Introduction
Nowadays, nurse practitioners (NPs) may play a great a variety of roles within both private and public hospitals and clinical organizations of different functional orientation. An NP can be either an educator, informaticist or administrator/leader.
Patient and staff education are essential NPs’ tasks because they contribute to the development of safety culture and achievement of better patient outcomes. NPs spend a lot of time handling patient concerns, and by establishing dialogs with patients, nurses stimulate their adherence to treatment and minimize various health risks (Spencer & Hanania, 2013). Ongoing nurse-patient dialogs allow NPs to understand patients’ needs and educate stakeholders on identified issues, diseases, or treatment procedures. Additionally, by coaching less experienced practitioners in hospitals or instructing students in medical colleges, an NP may significantly facilitate their functioning in healthcare teams and, in this way, contribute to the overall enhancement of hospitals’ performance.
As a leader, a nurse may be responsible for the development of organizational culture and enforcement of EBP. NP administrators are aware of the principles of policymaking and lobbying and, at the same time, know current topical public health concerns. This knowledge allows them to bring positive structural changes to hospitals and the healthcare system as a whole.
Lastly, a nurse informaticist is responsible for the selection, application, and analysis of hospitals’ infrastructural systems that foster safe and high-quality patient-oriented service. Healthcare is considered to be one of the most slowly changing industries, yet it is associated with a great potential for improvement due to the availability of advanced technology in the industry. A nurse informaticist may assist hospitals in realizing this potential by conducting research on the effects of IT and communication technologies on organizational cost efficiency, nurse productivity, or patient satisfaction and developing recommendations for practice based on the findings.
Healthcare Policy Change
The Scope-of-Practice Acts: Overview
“The scope of practice of a licensed healthcare profession 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, authorities in each state can rearrange nursing regulation acts and limit or expand the scope of healthcare practice. It is considered that the limitations present in the scope NP practice are usually meant to meet the current situation in the fields of education, technology, and healthcare and that the scope-of-practice acts and their amendments are primarily concentrated on the provision of security for the consumers of medical services.
It is suggested that patients should have opportunities to access high-quality medical service provided by competent practitioners. Thus, on the one hand, the limitation of the scope of nursing practice helps to minimize the risks associated with the delegation of intervention tasks to incompetent nurses. Nevertheless, on the other hand, the limited scope of practice creates barriers for efficient and professional NP practice. Thus, the scope-of-practice acts do not allow meeting the interests of the public in an effective way.
Nurse Roles, Change Process, and Stakeholders
An NP can contribute to change through advocacy, staff and stakeholder education, and EBP. However, the collaboration with organizations and other medical practitioners during the project realization should be prioritized.
The Institute of Medicine may be regarded as one of the major official supporters of the legislation change because, nowadays, it plays a proactive role in the proliferation of information regarding the scope-of-practice issues at both federal and regional levels. The professional medical and nursing organizations can be involved in the process as well − they are the primary stakeholders that may benefit from the policy change. Moreover, they could address the other groups of stakeholders such as local businesses and educational institutions.
Since the nursing practice is regulated by the state governments, organizations and nurse advocates could focus their efforts on targeting the local authorities. However, 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 should lobby for policy change at the national level as well. The development of public awareness is the crucial factor that may influence the policymakers’ decision.
Thus, to increase the effectiveness of the lobbying process, it is important to raise awareness of the issue by publishing relevant research findings and engaging in collaborations with nursing associations because the more resounding the problem is, the more effect on the legislation transformation it may have. It is important to remember that the high-quality evidence can largely support the policy change initiatives. Thus, the conduction of research related to the issues of the expansion of the scope of NP practice, its advantages and disadvantages, and multidimensional effects is a primary requirement.
Potential Outcomes of Policy Change
According to recent research findings, certified NPs, clinical nurse specialists, and RN 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). Therefore, the expansion of NPs’ scope of practice would be beneficial from administrative and practical points of view. The researchers state that a better use of APRNs’ skills and knowledge can help to reduce the length of the patients’ stay at hospitals and minimize the costs (Villegas & Allen, 2012). For this reason, the scope of nurses’ practice should be broadened to improve NPs’ roles in patient care.
References
Association of Social Work Boards, Federation of State Boards of Physical Therapy, Federation of State Medical Boards of the United States, National Association of Boards of Pharmacy, National Board for Certification in Occupational Therapy, & National Council of State Boards of Nursing. (2012). Changes in healthcare professions’ scope of practice: Legislative considerations. Web.
Spencer, P., & Hanania, N. A. (2013). Optimizing safety of COPD treatments: Role of the nurse practitioner. Journal of Multidisciplinary Healthcare, 6, 53–63.
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.