NR 506 Week 1 Discussion

NR 506 Week 1 Discussion

Student Name

Chamberlain University

NR-506: Healthcare Policy

Prof. Name

Date

NR 506 NP Week 1 Discussion

Barriers to Practice as an Advanced Practice Nurse (APN)

Advanced Practice Nurses (APNs) face multiple barriers that prevent them from practicing to the full extent of their education and clinical expertise. These barriers appear at both the state and federal levels, influencing areas such as licensure, prescriptive authority, reimbursement models, and public perception of the APN role. The variation in state regulations creates inconsistency in practice authority, which ultimately impacts patients’ access to safe, effective, and patient-centered care.

1. Practice Barriers for APNs: State and National Level

In Kentucky, nurse practitioners (NPs) can practice independently in several clinical areas; however, their prescriptive authority remains restricted. Specifically, when prescribing controlled substances such as opioids, NPs must maintain a collaborative agreement with a physician (Kentucky Board of Nursing, 2020). This limitation hinders the autonomy of APNs, especially in rural settings where physician collaboration may be difficult to obtain, leading to treatment delays for vulnerable populations.

At the national level, reimbursement inequalities pose a significant challenge. Medicare reimburses NPs approximately 29% less than physicians, even when both perform equivalent services (Perloff, DesRoches, & Buerhaus, 2016). This disparity diminishes the perceived value of NPs’ contributions and discourages healthcare organizations from hiring them.

Additionally, public perception remains a notable barrier. Many patients continue to believe that physicians provide higher-quality care, despite evidence indicating that APNs deliver care that is equally safe, effective, and often more accessible (Renshaw, 2019). This misconception affects patient trust and acceptance of NPs as primary care providers.

2. Competition Affecting APN Practice

Competition from physicians and physician assistants is another obstacle limiting APN independence. Physicians frequently oppose expanding APN practice rights, citing patient safety concerns. However, research consistently shows that patient outcomes under NP-led care are comparable to those under physician-led care (Davis, 2019).

Healthcare organizations also contribute to this issue. Many facilities prefer hiring physicians or physician assistants, either due to traditional hierarchies or patient preferences. This restricts employment opportunities for APNs and diminishes recognition of their advanced training. In specialized fields such as emergency care, skepticism about NPs’ preparedness persists, even though their training qualifies them for these roles (Corso, Dorrance, & LaRochelle, 2018).

3. Key State Lawmakers

The regulatory environment shaping APN practice in Kentucky involves both executive and legislative branches.

Executive Branch

Governor Andy Beshear and the Cabinet for Health and Family Services play leading roles in shaping healthcare policy. Their focus is on equitable access and improving healthcare delivery to vulnerable populations (Commonwealth of Kentucky, 2020).

Legislative Branch

The Kentucky House of Representatives and Senate create laws governing APN practice, Medicaid coverage, and prescriptive authority. Collaboration among lawmakers, healthcare professionals, and advocacy organizations is critical to reform policies that currently restrict APN practice.

4. Interest Groups at State and National Levels

State-Level Advocacy

The Kentucky Nurses Association (KNA) actively participates in legislative discussions and policy advocacy. It works to promote APN autonomy, ensure safe working environments, and advance scope-of-practice reforms through lobbying efforts and testimony before state committees.

National-Level Advocacy

The American Association of Nurse Practitioners (AANP) is a key national organization advocating for NPs. The AANP engages in lobbying Congress, educating the public about the NP role, and building coalitions with other healthcare groups to promote Full Practice Authority (FPA) across the United States (Kopanos, 2020). These advocacy efforts have already contributed to the adoption of independent practice laws in several states.

5. Methods of Influencing Policy Change

APNs and their advocates utilize multiple strategies to influence policy reform, including lobbying, grassroots mobilization, coalition-building, and evidence dissemination. By presenting data on the quality and cost-effectiveness of NP-led care, they strengthen their position in policy discussions and challenge restrictive laws.

Table: Methods of Influencing Policy Change

These methods empower APNs to advocate for greater autonomy, address professional opposition, and ensure healthcare policies reflect their education and clinical capabilities.

Conclusion

APNs continue to face significant barriers at both state and national levels, including prescriptive authority restrictions, reimbursement inequities, and public misperceptions. Competition from other healthcare providers further restricts their practice, despite evidence demonstrating their competence and safety. Through active advocacy, policy engagement, and coalition-building with legislators and professional organizations, APNs are making steady progress toward Full Practice Authority nationwide. This progress will not only enhance professional autonomy but also expand access to quality healthcare, particularly for underserved populations.

References

Commonwealth of Kentucky. (2020). General government. https://transparency.ky.gov/accountability/gengov/Pages/default.aspx

Corso, K. A., Dorrance, K. A., & LaRochelle, J. (2018). The physician shortage: A red herring in American health care reform. Military Medicine, 183(1–2), 220–224. https://doi.org/10.1093/milmed/usx209

Davis, W. D. (2019). Moving the emergency nurse practitioner specialty from resistance to acceptance: The Wyoming experience. Advanced Emergency Nursing Journal, 41(4), 279–283. https://doi.org/10.1097/TME.0000000000000266

Kentucky Board of Nursing. (2020). APRN prescriptive authority. https://kbn.ky.gov/practice/Pages/APRNPresAuth.aspx

Kopanos, T. (2020). AANP forum. Journal for Nurse Practitioners, 16(2), A13–A15. https://doi.org/10.1016/j.nurpra.2019.12.015

Perloff, J., DesRoches, C. M., & Buerhaus, P. (2016). Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians. Health Services Research, 51(4), 1407–1423. https://doi.org/10.1111/1475-6773.12425

Renshaw, A. (2019). The nurse practitioner role within the rehabilitation context: Barriers to its acceptance. Journal of the Australasian Rehabilitation Nurses’ Association, 22(3), 16–19.