Carrier and Barriers
Although the barriers are often the cause of why a nurse decides to continue his or her practice, they can nevertheless complicate the working process and even have an impact on a nurse’s self-esteem and motivation. I have come across different barriers during my practice, but I keep recalling some of them. It seems that it is not always clear what the responsibilities of the physician and the nurse are. They get blurry, and, while one clinic’s policy requires the nurse to diagnose the patient, others pass this role to the physician. Some organizations, as stated by Duncan and Sheppard (2015), do not clearly understand the duties of the nurse practitioners’ which leads to confusion (p. 5). The only way to overcome this barrier is to obtain information about such restrictions before the work; otherwise, one will have to carry some penalties (sometimes severe).
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The practice of a nurse can be hindered by State Nurse Practice Acts; they limit the authority of a nurse, prescribe what a nurse is allowed to do and what is prohibited. Such restrictions negatively affect both the work and the motivation of a nurse: sometimes, I could see the probable solution but was not allowed to perform any acts because of the restrictions. Nurses have to conclude collaborative agreements with physicians; some physicians may charge certain fees for it (Duncan & Sheppard, 2015, p. 6). I find this issue crucial to my career because I could independently manage my practice and determine my duties, but I will not be able to because the services I can provide are limited by the law.
Some hospitals restrict clinical privileges to nurses – this is a problem I also had to face. Nevertheless, no matter how hard you are trying to overcome these limitations, sometimes the only way is to find a hospital with another policy. Sadly, this practice is still common in many hospitals in the US.
What I Had to Overcome
There was one memorable conflict during my practice in one of the hospitals: one of the students who was also a trainee engaged in a quarrel with a physician about his and my duties. According to this student, our practice was deliberately limited by the physician. In return, the physician insisted that he had more authority in this case and was allowed to manage the duties in the way he had seen as acceptable. That conflict always reminds me of a constant barrier that exists between nurses and physicians: the collaboration conflict. My work would be much easier if I did not have to adjust to the existing hierarchy and just treat and care for my patients. Effective care is not possible when physicians regard nurses as “lacking competence” (Hain & Fleck, 2014, p. 3). This problem is sometimes possible to solve, but it requires an understanding physician and a persuasive nurse.
Career advancement is, as I believe, one of the most important goals in life. But, unlucky for nurses, this advancement can be hindered in different hospitals and organizations where a nurse can work for ten years and get no credit for or no benefit from it. I had to leave an otherwise very reliable hospital just because the career opportunities, as I had been told by various employees, were not very striking. Such management should be reviewed by the hospitals so they will not have to lose professionals.
The last issue I would like to address is credentialing. I hope to have a full practice authority one day, and credentialing would bring me assigned patients; however, it is not yet a common practice to credential nurses as primary care providers (Hain & Fleck, 2014, p. 5). This limits the reimbursement from insurers; moreover, it bounds my practice to certain duties that I cannot expand. This problem is to solve only by the law.
Why is Encouraging Important?
No matter how many barriers I have faced and overcome, there are always newly emerging from nowhere. When other nurses and I needed to fight for our rights once, demanding proper day-offs and payment for overtime work, I was encouraged by their unity and determination to bring something new into the system we have been working with. According to Gutchell, Idzik, and Lazear (2014), nursing organizations tend to compete with each other, while they should aim to increase credibility and trust among these alliances (p. 257). I think young professionals or students have to be more encouraged so that they will not back away from the challenges of our work.
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Teamwork and relationships between coworkers are also significant. It is much easier to work in a team that consists of people whom you can trust and be open with. I witnessed treatment fail because the team of caregivers was not able to openly discuss the problem and its solution with each other. New workers who are not familiar with the team and surroundings should be welcomed and treated as equal; otherwise, teamwork will lead to mediocre results (at best).
The biggest problem I have so far faced is the nurse’s self-consciousness. When you are still studying or fresh out of college, more experienced coworkers might treat you indulgently. Nevertheless, you have to believe in yourself and comprehend that your chiefs can make mistakes too. I have seen enough situations where the nurse was right, but the tutor was wrong, so a little encouraging, especially from a more experienced nurse, has always helped me to cope with stress and continue doing what I have chosen to do.
Duncan, C. G., & Sheppard, K. G. (2015). Barriers to nurse practitioner full practice authority (FPA): State of the science. International Journal of Nursing Student Scholarship, 2(3), 1-12.
Gutchell, V., Idzik, S., & Lazear, J. (2014). An evidence-based path to removing APRN practice barriers. The Journal for Nurse Practitioners, 10(4), 255-261.
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2), 1-8.