Sample Answer for NR 510 Week 1 Discussion 1: Barriers to Practice Included After Question
NR 510 Week 1 Discussion 1: Barriers to Practice
NR 510 Week 1 Discussion 1 Barriers to Practice
Week 1: Barriers to Practice Discussion
Read the assigned Hain & Fleck article, and discuss the following:
- What are the barriers to APN practice identified in the article? Describe these barriers in your own words.
- What are your impression of the barriers to APN Practice? (Are you surprised by these barriers? Is this new information to you? Have you ever been involved at the legislative level in nursing? Do these barriers concern you or motivate you toward becoming an APN?)
- Do these barriers represent Restraint of Trade? Why, or why not?
- Your thoughts on how nurses can influence these barriers.
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A Sample Answer For the Assignment: NR 510 Week 1 Discussion 1: Barriers to Practice
Title: NR 510 Week 1 Discussion 1: Barriers to Practice
The barriers to APN practice that were identified in the article are state practice and licensure, physician related issues, job satisfaction, payer policies and not being allowed to follow patients who are admitted to acute care facilities (Hain &Fleck, 2014).
These barriers to me mean that APN are restricted in their practice. They do not get to practice to the best of their education. I do feel that in the beginning there does need to be some guidance from a physician. The barriers can cause dissatisfaction with the job because of the amount of control taken from the APN regarding their decisions with their patients. This should be done in the first five years or so of practice. This would give the ANP the guidance needed while caring for patients. These barriers also mean the ANP does not get the same compensation as does a physician and payers will not pay at the same rate as they would for a patient being seen by a physician.
These barriers are not new to me nor do they come as a surprise. I have spoken with a few FNPs who have mentioned the fact that they are restricted to a certain extent. When working in the emergency room a lot of times the APNs would only be allowed to work on the lower acuity patients. In the event that there was someone who ended up being a higher acuity the APN would have to go to the physician for their opinion. This I did not see as a bad thing. It is always good to have the extra resource which can provide an additional set of eyes and knowledge for a situation. These restrictions do not concern me currently. I feel my motivation is seeing how certain physicians welcome the APN and are willing to work with them. Many I have seen give the APN more room to do their thing once they gain confidence in the APN.
These barriers do represent restraint of trade. They do not allow the APN to see patients and prescribe medications without restrictions. They have rules and regulations that restrict them and only allow them to practice in certain ways.
Nurses can influence these barriers by forming organizati0ons to appeal to their states about the way they are allowed to practice. To do this they will need to research and provide data stating the care they give, and the care given by physicians. They will need evidence about practices to be able to change the minds and get regulations changed. This will not be an overnight process, so they will also need to be willing to commit to making a change over years.
NR 510 Week 1 Discussion 1: Barriers to Practice Reference
Hain, D., & Fleck, L. (2014, May). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, Vol. 19, No. 2, Manuscript 2, doi: 10.3912/OJIN.Vol19No02Man02
I also work in the emergency department and we have both nurse practitioners and physician assistants working. I do see that many of the more critical patients are picked up by the doctors and not the PA or NP. This is not always the case as we have one NP who is without question a rock star. She has the ability to handle any situation and is involved in trauma cases when certain doctors are there. I was very impressed by her as I watched the confident manner in which she conducted her business. I think that there are definite times where opportunities are limited for the NP but I also feel that these obstacles can be overcome by displaying competence and gaining the reputation of being able to handle any and all cases. I see that the doctors have differing levels of confidence in the PAs and NPs based on how they view their abilities. I suppose this is just human nature and helps to protect the organization.
Hi Hasan! I also work in the ED and we also have PA’s and NP’s that work from 12p-12a. Until a few years ago they only hired PA’s. We typically run 3 pods with a Dr in each and the PA or NP in the central pod (with a doctor). During those hours our pediatric ED is also open and is run with a Dr and NP. A majority of the patients seen by our PA/NP are lower acuity ESI 4’s and some 3’s. But much like your ED it depends on who is working. Monday is typically our busiest days and we run what we call the pit and it’s an area in triage that has 4 rooms that a PA/NP and a nurse run with low acuity patients that can be turned over quickly (like a fast track). We have some PA’s and NP’s that see higher acuity and complex patients and others who rarely do. I agree with your statement about the NP needing to display more competence to gain respect and take on more difficult cases. When we have new ED doctors they are expected to see patients independently at every level of acuity. When PA’s and NP’s abilities aren’t consistent it makes it hard for the professions to be respected as a whole.
Cindy, payer policies are an interesting barrier for NPs as well, not only because of lower reimbursement rates but also because patients can voice concerns as well. Recently, I had a patient who no longer wished to see mid-levels because they didn’t feel it was right that the same amount was billed for seeing a mid-level as was an MD. How do you feel about this and what would your response to the patient be?
When I go to see my PCP I see the NP. She is great. I do not now what is billed when I go to the doctor. The only way I would request to see the MD is if the NP and I could no0t see eye to eye on a treatment. She is actually great about listening to me and dealing with my concerns. As for the patient I would ask if that is their only concern. I would inquire about the care they are receiving. My thought is if the care is good care then why would you switch to someone else? However I have had patient’s that did not like the prescription they got or the meds they were given and they would insist on seeing a “real doctor”. Not once when this happened did the doctor undo anything the NP had done. The outcome was still the same and the prescriptions did not change. This was explained as a professional courtesy between the MD and the NP. I do not now how this works in other areas besides the emergency room but it shows respect.
