Health Policy: Restrictive Licensing

Policy Background

The Florida Association of Nurse Practitioners (FLANP) recognizes that restrictive nurse practitioner licensure legislation is a problem for Florida, and it should be addressed from the perspective of recommending health policy change (“Current Issues,” n.d.). It is a state-level issue affecting advanced practice nursing, as regulations are different across the United States, but in Florida, the need for change is particularly stressed by practitioners.

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First of all, there is a physician shortage in the state, and the number of those who participate in social health care programs is below the national average; these two factors complicate the access to health care. Moreover, it is predicted that half of the physicians in Florida will be retired within the next ten years, and this creates a threat that appropriate care will be delivered to fewer and fewer people. In this situation, a larger number of nurses and the process of transferring some functions from physicians to nurses are expected to help improve the current situation and ensure better health care for Floridians.

Literature Review

Restrictive licensing has become an issue in nursing in connection to the process of progressing physician shortage. Florida is among the states with the lowest percentage (less than two percent) of community-dwelling Medicare patients whose primary care providers are nurse practitioners (Kuo, Loresto, Rounds, & Goodwin, 2013). With the health care reform, nurse practitioners around the country play an increasingly important role in care delivery; however, according to Hain and Fleck (2014), licensing and scope-of-practice regulations remain serious barriers to accessing care.

To obtain and keep full practice authority, a nurse is required to have a particular educational and practice level, pass the national certification, refer to other health care providers, and meet several more eligibility criteria based on professional practice, experience, conduct, background, and compliance with standards (Hain & Fleck, 2014). It is important that, in the states in which the regulations are less restrictive, the number of patients seen by nurse practitioners is larger (Kuo et al., 2013). Kleinpell et al. (2014), however, point out that not only the licensure restrictions but also the lack of uniformity of licensing, accreditation, and certification may be the problem.

The professional community of nurse practitioners in Florida lists several aspects of the current legislation that should be modernized (“Current Issues,” n.d.). First of all, the physician supervisory licensure requirements should be eliminated from the licensure process. Other recommendations include the ability to administer the Florida Mental Health Act, i.e. involuntary examination (Roggenbaum, Christy, & Murrin, 2013), the ability to sign death certificates, and all the documentation related to delivering care to a patient, and the ability to certify DNR orders.

In 2016, the legislation was modified, and a shift has been made toward expanding the practice of nurse practitioners; for example, starting in 2017, nurses in Florida were allowed to prescribe certain controlled substances (“Important legislative update,” 2016). Current licensure requirements include educational level (master’s or post-master’s), certain documentation related to previous practice, and malpractice insurance (“Advanced registered nurse practitioner,” 2017). Making the legislation less restrictive and providing more functions to nurses is controversial and may meet criticism (McCleery, Christensen, Peterson, Humphrey, & Helfand, 2014). However, according to Furrow, Greaney, Johnson, Jost, and Schwartz (2014), eliminating some restrictions can increase safety, effectiveness, and quality of care, increase access to it and reduce costs.

Goals and Options for Changes

The goal of the proposed policy change is to make the licensing process less restrictive, i.e. to eliminate certain criteria (e.g. physician supervisory licensure requirements) and enhance the scope of practice of nurse practitioners. As a result, more nurses will receive access to practice, and it is also expected that more nurses will be attracted to the state after changing the current legislation.

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This process is already taking place, as certain restrictions have been eliminated (“Important legislative update,” 2016); however, the proposed option is to continue the process by reducing the number of documents needed for licensure and increasing the amount of documentation that a nurse practitioner can process. Particular legislation that requires modifications according to the proposed policy change is the bill HB 423: Access to health care services approved by the Governor of Florida in 2016.

Risks and Benefits of the Changes

The main benefit of the proposed changes is that access to health care will eventually be increased. Individuals who will benefit from the change are those who currently lack such access due to their vulnerability in terms of social health care programs. Seeing a nurse practitioner as a primary care provider and receiving care of high quality from him or she is a valuable option for many individuals from this group.

Also, it can be argued that nurse practitioners themselves will benefit because enhanced abilities will increase quality standards and contribute to the profession’s development. Therefore, it is expected that the professional community of nurse practitioners and certain groups of citizens will support the policy change; particularly so because it is expected that the partial elimination of restrictions, according to the FLANP (“Current Issues,” n.d.), will not require extensive funding from the budget but will save “billions of dollars per year” (para. 20) in the long-term perspective.

The main risk of the proposed legislation modification—and the main argument of the opponents of this modification—is that the standards of the profession will be reduced, and less prepared people will be involved in delivering care to patients, which is a threat of decreasing the quality of this care. As it was mentioned above, a major consideration in addressing this risk is that enhanced scope of practice involves increased responsibility, which is why the mechanisms of evaluating nurses’ work are expected to further develop in Florida. Therefore, the process of making the licensure procedures less restrictive is expected to ultimately improve the profession’s standards, not deteriorate them.

Evaluation and Practice

The proposed policy change is expected to seriously modify the everyday work of many nurse practitioners and their relationships with physicians and patients. Moreover, more people will be attracted to the profession whose training and preparation will be different from those of nurse practitioners who were licensed according to the current legislation. This is why it is recommended to develop evaluation criteria and primarily consider the levels of access to health care and patient satisfaction.

An important thing to measure is the willingness of nurses to practice in Florida upon the adoption of new licensure and scope-of-practice laws; therefore, feedback from practitioners should be collected, too. Concerning the impact of the proposed policy change on a family nurse practitioner in Miami, it can be assessed the enhanced authority in terms of delivering health care to patients will help such a practitioner work more independently and ensure patients’ access to all the aspects of care that the practitioner was not previously allowed to provide.

References

Advanced registered nurse practitioner. (2017).

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Current issues. (n.d.)

Furrow, B., Greaney, T., Johnson, S., Jost, T., & Schwartz, R. (2014). Health law. St. Paul, MN: West.

Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. Online Journal of Issues in Nursing, 19.

Important legislative update for the medical and nursing professions. (2016).

Kleinpell, R., Scanlon, A., Hibbert, D., Ganz, F., East, L., Fraser, D., … Beauchesne, M. (2014). Addressing issues impacting advanced nursing practice worldwide. Online Journal of Issues in Nursing, 19.

Kuo, Y. F., Loresto, F. L., Rounds, L. R., & Goodwin, J. S. (2013). States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners. Health Affairs, 32(7), 1236-1243.

McCleery, E., Christensen, V., Peterson, K., Humphrey, L., & Helfand, M. (2014). Evidence brief: The quality of care provided by advanced practice nurses.

Roggenbaum, S., Christy, A., & Murrin, M. R. (2013). Baker Act receiving facility staff perceptions of community services.

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