NR 506 Week 6 Discussion Scope of Practice and Patients Healthcare Accessibility

Week 6: Scope of Practice and Patient€™s Healthcare Accessibility
Purpose
The purpose of this assignment is to identify the scope of practice in one’s state including level of independence of practice, prescribing authority, any limitations of practice, process for obtaining licensure in your state, certification and education requirements for licensure. Next, students will discuss how the level of independence of practice in their state, i.e., reduced, restricted or full practice, affects patient€™s access to care in their local community.

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Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
1. Understand NP practice as defined by law (CO2)
2. Determine legislation as defined by legislation, statutes and regulations (CO2)
3. Identify barriers to ensuring patient’s rights (CO3)
Requirements:
1. Discuss your state NP community in terms of scope of practice. Include Roanoke, Virginia’s scope of practice for NPs including:
o Level of independence of practice
o Prescribing authority
o Any limitations of practice
o Process for obtaining licensure in your state
o Certification and education requirements for licensure.
2. If you live in a restricted or reduced practice state, how has patient care been impacted in your local community from these barriers? For instance, is the ED used for primary care? Are the EDs overcrowded with long wait times? Are there urgent care clinics readily available? Is there adequate access to primary care? If you live in a full practice, how has independent practice of the APN resulted in improved patient access to healthcare?
3. How does access to NPs impacts any healthcare disparities?
4. A scholarly resource must be used for EACH discussion question each week of less than 5years

NR 506 Week 6 Discussion Scope of Practice and Patients Healthcare Accessibility Sample

Laws that regulate the scope of practice for nurse practitioners vary across states and play a significant role in influencing patient care accessibility, affordability, and convenience. According to the American Association of Nurse Practitioners (AANP, 2022b), all the 50 states, Washington DC, and US territories have specific regulations that decide the practice environment for nurse practitioners. These laws are either full practice, reduced practice, or restricted practice. In Virginia, nurse practitioners (NPs) face state practice and licensure laws restricting their ability to engage in at least one element of nursing practice. In essence, a restrictive law requires career-long supervision, delegation, or team management by another health provider for NP to provide care (AANP, 2022b). However, other healthcare providers’ career-long supervision and team management are essential aspects for facilitating care quality; restricting NPs’ scope of operation results in barriers to effective practice and can lead to adverse ramifications to public health.

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Level of Independence of Practice

Virginia is a restrictive state; meaning nurse practitioners can engage in at least one element of nursing practice under career-long supervision, delegation, or team management by an outside health discipline (Peterson, 2017). These restrictive laws limit the NPs’ level of Independence and the ability to operate consistent with their academic qualifications, skills, and expertise.

Prescribing Authority

Nurse practitioners (NPs) in Virginia can prescribe medication if they meet various requirements, including completing 30 contact hours of education in pharmacology or pharmacotherapeutics. Also, the state’s law requires NPs to have separate licensure for prescriptive authority for drug schedules II-VI (American Medical Association, 2017). Finally, nurse practitioners in Virginia can exhibit prescribing authority only as part of a patient care team, meaning they should be under physicians’ supervision.

Limitations of Practice

The major practice limitation facing nurse practitioners in Virginia is the regulatory requirement for career-long supervision, delegation, or team management by other healthcare providers, especially physicians. Ortiz et al. (2018) contend that qualified and high-performing nursing practitioners and advanced practice registered nurses (APRNs) can contribute to primary care access and utilization of healthcare services. As a result, restricting their scope of practice is a profound barrier to effective care provision.

Process for Obtaining Licensure in Virginia

The process of obtaining licensure for nursing practitioners in Virginia entails two profound components; licensure by education and by endorsement. According to the Virginia Board of Nursing (2022), initial license applicants must submit evidence of a graduate degree in nursing or appropriate nurse practitioner specialty from an approved educational program. Also, they file the required application and pay the application fees according to 18VAC90-30-50. When applying for licensure by endorsement, an applicant should provide verification of licensure as an NP or advanced practice nurse in another US authority, alongside a license of good standing and eligible for reinstatement. Also, it is essential to provide evidence of professional certification consistent with the specialty area of the applicant’s education preparation. Finally, applicants must pay the application fee as stated in 18VAC90-30-50.

Certification and Education Requirements for Licensure

A nurse practitioner (NP) must hold a bachelor’s degree in nursing, have a license as a registered nurse (RN), and pass a national NP board certification exam (American Association of Nurse Practitioners, 2022a). Also, they should have graduated from a nationally accredited graduate program that fulfills the national standards for advanced didactic and clinical education.

Effects of Practice Barriers to Patient Care

As a restrictive state, the subsequent practice barriers can lead to multiple effects to patient care. Firstly, restrictions on the scope of practice can affect how nurse practitioners and advanced practice registered nurses (APRNs) provide emergency and primary care. According to Peterson (2017), enacting full practice authority for nursing practitioners leads to more efficient office-based primary care visits, checkups, and fewer emergency visits. Despite these benefits of relaxing restrictions on NPs’ scope of practice, restrictive states like Virginia still maintain laws and regulations that limit NPs’ and APRNs’ independence. Consequently, these factors translate to overcrowded emergency departments, shortages in primary care providers, and care delays.

How Access to NPs Impacts Healthcare Disparities

Access to nurse practitioners can address various sources of health inequalities, including geographical aspects. According to the American Association of Nurse Practitioners (AANP, 2022a), the availability of nurse practitioners is consistent with the determination to remove practice restrictions by implementing full practice authority (FPA). In essence, relaxing scope of practice restrictions could enable advanced practice registered nurses (APRNs) to meet the increased demand for primary care services, especially in rural areas (Ortiz et al., 2018). Eventually, access to nurse practitioners can lead to patient satisfaction, improving access to quality and timely care, decreased care costs by avoiding duplication of services and reducing costs for outdated physician oversight of NP practice, and protecting patient choices.

Conclusion

Undoubtedly, states’ laws and regulations for nurse practitioners’ scope of practice determine the trajectories of care delivery. For example, states with restrictive laws require nurse practitioners to work under career-long supervision by physicians and form interdisciplinary teams. Although these regulations can promote team performance, they can lead to massive shortages of nurse practitioners in primary and emergency care, exacerbate health disparities among people living in remote settings, and result in overcrowded emergency departments. As a result, relaxing restrictions by implementing the full practice authority can improve care efficiency, reduce care costs, protect patients’ choices, and enhancing to timely and effective care.

References

American Association of Nurse Practitioners. (2022a, April). Issues at a glance: Full practice authority. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief#

American Association of Nurse Practitioners. (2022b, April 15). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

American Medical Association. (2017). State law chart: Nurse practitioner prescriptive authority (pp. 1–15). https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/specialty%20group/arc/ama-chart-np-prescriptive-authority.pdf

Ortiz, J., Hofler, R., Bushy, A., Lin, Y., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. Healthcare, 6(2), 65. https://doi.org/10.3390/healthcare6020065

Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74–81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/

Virginia Board of Nursing. (2022). Regulations Governing the Licensure of Nurse Practitioners (pp. 1–16). https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePract.pdf