Sample Answer for NURS 8100 Federalism’s Impact on Policy Included After Question
The fragmentation of the U.S. health care system, with its differing modes of financing and service delivery, is a reflection of a dispersed government structure. Policy making is shared and distributed across various branches and levels of government. As a result, policy making processes can be slow to respond, manipulated towards personal interests, and often redundant. Consider, for example, the public entitlement programs such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS), and the PPACA of 2010. Where is there overlap between these policies? How do they demonstrate a dispersed government structure?
This week, you will analyze the role of the federal government in health care policy making.
To prepare:
- Review this week’s Learning Resources focusing on the France article and the textbook readings.
- Identify two nursing or health care policies that address similar needs, one passed at the federal level and the other at another level of government (state or local).
By Day 3
Post a cohesive response that addresses the following:
- Provide an example of two policies that address similar needs, passed at two levels of government (i.e., federal, state, or local).
- What are the advantages and/or disadvantages of this duplication? How does this example reflect the implications of federalism? Provide support from the literature for your position.
- To what degree should the federal government get involved in health care policy making? Provide concrete examples to support your position.
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues in one or more of the following ways:
- Ask a probing question, substantiated with additional background information, evidence or research.
- Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
- Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
- Validate an idea with your own experience and additional research.
- Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
- Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
A Sample Answer For the Assignment: NURS 8100 Federalism’s Impact on Policy
Title: NURS 8100 Federalism’s Impact on Policy
In the state of Maryland some of the advanced practice registered nurses (APRNs) include certified midwives, nurse anesthetist, certified nurse practioner (NP) and a clinical nurse specialist. This should be similar to other states too. At a minimum and from personal experience Maryland board of nursing has to give permission to practice as an NP and there are basic requirements that have to be met to qualify to be certified. Not all the regulations that are set forth by the state of Maryland for APRN to practice are recent but they are however all currently used.
Code of Maryland regulations (COMAR) are the compilation of the state of Maryland regulations that help govern the state, (Maryland.org, n.d). Health care is not an exception and APRNP have to abide by the COMAR regulations. According to COMAR, (2020), APRNs can perform multiple functions independently. These include comprehensive assessments, complete a death certificate, do not resuscitate orders, interpret diagnostic and laboratory tests, prescribe medications, provide care and give referrals to other providers. An NP can also practice as a registered nurse and for those who have certifications for mental health, they can admit a client on an involuntary basis for treatment.
How State Regulations Are Supported within Place of Employment
The place of employment has set standards at the same level of practice as expected by the state but for some treatment approaches the expectation is to defer to the primary physician or the medical director. Establishing this baseline helps achieve the expected standards and also remain in compliance with the COMAR and federal regulations. The place is very supportive that when the NP completes an admission assessment, the doctor does not have to double check unless there is a concern.
As a nurse practioner, at the place of work there are multiple activities that can be performed independently. These tasks include but not limited to giving orders for medications and treatment, reviewing diagnostic tests, and responding to families as required. One task that is permitted by the state of Maryland but not encouraged at the place of work is signing of certificates of incapacity. (A. Speer, personal communication, July 26, 2021). The primary physician and the psychiatrist sign the Maryland order for life sustaining treatment (MOLST) also and only encourage the NP to sign it if they are not available. This is a task that is authorized by COMAR regulations.
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How States Differ in Terms of Scope of Practice
Different states have different prescriptive authorities and conditions that they give to their APRNs. There are those states that are referred to as independent states which allow APRN independent prescribing and there are those which do not, (Schirle & McCabe, 2016). Barriers to practice are not uncommon even when the states are flexible, health care settings can still impose different strict policies and procedures. This leads to restriction of some aspects of patient care and limited access to providers despite the states having full practice authority, (Schorn, Myers, Barroso, Hande, Hudson, Kim & Kleinpell 2022).
Impact on Professional Nurses across the United States.
Some nurses have opted to relocate or work where there is more prescriptive authority. Some nurses also have opted not to relocate but get licensures in neighboring states that can give them more autonomy. There are also nurses who have opted to work in other areas where they are needed. These areas include working as lobbyists, researchers, nurse educators and consultants. In this aspect their full potential is more effectively utilized.
References
COMAR 10.27.07.00 (2020) Practice of the Nurse Practitioner , http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm
Maryland.org (n.d), Division of state documents. http://www.dsd.state.md.us/COMAR/ComarHome.html
Schirle, L., & McCabe, B. E. (2016). State variation in opioid and benzodiazepine prescriptions between independent and nonindependent advanced practice registered nurse prescribing states. Nursing Outlook, 64(1), 86–93. https://doi.org/10.1016/j.outlook.2015.10.003
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
A Sample Answer 2 For the Assignment: NURS 8100 Federalism’s Impact on Policy
Title: NURS 8100 Federalism’s Impact on Policy
The goal of the state boards of nursing is protect the safety of the community by ensuring nurses who practice are competent and have received the required training to provide care (Thomas, Benbow, & Ayars, 2010). Since this scope of practice is defined at the state level, there can be a discrepancy in what nurses are allowed to do state-to-state and the license needed to practice in that state. There has been tremendous effort to form legislature around the compact nursing license to allow nurses reciprocity in participating states. However, this is not the standard with advanced practice registered nurses (APRN) (Watson & Hillman, 2010). In the state of New Mexico, the board of nursing is actively involved in promoting and encouraging the expansion of the APRN Compact (New Mexico Board of Nursing, n.d.). Currently, the only two states involved in the APRN are Utah, North Dakota, and Delaware (APRN Compact, n.d.). States not involved in the APRN Compact can vary greatly in terms of scope of practice. For example, recently in Florida it was passed that nurse practitioners have full practice authority while in many other states that has been the norm for years. This type of discrepancy can disrupt the distribution of qualified providers across the country due to scope of practice limitations. Additionally, it can cause confusion among practitioners on what they can/can not do by law.
At my organization, the state regulations are supported within my place of employment through the Professional Nursing Practice Department who advocate for state and federal legislature involving nursing and support the state regulations around registered nurses and APRNs. This department looks at our nurse residency program, nursing credentials, nursing accreditations etc. for the academic hospital. This department works in collaboration with several other complimentary nursing departments and reports directly to our Chief Nursing Officer.
References
APRN Compact. (n.d.) https://aprncompact.com/about.htm
New Mexico Board of Nursing. (n.d.) https://www.ncsbn.org/policy-and-government.htm
Thomas, M. B., Benbow, D.A., & Ayars, V. D. (2010). Continued competency and board regulations: One state expands options. Journal of Continuing Education in Nursing, 41(11), 524-528.
Watson, E., & Hillman, H. (2010). Advanced practice registered nursing: Licensure, education, scope of practice, and liability issues. Journal of Legal Consulting, 21(3, 25-29.