B A R R I E R S T O F U L L S C O P E O F P R A C T I C E

EXPANDING ROLE & AUTONOMY OF NURSE PRACTITIONERS

Dana Leigh Knoll

OBJECTIVES

•  Define APRN •  Current state of regulation •  Identify barriers facing NP’s ability to practice •  Discuss the changing landscape and needs of

healthcare populations •  Identify how NPs may improve quality and safety of

healthcare •  Address changes to support progress

THE ISSUE

•  APRNs •  CNP, CRNA, CNS, CNM •  Post-graduate education

•  State Regulation •  Fragmented Regulatory Requirements •  National Council of State Boards of Nursing

•  Full vs. Reduced vs. Restricted Practice •  Full practice - 18 states •  Reduced Practice – 20 states •  Restricted practice – 12 states

State-by-State Scope of Practice

THE RESEARCH

•  Cost reduction •  Decreased wait times

•  Patient satisfaction •  Consistent quality care

NURSING THEORY THE THREE C’S OF LYDIA HALL

•  The Core •  The Care •  The Cure

The Core patient

The Care nurse

The Cure medicine

SOCIOLOGY THEORY PROFESSIONAL SOCIALIZATION

•  Professional Socialization •  Adopting characteristics of

the group in which you seek membership

•  Changing Roles & Titles

HEALTHCARE ENVIRONMENT

“Physician-led team approach to care helps ensure high quality patient care and value for health care spending” AMA, 2010

“Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States” IOM, 2010

“Based on our extensive knowledge of health care markets, economic principles, and competition theory, we reach the same conclusion: expanded APRN scope of practice is good for competition and American consumers” FTC, 2014

ROOT CAUSE ANALYSIS

APRNs do not

practice to the full extent of

their scope &

education

Colleague Opposition

Public Knowledge

Fragmented Regulation

Legislative Change

Competition

“Patient Safety”

State-by-State Consistent with Physician Coverage

Enforce ACA

Role of APRN

Image of Nurses

Inconsistent Educational Requirements

INFERENCES & IMPLICATIONS

•  Primary Care Practitioners Supply & Demand •  Estimates anywhere from 20,000 – 65,000

•  Medically Underserved Areas & Populations •  Correlation with restricted practice? •  Fragmented regulation preventing NPs from covering MUAs? •  Migration to areas of independent practice

Health Resources and Services Administration (2013). Projecting the Supply and Demand for Primary Care Practitioners Through 2020. U.S. Department of Health and Human Services.

QSEN COMPETENCIES

•  Quality of Practice •  Resource Utilization •  Leadership

ANA STANDARDS

•  Teamwork & Collaboration •  Patient-Centered Care •  Evidence Based Practice

RECOMMENDATIONS

•  Collaboration (Teamwork & Collaboration, Resource Utilization, Patient-Centered Care)

•  Physician familiarity correlated with increased support

•  Regulation (Evidence Based Practice, Quality of Practice)

•  State à National or otherwise uniform regulation

•  Education (Leadership, Quality of Practice)

•  Public •  Self •  Image of Nursing

•  Research (Evidence Based Practice, Leadership)

•  Evidence-based practice •  Continue to support claims with rigorous scientific evidence

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Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf National Council of State Boards of Nursing. (2008). Consensus model for APRN regulation, licensure, accreditation, certification, and education. APRN Joint Dialogue Group

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