Nurses’ Roles, Barriers to Practice, and Solutions

Definition and description of the issue

• Nurse practitioners play key roles in health care services.
• Nurses facilitate interprofessional collaboration for medical practitioners.
• Barriers to nursing practice continue to exist.
• Many issues are results of physicians’ lack of awareness.
• Barriers impede the nurse’s ability to produce positive patient care outcomes (Clarin, 2007).

Nowadays, nurse practitioners play key roles in health care service, and their role has been steadily increasing. Nurses facilitate interprofessional collaboration for medical practitioners, and heavily partake in organizational initiatives, leading to better patient outcomes and more efficient services.

Despite this, there are still many harmful and debilitating barriers to nursing practice that inconvenience the nursing staff and hurt the industry, including the people in its care. Many of these issues are the results of physicians’ lack of awareness and attitudes which were instilled with their education.  Exploration of the background of the issue:

• Duties and goals of NPs and physicians overlap.
• Physicians are on top of the medical hierarchy.
• The value of nursing practitioners is underrated.
• Medical organizations oppose the removal of scope-of-practice barriers (Kunic & Jackson, 2013).
• State regulations and reimbursement policies restrict nurses (Hines & Yu, 2009).

Many duties of NPs and physicians overlap, and they share the same goals. Depending on the level of education, advanced practice nurses can be on the same level in terms of knowledge, as physicians, and be able to administer preoperative and postoperative surgical care, assist in operations, and provide other high complexity services. They are responsible for patient relations and observation of their treatment.

However, medical education creates a hierarchy with physicians on top. The services nurses can provide and their scope-of-practice is limited by most state organizations, and they are often underappreciated by both doctors and patients. Also, reimbursement policies are restrictive and can be demoralizing, especially for new staff members

Stakeholders

• Advanced practice registered nurses;
• Medical health care practitioners;
• Patients;
• Patients’ families.

These issues affect a wide range of stakeholders in the medical care industry. These include the nurse practitioners themselves, who find themselves restricted in their ability to help patients, even when possessing the necessary skills. The patients don’t get the best possible quality of care, which puts additional stress on their families and friends.

Finally, other medical health care practitioners and physicians, in particular, are also affected, since they are heavily dependent on nursing staff, and miss out on their skills.

Issue statement or statement of clarity

• The restrictiveness of PN scope of practice.
• Lack of respect and appreciation from physicians (Shannon & Myers, 2009).
• Lack of physician’s knowledge on the role of nurse practitioners.
• Lack of interprofessional communication (Hughes, R. (2008).).
• Inconsistent reimbursements (Kunic & Jackson, 2013; Reimbursement Task Force and APRN Work Group, 2012).

The medical situation in the US has changed in a way that makes the industry much more reliant on nurses. However, this is not reflected by most states’ legislations, which severely limit the nurse’s scope-of-practice.

This perpetuates a situation, where nurses don’t receive the deserved respect and appreciation from physicians and patients. While the new trends in health care require more professional communication and team collaboration, the current legislations limit the authority of nurses, hampering their ability to facilitate such communication. Finally, inconsistent reimbursement laws within and between states decrease the nursing motivators and lower the job market value of the advanced practice registered nurse profession.

Possible methods of addressing the issue

• Use transformational leadership to decrease power abuse by doctors.
• Create a patient-centric organization culture, with doctors and nurses as partners.
• Empower Nurse Practitioners to monitor and regulate multidisciplinary teams.
• Education of staff and patients to increase awareness.
• Integration of tools and technologies to support communication.

To resolve the inequality problem of nursing staff and doctors, transformational leadership needs to be applied. By focusing the medical care practitioners on the goal of caring for the patient, creating a patient-centric organization culture where doctors and nurses function as partners, regulatory organs would be able to decrease the power abuse by doctors.

By empowering the nurse practitioners to monitor and regulate multidisciplinary teams, providing better tools and technologies to facilitate communication, and educating the populace about the competencies and responsibilities of the NPs, the hospitals and clinics would be able to improve the efficiency of patient care, and patient and family relations.

Goals and options for changes

• Integration of new nurses into the profession through support and training.
• Improve communication, feedback, and increase transparency.
• Improve workforce planning to decrease skills deficit.
• Improve patient care through better interprofessional collaboration.
• Increase NP appreciations through increased awareness (Gbadamosi, 2015).

The discussed methods would the medical industry to achieve several notable goals, such as the integration of new nurses into the profession through support and training, improvement of communication, feedback, and, consequently, improved public appreciation of NPs through increased transparency. By giving more motivational and financial incentives for people to head for the nursing profession, these methods would help to improve workforce planning, and, as a result, decrease skills deficit that has resulted from the recent Affordable Care Act.

