Practice Barriers for All Four APNs' Roles

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Hello All,
Week One
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.
Nurse Midwife- One of the practice barriers for midwifery is the mile radius between APRNs and physicians which makes it difficult for nurse practitioners to care for patients in remote areas. Another barrier is the NP to physician collaboration ratio which limits the amount of NPs to practice with the ratio being 3:1 in South Carolina. Research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States (Ranchoff et al, 2020).
Nurse anesthetist- Requires physician supervision that prevents all CRNAs to practice at the full extent of their education and training.
Nurse practitioner- South Carolina requires NPs to have physician supervision to conduct patient evaluations, diagnose, order and interpret diagnostic tests, initiate and monitor treatment, and prescribe. NPs have to stay within a 45-mile radius of the physician to practice.
Clinical nurse specialist- Restricted practice authority in the state of SC.
On a national level, there is a lack of prescriptive authority, lack of physical supportiveness, and reimbursement difficulties. Especially for the nurse anesthetist since some facilities go through third parties for reimbursement of their services.
2. Identify forms of competition on the state and national level that interfere with APNs' ability to practice independently. Limited access to certain patient populations is a big form of competition. Another form of competition is making the healthcare system stronger to deliver effective quality care to patients. Having a physician who is more like an adversary rather than a collaborator when it relates to patient care. Collaboration between physicians and nurses is essential to healthcare delivery and is associated with high-quality patient care and greater patient satisfaction (Dahlawi et al, 2023).
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). South Carolina Legislature consists of Terry Alexander, Carl Anderson, Lucas Atkinson, William Bailey, Nathan Ballentine, Justin Bamberg, Bruce Bannister, Heather Bauer, Thomas Beach, just to name a few. There are factors that influence legislators' decision-making on NP scope of practice and the majority of the lawmakers have served less than fifteen years in the legislature (Clement, 2018).
4. Discuss interest groups that exist at the state and national levels that influence APN policy. The Nurse Practice Act which is governed by the Board of Nursing is an interest group that exists nationally. Some states have their own regulations and laws for example, the midwives in some states are regulated by the Board of Midwifery. Health reform implementation usually involves multiple policies seeking to achieve system-wide change (Campos et al, 2019).
5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups. As a future APRN joining the Board of Nursing to make an impact on nursing policy is a way to influence change in one’s state. Joining organizations such as the American Association of Nurse Practitioners can help impact policy and/or policy changes. Joining these boards and committees from nurses who actually have worked in direct care with patients who are familiar with what needs to be changed would be great members to advocate for change. APRNs play a pivotal role in healthcare to the public (Kleinpell et al, 2023).
Campos, P. A., & Reich, M. R. (2019). Political analysis for health policy implementation. Health Systems & Reform, 5(3), 224-235.
Clement, D. M. (2018). Factors Influencing Georgia Legislators' Decision-Making on Nurse Practitioner Scope of Practice. Policy, Politics, & Nursing Practice, 19(3-4), 91-99.
Dahlawi, H. H., Al obaidellah, M. M., Rashid, N. A., Alotaibi, A. A., Al-Mussaed, E. M., Cheung, M. M. M., ... & Cordero, M. A. W. (2023, July). Defining Physician–Nurse Efforts toward Collaboration as Perceived by Medical Students. In Healthcare (Vol. 11, No. 13, p. 1919). MDPI.
Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19. Journal of Nursing Regulation, 14(1), 13-20.
Ranchoff, B. L., & Declercq, E. R. (2020). The scope of midwifery practice regulations and the availability of the certified nurse‐midwifery and certified midwifery workforce, 2012‐2016. Journal of Midwifery & Women's Health, 65(1), 119-130.
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