The role of the advanced practice registered nurse (APRN) is continuously evolving, gaining recognition and enabling superior standards of care. In particular, the Affordable Care Act (ACA) has led to an increase in practice authority for APNs and higher wages for medical professionals overall. Nevertheless, there is significant opposition to the establishment of the role, and numerous states continue restricting the work that nurses can do without supervision regardless of their competences or training. This essay discusses the benefits that APNs bring to the care and analyzes the impact of the ACA on the professional environment.
The Impact of APRNs
Depending on their specialization, APRNs are capable of delivering high-quality care to a specific category of patients without the need for a doctor’s supervision. This quality benefits both medical specialists, who can concentrate on fewer patients and spend more time working with each one, and the patients, who receive competent care from a professional who knows the particulars of their conditions and can quickly and efficiently respond to any developments.
Institutions such as long-term care facilities benefit from employing APRNs as well as the latter can address a variety of patient health concerns without the need to keep a specialist on the staff for every category of illness or wait for one to arrive from a nearby hospital.
However, most of the above benefits can only be realized if the APRN has full practice authority (FPA), which enables him or her to work and prescribe specific medications without the need for a doctor’s supervision or control. According to Brom, Salsberry, and Graham (2018), while the number of states that allow FPA has been increasing at a faster rate after the implementation of the ACA, 28 states that restrict APRN authority continues to move for a change in federal policy. The need to consult doctors and report to them restricts an APRN’s ability to respond to health threats and provide care to rural communities, which impedes many of the advantages of the role.
The Reasoning behind Authority Restrictions
There are two primary reasons why states that refuse to enable full practice authority as per the ACA do so. The first is the lack of trust in the role which arises from the decentralized nature of the United States and the resulting lack of unified legislation. Some states may consider the federal standards for becoming an APRN insufficient based on the lawmakers’ perception of the local education facilities, while others may believe the same for out-of-state facilities.
Furthermore, the image of nurses as helpers who do not play a central role in healthcare may still be prevalent in some locations. Overall, APRNs need to establish a sound foundation with solid proof of their necessity to be recognized as a vital part of quality care.
The second reason why some states may refuse to allow APRNs to practice independently is the competition that would ensue. APRNs can address a massive variety of illnesses and health concerns without the need for a specialist’s intervention, and thus the demand for the latter would be reduced. Fontenot (2014) provides an example of anti-competitive behavior in the field of dentistry, and, while the case does not involve APNs, it sets a precedent for the practice of the safer medical procedures by non-professionals.
While the intervention of a qualified professional is necessary where there is a threat to the patient’s life or continued well-being, many medical procedures can be handled by trained individuals without supervision, especially ones with the extensive competencies that are expected of APNs.
Demand and Wages
The ACA has introduced significant changes to the United States’ health care system. Parente, Feldman, Spetz, Dowd, and Baggett (2017) claim that the Act will lead to a shortage of health care providers and a large increase in their wage growth. However, it is challenging to increase the number of new medical practitioners to match demand.
The support for nursing education and the independence of APRNs that is integrated into the ACA as described by Fontenot (2014) is most likely due to the legislators’ awareness of the trends that the law would cause. As such, states that choose to comply with the federal policy on health care will find it necessary to increase the standing and authority of APRNs, both from a legislative and a practical standpoint, which will lead to the growth of the role in the future.
The role of the advanced practice registered nurse continues gaining support and recognition, mainly due to the Affordable Care Act’s promotion of the nurse profession. APRNs can bring significant benefits to nursing care, particularly when it comes to the treatment of patients in long-term care facilities or rural settings. However, they can only realize these advantages when they are granted full practice authority, which 28 states still restrict.
The reasons for the prohibitions include a lack of recognition of the role’s competencies and advantages and possible concerns over the competition that will appear when numerous independent professionals enter the field of health care. Nevertheless, the implementation of the ACA will create a shortage of medical workers, and the Act positions APRNs as the group that will fill the gap. States that choose to adopt the ACA will find it necessary to grant APRNs full practice authority, improving the situation of the role.
Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120-130.
Fontenot, S. F. (2014). The affordable care act, the FTC and the independent practice of nurses. Physician Executive Journal, 40(3), 98-101.
Parente, S. T., Feldman, R., Spetz, J., Dowd, B., & Baggett, E. E. (2017). Wage growth for the health care workforce: Projecting the affordable care act impact. Health Services Research, 52(2), 741-762.