practice, and policy: Redesigning advanced practice for the 21st century (2nd ed.) (pp. 3-26). Springer Publishing Company.
Chism, L.A. (2017). The DNP graduate as expert clinician. In L. A. Chism (Ed.), The Doctor of Nursing Practice (4th ed.) (pp. 61-96). Jones & Bartlett Learning.
Tracy, M. F., & O’Grady, E. T. (2018). Hamric & Hanson’s advanced practice nursing: An integrative approach (6th ed.). Elsevier Health Sciences.