Finally, better trained and motivated NPs would help improve patient care through better interprofessional collaboration.

Risks and benefits of the changes

• Treatment errors due to increased authority without in-depth knowledge.
• Risk of lowering the prestige of physicians in favor of the nurses.
• Conflicting authorities and lack of clear hierarchy.
• Increased prestige of the nursing professions and decrees the turnover rates (Stokowski, 2014).
• Increased effectiveness of patient treatment (Llopis, 2014).

Without in-depth medical knowledge and regulations for the presence of such competencies, the increased authority of nurse practitioners can lead to treatment errors. I can also lead to confusion on behalf of patients about whom they need to address their problems

By improving the conditions of nurses to the same level as physicians, there is a risk of lowering the prestige of the latter in favor of the former. This is possible because, despite more equal authority and responsibilities, the physicians still have to undergo more years in costly education, which can make nursing a more sensible decision for the undergraduates. Finally, these conditions can cause conflicts in the workplace due to conflicting authorities and a lack of clear hierarchy.

On the other hand, these changes can increase the prestige of the nursing profession and decrees turnover rates, which have been a severe problem so far. Secondly, they can increase the effectiveness of patient treatment, due to better collaboration between different branches of medical care, and more emphasis on teamwork.

Evaluation methodology

• Define the parameters of evaluation.
• Design the methods used for the evaluation.
• Set standards and collect evidence.
• Report and make decisions (Baehr, 2004).

To efficiently evaluate the methods, it is necessary to follow a consistent procedure. First, it is necessary to define the parameters of evaluation. In this situation, they are the satisfaction levels of the stakeholders involved. The best methods for collecting this data is by assessing the workplace, interviewing the stakeholders (nurses, physicians, patients, their families), and evaluation of statistical data. By studying this information, the researchers would be able to determine if the proposed policy changes would help improve the workplace and make decisions based on those conclusions.

Recommendation or solution

• Enable the APRNs to practice to the full extent of their education and training.
• Implement evidence-based practice
• Create an effective report and feedback system.
• Institute a punishment system for disruptive behavior towards nurses by doctors.
• Implement communication systems for better organization.
• Give nurses more authority in decision-making.

The risks to the patient can be mitigated by implementing evidence-based practice for nurses, which would allow them to achieve the highest level of care quality due to individual approaches, and by enabling them to practice to the full extent of their education and training. An effective report and feedback system would allow the management to spot conflicts at the early stages, and carry out disciplinary actions to reduce the disruptive behavior from the doctors. It would also allow nurses to use their new authority to provide ideas for innovation or improvement.

Identify the type of legislation

• Federal.
• Workplace conduct.
• Scope of practice.
• Reimbursement.

The legislation that would need to be introduced to support these methods and goals would be federal legislation, with the primary focus on scope-of-practice, efficient reimbursements, and better workplace conduct to accommodate changes to the workplace culture.

Review of literature

• 5 Ways Leaders Enable Innovation In Their Teams (2014).
• Evaluation Methodology (2004).
• Nurse-to-Physician Communications: Connecting for Safety (2009).
• Nurse Turnover: The Revolving Door in Nursing (2014).
• Patient safety and quality: An evidence-based handbook for nurses (2008)
• Primary Care Workforce Shortages: Nurse Practitioner Scope-of-Practice Laws and Payment Policies (2013).
• Reimbursement of Advanced Practice Registered Nurse Services: A Fact Sheet (2012).
• Strategies to Overcome Barriers to Effective Nurse Practitioner and Physician Collaboration (2007)
• The Changing Reimbursement Landscape: Nurses’ Role in Quality and Operational Excellence (2009).
• Transforming Nursing Practice: Barriers and Solutions (2013).
• What are the barriers to implementing change in the NHS? (2015).

Describe the current policy issue

• Limited scope-of-practice for nurses.
• Restricts how and where NPs can be employed.
• No federal law on insurance mandates for NP reimbursements (Lee, Cross & Samuel, 2013)
• State laws have not been updated with the new role of NPs.

Current nursing legislations provide limited scope-of-practice for nurses and restrict how and where NPs can be employed. Additionally, there is no unifying federal law on insurance mandates for NP reimbursements, and not all states have laws to bridge this gap in legislation since many state laws have not been updated to account for the development of NPs.

Specify how it impacts nursing

• Restricts services nurse practitioners can provide.
• Ties NPs geographically to a collaborating physician.
• Discourages NP innovation.
• Discourages more efficient and diversified use of NPs in primary care.

In the face of the ACT federal statute, current nursing policies restrict which services nurse practitioners can provide, in disregard of their actual education. It also ties NPs geographically to a collaborating physician, further decreasing whom they can access. The limitations severely discourage NP innovation, as well as more efficient and diversified use of NPs in primary care.

