APRNs Roles and Issues
APRNs Roles and Issues
Advanced Practice Registered Nurses (APRNs) have crucial roles to play in the delivery of both preventive and curative care in the United States of America. This paper discusses the roles of APRNs in the health care system. It also explains the APRNs' significance and issues that affect their practice. In this regard, the paper will also discuss the APRN consensus model and the Institute of Medicine (IOM) recommendations on the practice of APRNs.
Roles
Among other duties, APRNs diagnose illnesses, offer public health advice, and manage chronically ill patients. In addition to being registered nurses (RNs), the specific roles fall under four broad categories of certified nurse practitioners (CNP), clinical nurse specialists (CNS), certified nurse-midwives (CNM) and certified registered nurse anesthetics (CRNA) (Englebright, 2017). The CNPs have the role of providing primary, acute, and specialty health care by diagnosing and management of the patients. The CNMs offer reproductive health care, provide primary and gynecological services. The CNS also diagnose illnesses, provide treatment, manage patients, offer expert support to nurses who are caring for patients, ensure that best practices and evidence-based care to achieve the possible patient outcome, and drive practice changes in the organization. On the other hand, the CRNA provides anesthesia and pain management services (American Nurse Association, n.d.).
Significance of APRN Scope of Nursing and Issues
Some APRNs work in roles that entail direct care for individuals and hence a need for a clear regulatory framework (Englebright, 2017). A study by Woo et al. (2017) synthesized the available evidence on the impact of APRN on patient satisfaction, clinical outcome, and quality of care in an emergency and critical care setting. It established that the involvement of APRNs improved patient outcomes and quality of care. Despite the criticality of the nurses in the healthcare practice, many issues surround the practice. These issues reduce the extent to which the nurses can be effectively utilized in the American health care system. The issues usually relate to the nursing regulatory framework that varies from state to state, federal policies, and a lack of knowledge by some organizations on how to utilize the APRN effectively. For instance, Englebright (2017) found out that organizations did not know how to utilize APRNs in the acute care setting effectively. It is on the confines of the gray areas that the APRN Consensus Model was developed to address the issues, especially those relating to the practice.
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Health care reform and its impact on APRNs
APRN Consensus Model was developed through a collaborative effort of over 40 nursing organizations that endeavored to make nursing practice more uniform. Different state regulations imply that people who access APRNs' services were limited due to lack of portability (Mack, 2018). As a result, the model provides uniformity that ensures that the APRNs can practice to the full extent of the educational qualification and licensure. It is founded on a uniform system to ease the mobility of the practitioners across the different states. It guides all states to adopt uniformity in regulating the roles of APRNs (Mack, 2018). In addition to addressing the barriers, the model provides regulation of APRN practice in the realms of professional qualifications and accreditation, such as the requirement for include a minimum of 500 faculty-supervised clinical hours in the specialization role and population.
The Future of Nursing: Leading Change, Advancing Health, a report by the Institute of Medicine (IOM) underscored the need for fundamental shifts in the care delivery practice (IOM, 2011). IOM (2011) pointed out that there was a shortage of primary health care professionals in the U.S following the expansion of insurance coverage under the Patient Protection and Affordable Care Act (ACA). IOM thus recommended that APRNs should be permitted to practice the full of their educational qualification (IOM, 2011). According to the IOM, the full extent of practice for APRNs would lead to the realization of the workforce needed to meet the primary care needs. Furthermore, the unique skills of APRNs would help in the delivery of quality care and enhance access. It is worth noting that APRNs are highly trained and can provide a variety of essential services to increase access and quality of care. However, limited portability is occasioned by state laws for nurses' practice, models of reimbursement, federal policies, institutional practices, and culture.
The IOM report (2011) provided policy recommendations for APRN licensure, privileges, and reimbursement in line with educational and training qualifications. The goal is to ensure full practice and reduced restrictions. In corroboration with the IOM policy recommendations, ACA added a provision to the public health service act prohibiting health insurers from discrimination of health care providers. The provision protects healthcare providers working within the scope of the applicable license, from any discrimination. Conclusion
APRNs play a critical role in healthcare delivery in the U.S. However, issues of portability across states have been significant impediments that limit the extent Americans can enjoy APRN services. Therefore, the APRN consensus model is in line with ACA provisions for increased access to quality care based on the IOM's health insurance coverage and policy recommendations to allow the full extent of the practice. The model endeavors to ensure uniformity for APRNs practice and accreditation across the U.S.
References
American Nurses Association. (n.d.). Advanced practice registered nurse (APRN): Scope of practice. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/
Englebright, J. (2017). The emerging role of APRNs in hospital nursing practice: Perspectives from a survey of chief nursing officers. Nurse Leader, 15(6), 387-391. https://doi.org/10.1016/j.mnl.2017.09.004
Institute of Medicine (U.S.), & Robert Wood Johnson Foundation. (2011). The future of nursing: Leading change, advancing health. National Academies Press.
Mack, R. (2018). Increasing access to healthcare by implementing a consensus model for advanced practice registered nurse practice. The Journal for Nurse Practitioners, 14(5), 419-424. https://doi.org/10.1016/j.nurpra.2018.02.008
Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15(63). https://doi.org/10.1186/s12960-017-0237-9
