Regulatory, State, and Institutional Barriers
Healthcare costs are often high in jurisdictions with many barriers to access. Kleinpell et al. (2022) note that the cost of state-mandated collaboration or supervisory services is frequently uncontrolled and can be prohibitively expensive. As a result, compliance with the outlined measures leads to exorbitant healthcare costs, negatively impacting access to services and the quality of care individuals can receive from healthcare institutions.
There are specific barriers that limit patient access to care. According to Kleinpell et al. (2022), state and regulatory barriers to practice, such as limited hospital admitting privileges and limited home health approval, negatively impact access to care. In addition, laws that require a physician’s signature to order numerous medical supplies and the need for a physician’s co-signature on APRN orders further compound the problem.
Finally, requiring a doctor’s approval for treatments within an APRN’s scope of practice decreases the number of patients APRNs may treat. The quality of care is adversely affected by regulatory, state, and institutional barriers. The American Association of Nurse Practitioners (AANP) classifies state legislations and guidelines influencing APRN work and awards a complete, limited, or restricted practice environment to each jurisdiction (Kleinpell et al., 2022).
Licensure laws in full practice authority (FPA) states permit APRNs to assess patients, diagnose client problems, order and interpret diagnostic tests, and initiate and oversee treatments, including prescribing medications and controlled substances, under the authority of a state board of nursing. Practice and license legislation in limited practice jurisdictions limit APRNs’ capacity to take part in at least one of the four areas of APRN practice. As a result, patients in affected areas receive substandard services due to the state-imposed limitations.
APRN Consensus Model
The state of Alabama regulates the practice of APRNs within its jurisdiction. The APRN roles recognized in the state include Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Certified Nurse-Midwives, and Certified Nurse Practitioners (Hayes et al., 2023). In Alabama, the term ‘licensure’ refers to specific regulatory measures governing APRN practice.
There are specific academic requirements that are associated with APRN practice in most states, including Alabama (Buck, 2021). After completing an RN program, each individual seeking APRN licensure must complete a graduate-level program for their desired APRN role. Alabama requires its APRNs to have national certification before issuing a valid license (Hayes et al., 2023).
Alabama allows for reduced practice among its APRNs in the healthcare system. This means that Alabama’s practice and licensing requirements limit NPs’ capacity to participate in at least one aspect of practice. For the NP to offer patient treatment, state legislation requires a career-long collaborative agreement with another healthcare practitioner (Hayes et al., 2023). It is worth noting that Alabama allows its APRNs to prescribe medications.
Legislation
All APRNs in Alabama are subject to practice restrictions. In 1995, Alabama’s legislative body mandated that APRN oversight and joint practice contracts between doctors, CNPs, and CNMs be established to protect the public (Hayes et al., 2023). As a result, the Alabama Nurse Practice Act (Code of Ala. 1975, 2022, 34-21), the ABN Administrative Code (ABN Admin. Code, 2021a, 2021b), and other laws govern Alabama’s APRN scope and standards of practice (Hayes et al., 2023).
The laws have been largely successful in regulating healthcare practices. The most recent legal measures in Alabama included lifting restrictions on APRN practice to address the COVID-19 pandemic (Buck, 2021). The law succeeded in providing access to care to people in need (Rodriguez, 2023). However, as the fear of the pandemic receded, some states, including Alabama, reintroduced limitations on APRN practice.
Policy Initiatives
There are numerous examples of nurses getting involved in policy. Advocacy is essential for the provision of quality and essential care (Vitale et al., 2019). For instance, Sharpnack (2022) highlights the unique role nurses play in resolving complex policy concerns. The author demonstrates how nurses outline opportunities for engagement, such as informing elected officials about their experiences and views regarding the Affordable Care Act (ACA), describing how nurses tackle cost, quality, and equal care, as well as ways to prepare the workforce to face the challenges that remain at the forefront of healthcare 12 years after the ACA’s implementation (Sharpnack, 2022).
The authors also advocate for policy-influencing tactics, such as maintaining the campaign for nurse nominations to community boards, strategies to establish robust Academic-Practice Partnerships, and techniques to tackle the quadruple aim by promoting nurses’ well-being. Nurses play a crucial role in shaping healthcare policy decisions.
Mental Health
The stressors that impact my current practice include the restrictive regulatory environment, limited access to resources, and poor health coverage in disenfranchised communities. There are numerous techniques to build resilience in the nursing profession. The first is finding a sense of purpose, which has helped me make sense of life’s problems. Instead of being disheartened by my issues, with a clear goal in mind, I am more driven to learn from my mistakes and keep trying to improve.
Being confident in my ability to handle life’s stressors is essential to resilience. Finally, the development of a robust social network is critical. It is essential to have people with whom one can confide. Having loving and helpful individuals nearby serves as a buffer during times of difficulty. I am dedicated to the APRN journey because I have a genuine desire to create meaningful change in people’s lives by alleviating the suffering caused by disease.
References
Buck, M. (2021). An update on the consensus model for APRN regulation: More than a decade of progress. Journal of Nursing Regulation, 12(2), 23–33.
Hayes, W., Baker, N. R., Benson, P., & O’Keefe, L. C. (2023). The state of advanced practice registered nursing in Alabama. Journal of Nursing Regulation, 13(4), 44–53.
Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N. (2022). Breaking down institutional barriers to advanced practice registered nurse practice. Nursing Administration Quarterly, 46(2), 137–143.
Rodriguez, S. (2023, January 23). Practice led to greater workforce diversity. Patient Engagement HIT.
Sharpnack, P. (2022). Overview and summary: Nurses’ impact on advocacy and policy. OJIN: The Online Journal of Issues in Nursing, 27(2), 1–5.
Vitale, E., Germini, F., Massaro, M., Silvia Fortunato, R., Bari, A., Bat, A., & Bologna, A. (2019). How patients and nurses defined advocacy in nursing? A review of the literature. Journal of Health, Medicine and Nursing, 63, 64–69.