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Sample Answer for NR 506 Week 1: Barriers to Practice Included After Question
NR 506 Week 1: Barriers to Practice
Discuss barriers to practice as an APN in one’s state from both a state and national perspective. Research methods to influence policy change from various forms of competition, state legislative and executive branches of government and interest groups.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
- Discuss the history of policy development and policy-making in nursing (CO1)
- Examine different types of policy and their relationships to healthcare policy (CO1)
- Explain current barriers to practice for advanced practice nurses (CO2)
- Discuss health policy and methods of lifting barriers to practice (CO2)
Due Date: Wednesday by 11:59 pm MT of Week 1
Initial responses to the discussion topic must be posted by Wednesday 11:59 pm MT. Two additional posts to peers and/or faculty are due by Sunday at 11:59 pm MT. Students are expected to submit assignments by the time they are due.
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday of week 1 by 11:59 pm MST, regardless of the number of days late. NOTHING will be accepted after 11:59 pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59 pm MT.
Total Points Possible: 100
A Sample Answer For the Assignment: NR 506 Week 1: Barriers to Practice
Title: NR 506 Week 1: Barriers to Practice
Preparing the Discussion
Using the readings from this week as well as reliable outside resources to:
- Identify and describe practice barriers for all four APNs’ roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
- Identify forms of competition on the state and national level that interfere with APNs’ ability to practice independently.
- Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
- Discuss interest groups that exist at the state and national levels that influence APN policy.
- Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
- A scholarly resource must be used for EACH discussion question each week.
|Provides relevant evidence of scholarly inquiry clearly stating how the evidence describes APN barriers to practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
|Provides relevant evidence of scholarly inquiry clearly stating the forms of competition to APN practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
|Key Law Makers
|Provides relevant evidence of scholarly inquiry in identifying law makers at the state level. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
|Provides relevant evidence of scholarly inquiry at identifying interest groups at the state and national level. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
|Methods to Influence Change
|Provides relevant evidence of scholarly inquiry of methods used to influence a change to eliminate barriers.
Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
|Total CONTENT Points = 75 pts
|4 Required Elements:
|Grammar, Syntax, Spelling, & Punctuation
|Grammar, syntax, spelling, and punctuation are accurate.
|Total FORMAT Points = 25 pts
|DISCUSSION TOTAL = 100 pts
Identify and describe practice barriers for all four APNs’ roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
In the state of New Jersey there are a few practice barriers for all the four APN roles. In NJ we have a reduced practice in which all APNs must have a collaborative agreement with a practicing physician to prescribe or practice. This is a reduction of NP ability to engage in participation of NP practice without the agreement in accordance with the NJ law (AANP, 2023). The 4 roles of APN practice are governed by the Board of nursing but on a national level in some states, the Board of Midwifery will govern over nurse-midwives.
Clinical Nurse specialists may be governed in the same way that Registered Nurses, sharing the same scope of practice, are regulated, and may not be recognized by the Nurse Practice Act; this is the same with CRNAs (AMA, 2022). According to the NCSBN (2022) in the state of NJ, CRNAs are supervised by a physician, while CNM, CNS, and CNP must have a collaborative agreement prior to practicing.
Regarding defining APN practice, scope of practice is defined by laws and regulations of the board of nursing. Some states such as Louisiana, New York, Ohio, and Oregon have their own state-specific resources for scope of practice definition (NCSBN, 2022). To summarize it, APNs in all 4 roles are not allowed to practice to the full extent of their education in the state of NJ. On a national level, there are many states that prevent APNs from practicing with full authority and require either supervision, or a collaboration agreement. According to NCSBN (2022) NJ is not an independent state and a written agreement is necessary to specify scope of practice and allowance of medical acts with or without a general supervision by an MD, DO, DDS, Podiatrist, or APRN.
Direct supervision is required in the presence of an MD, DO, DDS, Podiatrist or APRN with or without a written agreement with some specialties such as CRNA (NCSBN, 2022). As an APN you need the collaborative agreement in order to prescribe medications and although you have the right to assess, diagnose, order diagnostics, and sign POLST forms, an APN can not declare death in NJ (NJ Division of Consumer Affairs, 2023).
