In this rapidly growing and complex healthcare settings the transition in the healthcare systems has bestowed greater responsibilities on advanced practice nurses. Nurse Practice Act differs in each state and state legislation determines the scope of practice. The role of nurse practitioner constitutes the wide range of practice privileges within a population focus based on the certification and the licensure.The changing role of advanced practice nurses is challenging as the focus is not only on the individual patient but also the family and community as a whole. As per Everett and Sitterding, “By the year 2020, as hospitals morph into entirely different kinds of service providers, nurses too will look altogether different. Those with the capacity to embrace disruptive innovation, along with the unknowns that accompany it, will be successful in guiding their organizations into the future” (page 194).
In this dynamic healthcare environment, the advanced practice nurses play a pivotal role in supporting the legislative law to bring a comprehensive transformation to US health care of cost-effective, safe and quality care for the growing population and increase access for the under and uninsured. As hospitals concentrate on sickest and unstable patients the demand of APRN is growing as the health services have been transitioned to community clinics, homes, nurse-managed clinics, schools and other places. Studies show that the care provided by nurse practitioners are equivalent to physicians often with lower costs and higher patient satisfaction (American Nurses Association,www.nursing world.org). Compared to care provided by physician, the NP's focused more on health promotion and scored higher on diagnostic accuracy and completeness of care as per the studies conducted by the American Nurses Association. Based on the studies, the state laws should be regulated regarding the health care reform laws so that patients can have access to high-quality care in a timely manner. The Institute of Medicines Future of Nursing report recommends states to conform to the consensus model where APRN's can practice to the full extent of their knowledge and education. With this information, thus reform the scope of practice regulations as per the National Council of State Boards of Nursing Practice Act and Model Administrative Rules.
Nurse practitioner should be familiar with the scope of practice in that particular state as it determines the privileges and restrictions of one's licensure and certification, practicing outside the scope can lead to significant liability issues. Nursing practice is regulated and governed by Nurse Practice Act in each state, NP must hold individual license or certificate to practice in that particular state as the laws are different in each state. As per the report published by Pearson 2007, a licensed NP can practice independently without physician supervision in 23 states while the remaining states require some amount of formal or written physician involvement. The Joint Commission on Accreditation of Healthcare Organizations has acknowledged NPs as Licensed Independent Provider with hospital privileges based on NP's individual credentials, competency, and special training of practice. Collaboration is the most common model of NP's practice where physician and NP's works together as a colleague but practices independently within their own scope of practice(ANA 1994).(Medscape)The professional certification and licensure validate the criteria for practice in a focused rather than wide scope of practice. As the lack of congruence between the practice environment and competency level will adversely affect patient safety, negative patient outcomes and increase NP's liability. To practice in a specialized area the individual must hold additional licensure and training that qualifies as a specialist.
Professional networking is important for career growth and to keep oneself updated with the changes in the health policies and regulation.There are many organizations that cater to the needs of the APRN depending on the specialties.
1.The American Association of Nurse Practitioner (AANP) provides informative resources on important health issues, assist in providing education to their patient, promoting professional excellence in practice and credibility in the profession. AANP provides accredited educational programmes to enhance knowledge and keep updated with latest studies on health care topics, advocation at the state and national level which will enhance the professional growth as an NP. Continuing education activities is an important aspect of this organization, to maintain the membership eligibility. The members have free access to AANP accredited online activities.
2.American Academy of Nurse Practitioners Certification Board (AANPCB) is an independent nonprofit certifying body which helps NP students in testing and certification for nurse practitioners. It provides a reliable programme for education, professional expertise, and also provides a process of validation of APRN for practice as NP.
AANPCB holds highest standards for certification for nurse practitioners, the certificants can maintain continued competence in the profession through certification renewal policies. To qualify for the AANPCB certification examination, the applicant must have completed an accredited NP programme in the US.
3.The Nurse Practitioner Healthcare Foundation is a nonprofit organization that engages nurse practitioner in new research opportunities, to foster innovative interdisciplinary collaboration to improve health outcomes and promotes access to high-quality care. NPHF is accredited by American Nurses Credentialing Center's Commission on Accreditation as a provider of continuing nursing education. Scholarship and award programmes are some of the projects funded by NPHF in encouraging research and innovation in NP practice. In the near future, I would like to get the membership in all this organization as it will help me to grow professionally and keep myself updated with the health care transformations.
Despite the advancement and development of APRN's role in this dynamic healthcare environment, there are still many barriers that NP's face in providing care in an effective and cost-effective manner. State legislative determines the scope of practice of NP's and is a hindrance to providing care to the fullest extent of their education and training.The lack of defined roles of APRN, overlapping scope of practice based on restrictive practice as per state legislative laws, inconsistency in educational standards has contributed to limited patient access to APRN's as care providers(NCSBN,2010)The indifference in the state licensures laws regarding NP's scope of practice has an indirect effect on patient care because the degree of physician supervision may affect the practice opportunities and payers policies for NP's (Yee, Boukus, Cross, and Samuel,2013.As per Safriet, NP's with same educational background and national certification will have a restriction in their roles when relocating from one state to another, thus limiting the scope of practice (2011). Some of the other barriers are Payer policies which are linked to state law and practice regulation. The restrictive scope of practice leads to stricter payer policies. State insurance mandates are the important factor which affects NP's ability to practice and bill for services, some states have not set mandates for specific reimbursement for NP's as primary care providers. The federal law through the establishment of Patient Protection and Affordable Care Act has enabled to accomplish many of the needs of the healthcare reforms, but the state is responsible to establish the scope of practice based on the state licensing law. The healthcare reforms have increased the demand for healthcare needs as new health care coverage provides more consumer-friendly insurance coverage, on the other hand, shortage of physician and restriction in the scope of practice of APRN has adversely affected the health care system in some states. APRN's must actively be involved in the regulatory bodies and must be active participants in the policy-making process so that the APRN's can utilize their knowledge and expertise to the full extent.
Adaptation to changes is crucial and challenging for health care professional, as the healthcare reforms are changing the health care delivery system.To address these challenges, the National Transitions of Care Coalition(www.ntocc.org)was formed, being a part of the health care system APRN can shape policies by collaboration with other healthcare providers from various healthcare settings, leaders, and consumers to advocate for regulations that will help the public to attain better and accessible quality care. APRN should take up the initiative and get familiarized with the regulatory process. Many nursing organization provides an avenue for APRN's to get involved in their activities so that they provide a strong foundation from which change can be brought in the political and regulatory arenas thus helping APRN to bring a difference as they have more knowledge than the key stakeholders and legislators who have very little background to healthcare issues.The integration of evidence-based study into the policy-making decision will help to achieve the triple aim of healthcare that is better care, better health, and lower healthcare cost (Berwick,Nolan, and Whittington,2008).