Identify and describe practice barriers for all four APN 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 and describe practice barriers for all four APN 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 and describe practice barriers for all four APN 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

The need for primary care services has continued to rise notably in the past decade in the USA and various states such as California. Yet still, the demand is expected to even rise further as more  Americans age and due to increased healthcare coverage caused by the affordable care act and the enhanced incidences of chronic conditions (Spetz & Muench, 2018). The implication is that the primary care physician supply has not kept pace with the demand. Therefore, there is a genuine need for advanced practice nurses to step up and fill the arising gaps. However, such has not been the case due to various practice restrictions placed on the nurse practitioners, both at the state and the federal level. Therefore, the purpose of this discussion is to explore the barriers to practicing as an APN in the State of California and from the national perspective. As such, various aspects will be discussed, including practice barriers, competition, key lawmakers, interest groups, and methods to influence change.

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The Practice Barriers

As earlier indicated, there are various barriers that face APN roles at the federal level and in California State. These barriers are for all four roles (clinical nurse specialist, nurse practitioner, nurse anesthetist, and nurse-midwife. In California, NPs’ work is restricted since they can only work with physician oversight. This implies that for an NP to practice, they have to write an agreement with a physician and collaborate with the physicians when making treatment decisions (Montague, 2020). The APNs also have to acquire additional certification from the board of registered nursing for drug orders or prescription or ordering devices under standardized procedures. Even though a recent law allowed NPs to start independent practice, the law is still restrictive since they can only do so under limited settings since physicians are still required to be part of the practice.

The Existing Forms of Competition

Even though recent amendments in the law allows the APNs in California to practice independently to an extent, the laws are still restrictive. The need to still involve physicians in some settings when evaluating and treating patients is a source of competition. Indeed, research shows that they are capable of offering the same services as a physician at reduced costs (Montague, 2020). However, the laws imposing the barriers work against them as competition arises. Such restrictions are both at the federal and state levels, hence interfering with independent practice.

The Specific Law Makers

California State has various important individuals who participate in law-making. These members belong to the executive branch, while others are members of the legislative branch. The current head of the executive branch is Gavin Newsom, the governor. The governor accents the bills from the legislators to make such bill laws. The legislative branch is bicameral, with both the upper house and the lower house. Notable lawmakers include Anthony Rendon, who is the speaker, and Eloise Reyes, the majority leader (“California,” 2022). Both are democrats and actively participate in law-making.

Interest Groups that Exist at the State and National Levels that Influence APN Policy

APNs play a critical role in patient care, and therefore a policy that influences them usually attracts various stakeholders who are always ready to play a role. Among them are the interest groups. Interest groups operate to influence policies to take the direction they deem fit and to follow the paths that they believe would help serve their interest. California State has various interest groups that may influence the APN policy. One of the groups is the California Association for Nurse Practitioners. Established in the year 1977, the group has participated in several efforts to shape nursing practice in California, among other policy and advocacy involvements (“CANP,” 2020). Similar groups are also found at the national level. One of the most famous groups is the American Nurses Association. This group has members throughout the United States and has participated in APN policymaking for many years. Through leadership and representation, the American Nurse Association has influenced many policy decisions that touch on Advanced Practice Nursing.

The Methods for Influencing Policy Changes

Policymaking and amendments usually take long steps to accomplish. As such, it is always challenging to complete the process as interest groups, legislators, and various stakeholders may need to debate the policy change proposal to come up with a consensus (Mason et al., 2020). Various strategies can be used to influence desired policy changes. For example, lobbying is one of the most common strategies. Through lobbying, various stakeholders make efforts to directly engage the lawmakers and other officials to align their policy choices towards a preferred way. The lawmakers can also be influenced indirectly using strategies such as grass-roots mobilization. Through this method, a stakeholder may inform a particular lawmaker that there is a need for a policy formulation or policy change to remedy an issue. At the national and state levels, public opinion-shaping can be applied.

Conclusion

Policy and policy formulation are key aspects of nursing practice since policies are used in guiding the practice and determining the scope of practice. Therefore, various barriers to APNs in California have been discussed. In addition, various aspects of policy and policy creation have also been explored.

References

California State Assembly. (2020). Officers of the California State Assembly. https://www.assembly.ca.gov/leadership.

CANP. (2021). History. https://canpweb.org/about/history/

Spetz, J., & Muench, U. (2018). California nurse practitioners are positioned to fill the primary care gap, but they face barriers to practice. Health affairs, 37(9), 1466-1474. https://doi.org/10.1377/hlthaff.2018.0435.

Mason, D. J., Perez, A., McLemore, M. R., & Dickson, E. (2020). Policy & Politics in Nursing and Health Care-E-Book. Elsevier Health Sciences.

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Montague, A. (2020). Expanding Scope of Practice for Nurse Practitioners in California: AB 890 Compromises to Permit Independent Practicehttps://sourceonhealthcare.org/expanding-scope-of-practice-for-nurse-practitioners-in-california-ab-890-compromises-to-permit-independent-practice/

This is a graded discussion: 100 points possible

due May 8

Week 1: Barriers to Practice (Orig Post due Wednesday, Responses due Sunday)
7 7

Purpose

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:

1. Discuss the history of policy development and policy making in nursing (CO1)
2. Examine different types of policy and their relationships to healthcare policy (CO1)
3. Explain current barriers to practice for advanced practice nurses (CO2)
4. Discuss health policy and methods of lifting barriers to practice (CO2)

Initial responses to the discussion topic must be posted by Wednesday 11:59pm MT. Two additional posts to peers and/or faculty are due by Sunday at 11:59pm 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 11:59PM MST, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on
Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT.

Total Points Possible: 100 Requirements:
Using the readings from this week as well as outside reliable resources to:

1. 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.
2. Identify forms of competition on the state and national level that interfere with APN’s ability to practice independently.

3. 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)
4. Discuss interest groups that exist at the state and national levels that influence APN policy.
5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government and interest groups.
6. A scholarly resource must be used for EACH discussion question each week.

DISCUSSION CONTENT

Category
Points
%
Description

Practice Barriers

15

15%
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.

Competition

15

15%
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

15

15%
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.

Interest Groups

15

15%
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

15

15%
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.
75
75%
Total CONTENT Points= 75 pts

DISCUSSION FORMAT

Category
Points
%
Description

Interactive Dialogue

20

20%
4 Required Elements:

Responds a minimum of two other posts to peers and/or faculty in the threaded discussion;
Responses to peer/faculty are substantive (adds importance, depth, and meaningfulness to the discussion)
Responds to all direct questions from faculty (if no question asked directly, student responded to questions posed to the entire class)
Summarizes what was learned from the lesson, readings, and other student posts for the week. The summary could be
included in one of the three minimum posts.

Grammar, Syntax,
Spelling, & Punctuation

5

5%

Grammar, syntax, spelling, and punctuation are accurate.
25
25%
Total FORMAT Points= 25 pts

100
100%
DISCUSSION TOTAL=100 points

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