Failure to secure such an agreement with a practicing physician will greatly impact the APNs ability to deliver nursing care at the level of their education. There are 24 states that allow for full NP practice authority and do not restrict care (AANP, 2023). CNS is limited in many states because they are not always recognized as APRNs. Only six states allow for prescribing authority for the CNS role. CRNA can order medications preoperatively, intraoperatively, and post operatively and it is not considered prescribing under federal law, so they don’t have to register with the DEA. 24 states allow CRNAs to practice without physician oversight.
Nurse Midwives are identified as one of the four APN roles and their practice may require delegation or supervision of a physician and in some states requiring no oversight or written agreement. 12 states allow for full practice authority for CMAs (Goudreau & Smolenski, 2023). APNs are allowed to prescribe schedule LL through V controlled substances in Nj once they complete the Controlled Dangerous Substance registration (CDS) once a 6-hour course is completed, then they must register with the DEA to obtain a Federal DEA number (AANP, 2023).
Another obstacle is the NJ APN licensure which was adopted to allow multi licensure for APNs to practice in other states. It has only been accepted in Delaware, Utah, and North Dakota thus far and will require 7 states to accept prior to it taking effect (NCSBN, 2023). This restricts portability of APN licensure.
Identify forms of competition on the state and national level that interfere with APNs’ ability to practice independently.
When discussing forms of competition on the state and national level interfering with APN independent practice, physicians are the first to come to mind. Many physicians still believe that if APNs were given the ability to practice independently without some sort of supervision quality of care and patient safety would be affected (Goudreau & Smolenski, 2023). Besides the opposition from physicians without proof that there is diminished care under unsupervised APNS, it is costly to obtain and maintain collaborative agreements. According to Goudreau & Smolenski (2023) costs for obtaining a written agreement range around $650 with a $500 per month charge to maintain such agreements with physicians.
I was alarmed to find this out in NJ and many other states the cost is high, considering as an NP you are practicing off your own license, ability, and malpractice insurance. The collaboration seems like the physicians are getting all the benefits, while the APN is restricted and coming out of pocket to even practice at their level of education. APNs are not able to open practices independent of a physician and will need to secure a collaboration agreement prior to moving forward.
Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
APRN practice is defined by the Nurse Practice act and regulated by the Board of Nursing. In NJ the regulating body is the NJ Division of Consumer affairs. Certification is designated by the NJ Board of Nursing for APNs as per statue N.J.A.C. 13:37-7.1 (a). (NJ Division of Consumer Affairs, 2023). NJ certifies clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetists as advanced practice nurses. The Midwifery Committee falling under the supervision of the State Board of Medical Examiners is responsible for licensure of CMAs (NJ Division of Consumer Affairs, 2023).
Phill Murphy is the NJ current governor and Sheila Oliver is the lieutenant governor of NJ (New Jersey Legislature, 2023). The director of the NJ Board of Nursing is Cari Faris and the current Attorney General is Matthew J. Platkin (NJ Division of Consumer Affairs, 2023). These people are directly involved and responsible for NJ Nursing laws, APN practices in the state of NJ from an executive and legislative authority.
Discuss interest groups that exist at the state and national levels that influence APN policy.
Interest groups that exist in NJ and on national levels influencing APN policy included the American Association of Nurse Practitioners and the Advanced Practice Nurses of NJ. The AANP has worked toward changing laws and improving health policies for NPs of every state. Their purpose in regard to state policy is to back the expertise of the nurse practitioner5 and allow them to help guide health care policy. They are actively involved in removing barriers in NP practices to end health inequalities and improve access to care. This group acts on a national level to assist APNs in modernizing state licensure laws. (AANP, 2023). AANP works with states to update licensure laws providing patients with direct access to NPs. They are actively working to allow full practice authority to NPs in all states (AANP, 2023).