Specify how it impacts healthcare

• Puts more strain on physicians.
• Decreases the quality and availability of patient care.
• Constrains innovation and collaboration.

It also impacts healthcare as a whole by putting more strain on physicians, due to increased numbers of patients as a result of Obamacare, and no noticeable increase in health care provider numbers. The policies decrease the quality and availability of patient care, by limiting potentially valuable nurse input. It also overall constrains innovation and collaboration.

Describe the specific aspects of the proposed policy or policy change

• Scope-of-practice increase.
• Lessen the restrictions on how and where NPs can be employed.
• Introduce insurance mandates for NP reimbursements.
• Public payer reform (Lee, Cross & Samuel, 2013).
• Better workplace relations.

The proposed policy would focus on such factors as scope-of-practice increase, which determines the types of services nurse practitioners can provide, and where their independence ends. It would also lessen the restrictions on how and where NPs can be employed, potentially no longer tying them geographically to a collaborating physician. Financial aspects of the reform would introduce insurance mandates for NP reimbursements and a public payer reform aimed at reducing the workforce shortages. Finally, in terms of conduct, the reform would promote better interprofessional workplace relations.

Identify the individuals who would benefit from the policy change

• Nursing Practitioners.
• Patients.
• Patients’ families.
• Physicians.
• Other primary care providers.

The principal stakeholders affected by this policy would be nursing practitioners themselves, particularly the advanced practice nurses, as well as patients, patients’ families, physicians, and other primary care providers.

Explain where support for the change would be found

• General public.
• Medical care community.
• Government officials.

Due to its transformative nature and the promise of improvement of medical service, this legislation would be supported by the general public, which is also the main customer of the industry, as well as the medical care community and government officials, for the same reasons.

Describe the impact of the policy change on nursing practice

• Enable NPs to fully use their education and training.
• Increase the prestige of nursing.
• Increase NP standards.

This policy would allow nurse practitioners to use the full extent of their education and training in the workplace and would make nursing a more respected profession both in the workplace and among the populace. By increase the NP standards, it would also lead to higher competencies.

Describe the impact of the policy change on health care

• Reduce the pressure on the health care system.
• Improve patient care.
• Promote innovation and collaboration.

The policy would improve health care by taking some pressure off the health care system, following the Patient Protection and Affordable Care Act. As mentioned before, it would improve patient care and make it more available to the populations through the nurses. Finally, by giving nurses the additional authority to make suggestions and provide feedback, it would promote innovation and collaboration.

Provide an analysis of the policy from your point of view

• Very beneficial for the medical industry.
• More NPs.
• Resolve conflicts between NPs and physicians.
• More emphasis on teamwork.
• Increase the NP standards.

The policy would be very beneficial for the medical industry. It would invite more people into the NP profession, amending the issue of workforce deficiency. As mentioned before, it would resolve many conflicts between NPs and physicians shifting the focus of medical care towards team effort, and by increase the NP standards, leading to higher competencies.

How this will influence your practice

• Easier to enter the industry.
• New medical practice opportunities.
• Nurses more appreciated.
• Better opportunities to provide care.

It would improve my practice by making it easier for me to enter the industry, with more motivating factors, better conditions, and more opportunities to self-actualize through medical practice and by helping patients.

References

Baehr, M. (2004). Evaluation Methodology. Web.

Clarin, O. A. (2007). Strategies to Overcome Barriers to Effective Nurse Practitioner and Physician Collaboration. Medscape, 3(8), 538-548. Web.

Gbadamosi, N. (2015). What are the barriers to implementing change in the NHS? Web.

Hines, P. A., & Yu, K. M. (2009). The Changing Reimbursement Landscape: Nurses’ Role in Quality and Operational Excellence. Medscape, 27(1), 7-13. Web.

Hughes, R. (2008). Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Dept. of Health and Human Services.

Kunic, R. J., & Jackson, D. (2013). Transforming Nursing Practice: Barriers and Solutions. AORN Journal, 98(3), 235-248. Web.

Lee, T., Cross, D., & Samuel, D. (2013). Primary Care Workforce Shortages: Nurse Practitioner Scope-of-Practice Laws and Payment Policies. National Institute for Health Care Reform, (13), 1-7. Web.

Llopis, G. (2014). 5 Ways Leaders Enable Innovation In Their Teams. Web.

Reimbursement Task Force and APRN Work Group. (2012). Reimbursement of Advanced Practice Registered Nurse Services: A Fact Sheet. Journal of Wound, Ostomy & Continence Nursing, 39(2S). Web.

Shannon, D. W., & Myers, L. A. (2009). Nurse-to-Physician Communications: Connecting for Safety. Web.

Stokowski, L. A. (2014). Nurse Turnover: The Revolving Door in Nursing. Web.