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Please respond to this post: Be in support of the post in your explanation.
Institutional Barriers
Regulatory, state and institutional barriers to APRN practices affect healthcare costs, access to, and quality of care. According to a review of over thirty studies, there was a significant decrease in quality of care seen due to a lack of understanding in the role of an APRN, poor professional relations, and policy restrictions on practice (Schirle, Norfu, Rudner, & Poghosyan, 2020). Often times, it seems that both patients and fellow healthcare workers are not fully aware of what the scope of practice is for the APRN, which can not only affect quality care but access to care, as well. With policy regulations, it limits the APRN and does not allow he/she to practice to their full potential, therefore, limiting the care people have access to. The study should by increasing autonomy and allowing the APRN to practice fully, it would increase productivity, and overall provide better and more access to care (Schirle et al., 2020). Due to a lack of access to care, this may contribute to higher healthcare costs related to more emergency room visits, costing the patient unnecessary funds.
Consensus Model for California
The consensus model is the regulatory standards that are used in California to assist in identifying the criteria to complete APRN certification. According to the California Board of Nursing, the title used for APRN’s in the state of California is “advanced practiced registered nurse” or “certified nurse practitioner” (California Code of Regulations, 2019). The following is a list of recognized APRN roles in California: Family, Adult-gerontology, (primary care or acute care), Neonatal, Pediatrics (primary care or acute care), Women’s health/gender-related, and Psychiatric-Mental Health. The term “certification” is used within the state of California, rather than licensure with respect to the APRN. The APRN must have a current registered nurse license and keep it active and it is required that the APRN received training from an accredited graduate or post graduate certification program and be signed off on clinical skills from an MD/DO or NP. The following certifications are recognized as appropriate certifications for the APRN in the state of California and are at a national level: American Academy of Nurse Practitioners (AANP), American Association of Critical-Care Nurses (AACN), American Nurses Credentialing Center (ANCC), National Certification Corporation for the Obstetric, Gynecologic and Neonatal Nursing Specialties (NCC), and Pediatric Nursing Certification Board (Nursing Licensure, 2022). According to the California Association for Nurse Practitioners, currently, we are awaiting regulations after the passing of AB890, which allows the APRN to practice without the supervision of a physician. Currently, regulations are expected by January 2023 and will expect the requirement of 3 years of practice or 4,600 clinical hours and passing of a supplemental exam before this will be granted (CANP, 2022). For prescribing in California, the APRN must have a furnishing number and is required to have gone through a master’s level pharmacology course in order to prescribe independently (Nursing Licensure, 2022). Overall, the consensus is changing as we speak, and I am excited to see that APRN’s are soon going to have the ability to practice to their full potential.
APRN Policy Issues
In a review study that studied suicide cases between the years 2008-2018, 159,000 occurred within the U.S. Of those cases, almost 2,400 involved nurses and 850 involved doctors (Davis, Cher, Friese, & Bynum, 2021). Something interesting is that with each year, the numbers progress. This goes to show the amount of stress these healthcare workers are under. Being and emergency room nurse, I see everything and there are times when I just need a moment, but it is not encouraged. A policy idea that should be federal is mandating debriefing after traumatic events and offering mental health support to those effected. This sort of thing is not discussed and should be highly encouraged to make staff feel more supported and able to cope with the traumas they endure.
Legislation
Currently, SB-1375 is a pending legislation in California making it legal for the APRN or nurse midwife to perform abortions (SB-1375, 2022). The most recent successful legislation is AB-890, which has been passed and is in the middle of the regulatory review process and will be enacted in January of 2023 (AB-890, 2020). This was a long and hard fight to encourage the independent practice of nurse practitioners in California. A not so successful bill has also been AB-590, as it went through years and years of rejection before finally being passed. This bill was finally passed due to the efforts made from the California Association of Nurse practitioners. The issue is that there is an issue with the access, quality and cost of care. By allowing nurse practitioners to practice to their fullest potential, patients have more access to care, and therefore reduce costs to prevent emergency care visits. The California Association of Nurse Practitioners is solely developed on the idea of closing the primary care gap (CANP, 2022). Efforts that were done in the passing of this bill consisted of intense lobbying and fundraising/committee meetings. After years of rejection, 2020 was finally the year all their efforts became worth it, as California nurse practitioners are finally able to practice to their fullest potential after three years, beginning in 2023.
References
AB 890 (2019-2020). Nurse practitioners: scope of practice: practice without standardized procedures. September 30, 2020. Retrieved from https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB890.
California Association of Nurse practitioners. (2022). AB 890 Implementation: Turning law into action. Retrieved from https://canpweb.org/advocacy/ab-890-implementation/.
California Code of Regulations. (2019). Board of Registered Nursing. Retrieved from https://www.rn.ca.gov/pdfs/regulations/approval-aprn.pdf.
CANP. (2022). 2022 Legislation status: The legislative and regulatory process. Retrieved from https://canpweb.org/advocacy/ab-890-implementation/2022-legislation-status/.
Davis, M. A., Cher, B. A., Friese, C. R., & Bynum, J. P. (2021). Association of US nurse and physician occupation with risk of suicide. JAMA Psychiatry, 78(6), 651. https://doi.org/10.1001/jamapsychiatry.2021.0154
Nursing Licensure. (2022). Advanced Practice Nurse Requirements in California. Retrieved from https://www.nursinglicensure.org/np-state/california-nurse-practitioner/#script.
SB 1375 (2021-2022). Nursing: nurse practitioners and nurse-midwives: abortion and practice standards. June 22, 2022. Retrieved from https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1375.
Schirle L, Norful AA, Rudner N, Poghosyan L. (2020). Organizational facilitators and barriers to optimal APRN practice: An integrative review. Health Care Manage 45(4):311-320. doi: 10.1097.