The APN of NJ is a grassroots advocacy coalition of APNs who work to improve healthcare in NU by removing scope of practice barriers. They have worked on passing the senate bill 1522 which will eliminate practice restrictions for APNs in NJ. This bill has passed out of the health committee as of December 15th, 2022. Their website links you to advocacy channels, brings awareness to the NJ legislative process, and helps you find your legislator to become more involved (Advanced Practice Nurses of New Jersey, 2023). This is a NJ state specific advocacy for nurse practitioners to assist in overcoming delays to patient care related to collaborative agreements and restrictions placed on NP practice authority in NJ.
Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
Methods used to influence change in policy for APNs involve advocacy, involvement, and being part of the change. Groups like APN of NJ not only work actively towards making changes to policy but also help to bring awareness to those who don’t know where to start. Just looking at their website, I gain access to how the law works, who my legislator is, and some jobs for APNs in NJ (Advanced Practice Nurses of New Jersey, 2023). You can become involved in changing APN policies by participation in memberships like with the AANP which will provide educational opportunities, CEUs, opportunities to advance your career, and ways to get involved (AANP, 2023).
These groups help to advocate for your rights as a nurse practitioner at a state and national level. Working in partnership with these advocacy groups can help to reduce competition in your state or others by removing barriers to scope of practice, changing the laws, and creating independence as an APN. Once the law is changed at a Legislative level, all other parts of state government will have to follow, including the nursing regulatory bodies.
Advanced Practice Nurses of New Jersey. (2023) Advocating for Healthcare Quality and Access to Care for NJ Residents. Retrieved from https://www.apn-nj.org
American Nurses Association. (2022) Advanced Practice. Retrieved from https://www.nursingworld.org/advanced-practice/Links to an external site.
American Association of Nurse Practitioners. (2023) Practice Information. Retrieved from https://www.aanp.org/advocacy/new-jerseyLinks to an external site.
Goudreau, & Smolenski, M. C. (2023). Health policy and advanced practice nursing: impact and implications (Goudreau & M. C. Smolenski, Eds.; Third edition.). Springer Publishing.
NCSBN. (2022). APRN Consensus Model by State. Retrieved from https://www.ncsbn.org/public-files/aprn_consensus_model_by_state.pdfLinks to an external site.
NJ Division of Consumer Affairs. (2023) Advanced Practice Nurse FACTS. Retrieved from https://www.njconsumeraffairs.gov/nur/Pages/APN-Certification.aspx.
New Jersey Legislature (2023). Retrieved from https://www.njleg.state.nj.us/our-legislatureLinks to an external site.
I was particularly interested in Bill 1522 that you mention. I did some research of my own to see if I could find any additional updates or information. I located Bill 1522 (also known as Bill A2286) on the State of New Jersey Legislature website (2022). This bill was introduced last February and was referred to the Assembly Health Committee during that time (State of New Jersey, 2022). In December of 2022 the Senate Committee voted in favor of passing it with an overwhelming seven votes for yes and zero votes for no (State of New Jersey, 2022). While this has passed through the Senate, it seems that this Bill has not crossed over to the House for approval yet. It can be frustrating waiting for these Bills to pass. I am eager to follow this one and hope that it will be passed into law soon.
One other interesting concept I learned from reviewing the New Jersey nurse practice act regards the current set up for physician collaboration agreements. I learned that the collaborating physician does not have to work within proximity to the APRN and does not have to focus on the same specialty as the APRN they are overseeing (State of New Jersey, 2022). This means that potentially a women’s health focused physician could “oversee” an emergency care APRN. While medical doctors carry vast knowledge, this seems like it could potentially present problems such as lack of knowledge and disruptions to patient safety. Ideally, you would have a physician collaboration with a similarly focused specialty but since it is not required, it likely does not always work out that way.
State of New Jersey. (2022). Assembly, No. 2286. State of New Jersey: 220th Legislature. https://pub.njleg.state.nj.us/Bills/2022/A2500/2286_I1.PDF