The purpose of this essay NR 510 Week 1 Discussion 1: Barriers to Practice is to look at various obstacles APNs encounter both within New Jersey and nationwide and why it is necessary to tackle them. Advanced Practice Nurses (APNs) are highly educated healthcare professionals with advanced degrees and specialized nursing experience who provide quality healthcare to underserved areas in the US (Brom et al., 2018). APNs play an invaluable role in delivering this vital service. However, despite their significant contribution, APNs in New Jersey and across the nation often face numerous barriers to practice ranging from legal constraints and limited scope of practice to insufficient reimbursement of services provided and limited resources and technology access. Addressing APN challenges through policy and advocacy efforts is imperative to ensure they can effectively contribute to improving access to quality healthcare for all patients.
Practice Barriers
Nurse midwives must work under physician supervision, which delays care delivery and adds unnecessary costs. Nurse anesthetists face restrictions in providing anesthesia independently, while nurse practitioners may be restricted in prescribing certain drugs and must enter collaborative practice agreements (Schorn et al., 2022). Clinical nurse specialists may be limited in their ability to deliver certain services and have limited job prospects, creating delays in care, higher healthcare costs, and reduced patient access to services. It is essential to address these obstacles so they can provide high-quality patient care.
Competition
APNs face several forms of competition that impede their ability to practice independently, particularly from physicians and physician assistants. Physicians tend to be seen as leaders within healthcare, possessing more resources and influence than APNs themselves (Schorn et al., 2022). Furthermore, some may view APNs practicing independently as an attack on their authority within healthcare systems and might resist APNs being independent providers altogether.
Interest Groups
Numerous interest groups influence APN policy at both state and national levels. These include professional nursing organizations, consumer advocacy groups, and healthcare organizations. Professional nursing organizations like the American Association of Nurse Practitioners and the National Association of Clinical Nurse Specialists advocate for policies to promote Advanced Practice Nurse (APN) practice while removing practice barriers posed by APNs. Furthermore, these organizations aim to raise awareness regarding its significance and expand its scope. Consumer advocacy groups such as the American Consumer Institute and AARP also play an integral role in shaping APN policy. These organizations lobby for policies that ensure access to high-quality healthcare at an affordable cost, including practices like APNs. Their advocacy helps ensure patients receive the care they require regardless of location or financial circumstance. Healthcare organizations such as hospitals and insurance companies also play an integral role in APN policy development. These entities may support policies that expand APN practice to increase access and decrease healthcare costs; conversely, they could oppose expansion due to concerns regarding quality, liability, or financial considerations.
Lawmakers and Interest Groups
Lawmakers play an integral part in shaping APN policy at both the state and national levels. Key figures within New Jersey’s legislative and executive branches that shape policy for APNs include Governor Phil Murphy, Senate President Edward Durr, and Assembly Speaker Craig Coughlin.
Methods of Influencing Policy
APNs and their supporters can employ various means to sway policy change, such as lobbying lawmakers, organizing grassroots campaigns, advocating for reimbursement policy changes, or simply informing the public and lawmakers of their role in healthcare, benefits provided to patients by APNs, and need for policy modifications that remove obstacles to practice (Eden et al., 2021). By using these processes to initiate change, APNs can contribute to improving healthcare provision in the U.S.
NR 510 Week 1 Discussion 1: Barriers to Practice Conclusion
Advanced practice nurses face numerous practice barriers that impede their independence both in New Jersey and across the US, such as restrictions on their scope of practice, educational and certification requirements, collaborative practice agreements, competition from other healthcare providers, and legislative advocacy. Through effective advocacy and education efforts, APNs and their supporters can work to remove these obstacles to increase access to high-quality health services for patients.
NR 510 Week 1 Discussion 1: Barriers to Practice References
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. https://doi.org/10.1097/jxx.0000000000000023
Eden, L. M., Merrill, H., & Luthy, K. E. (2021). Empowering nurse practitioners to make health policy CHANGE: Steps to successful passage of legislation in Utah. Journal of the American Association of Nurse Practitioners, 33(12), 1254-1260. https://doi.org/10.1097/jxx.0000000000000561
Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a national survey: Ongoing barriers to APRN practice in the United States. Policy, Politics, & Nursing Practice, 23(2), 118-129. https://doi.org/10.1177/15271544221076524
NR 510 Week 1 Discussion 1: Barriers to Practice Grading Rubric Guidelines
| Performance Category | 10 | 9 | 8 | 4 | 0 |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic decisions. |
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| Performance Category | 10 | 9 | 8 | 4 | 0 |
| Application of Course Knowledge –
Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations |
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| Performance Category | 5 | 4 | 3 | 2 | 0 |
| Interactive Dialogue
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread) |
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Summarizes what was learned from the lesson, readings, and other student posts for the week. |
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| Minus 1 Point | Minus 2 Point | Minus 3 Point | Minus 4 Point | Minus 5 Point | |
| Grammar, Syntax, APA
Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition |
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| 0 points lost | -5 points lost | ||||
| Total Participation Requirements
per discussion thread |
The student answers the threaded discussion question or topic on one day and posts a second response on another day. | The student does not meet the minimum requirement of two postings on two different days | |||
| Early Participation Requirement
per discussion thread |
The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. | The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT. |
Read Also: NR 510 Week 1 Welcome from the Practicum Team and the FNP Practicum Process Assignment