The health care system should be continuously evolving to keep up with the patient’s needs. Nevertheless, in the USA, there are several legislation pieces that may provoke the potential barriers to the improvement of medical services and the increase of the nursing practice efficiency. According to the report published by the Institute of Medicine in 2011, “nurses should practice to the full extent of their education and training” (Institute of Medicine, 2011, p. 4). The US education and certification programs, such as APRN, help nurses to develop skills and build knowledge that would allow them to increase the patients’ access to health care services and enhance the clinical outcomes. However, the medical institutions in many states of the USA adopt legislation and policies preventing the nurses to practice to the full extent of their expertise. In this way, scope-of-practice regulations can be regarded as the obstacles to the effective adjustment to the dynamic changes in the healthcare environment.
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Scope of Practice
“The scope of practice of a licensed healthcare professional is statutorily defined in each state’s laws in the form of a practice act” (Association of Social Work Boards et al., 2012, p. 6). Nowadays, the legislatures in each particular state are authorized to rearrange the nursing regulation acts and limit or expand the scope of healthcare practice. It is observed that the modifications of the scope-of-practice acts are usually meant to meet the current situation in the fields of education, technology, healthcare demands, etc. However, in the case of nursing, the scope-of-practice act and its modifications are primarily aimed at public protection.
It is mentioned that the legal decisions must be concentrated on the provision of security for the consumers of medical services rather than “the professional self-interest” (Association of Social Work Boards et al., 2012, p. 7). The patients need to have the possibility of access to high-quality medical services provided by competent practitioners. Thus, on one hand, the limitation of the scope of medical practice helps to minimize the cases of patients’ treatment by the unprofessional nurses and, in this way, reduce the potential threat to public well-being. But, on the other hand, the limited scope of practice creates barriers to efficient and professional practice. Thus, the US health care system fails to meet the interests of the public.
According to the findings in the recent research related to APRNs proficiency issues, the certified nurse practitioners, clinical nurse specialists, and registered nurse anesthetists “are proficient not only in the use of skills in the realm of medicine but also in integrating skills from a holistic nursing lens and from several other disciplines” (Villegas & Allen, 2012, p. 405). However, the medical organizations often limit the APRNs practice considering it unsafe. But, at the same time, many of the US medical institutions claim that the expansion of certified nurses’ scope of practice would be beneficial from administrative and professional points of view. It is mentioned in the research findings that a better use of APRNs’ skills and knowledge can help to reduce the length of the patients’ stay at the hospital and minimize the costs (Villegas & Allen, 2012, p. 405). Therefore, the scope-of-practice act should be changed and enhanced to improve and expand the certificated nurses’ role in patient care.
Plan for Change Implementation
The Institute of Medicine may be regarded as one of the major official supporters of the legislation change and, nowadays, it plays a proactive role in the proliferation of information regarding the scope-of-practice issues. According to the Institute’s recommendations, it is necessary to remove the barriers in the legislation at both federal and regional levels (Institute of Medicine, 2011).
The professional medical and nursing organizations are regarded as the main stakeholders who would benefit from the scope-of-practice change. Since the nursing practice is regulated by the state governments, the local organizations need to focus their efforts and influences on targeting the states’ officials. Moreover, it is important to address the other groups of stakeholders such as local businesses, educational, and healthcare institutions (Texas Team Advancing Health through Nursing, 2011).
Despite the fact that regional governments may significantly influence the scope-of-practice change at the local levels, the federal legislation plays the major role in the policy renewal. Therefore, the multiple nursing organizations need to lobby for policy change at the national level as well. The raise of awareness is the crucial factor that may influence the policymakers’ decision. Thus, for the increase of the lobbying process effectiveness, it is important to raise the issue through the publications and engagement in collaborations with nursing associations because the widespread issues can affect the legislation transformation more efficiently. Moreover, the conduction of research related to the issues of nursing practice independence and scope-of-practice expansion, their advantages and disadvantages, and multidimensional effects can provide necessary evidence that could be used.
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Nurses alone cannot succeed in leading the legislation changes; the collaboration with the organizations and other medical practitioners will help them to achieve the professional recognition.
Association of Social Work Boards, Federation of State Boards of Physical Therapy, Federation of State Medical Boards of the United States, Inc., National Association of Boards of Pharmacy, National Board for Certification in Occupational Therapy, Inc., & National Council of State Boards of Nursing, Inc. (2012). Changes in healthcare professions’ scope of practice: Legislative considerations.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
Texas Team Advancing Health through Nursing. (2011). Initiative on the future of nursing. Web.
Villegas, W., & Allen, P. (2012). Barriers to advanced practice registered nurse scope of practice: Issue analysis. The Journal of Continuing Education in Nursing, 43(9), 403-9. Web.