inconsistencies among states regarding to APRN restrictions on scope of practice
The state of Utah gives APRNs a great deal of leeway regarding the provision of primary care. APRNs can function as primary care providers in autonomous practice settings. APRNs are also authorized to prescribe medications and offer physical therapy independent of physician collaboration, delegation, or supervision. APRNs can sign death certificates, issue handicap parking permits, and oversee worker compensation claims. From the point-of-view of the profession, APRNs are increasingly being called upon to fulfill the roles of physicians: this is a cost-effective approach to care and also an acknowledgement of the additional training that APRNs go through. However, from the point-of-view of other healthcare providers, such as physicians and licensed and registered nurses, there may be tensions because of a perception that APRNs are ‘straddling the line’ between the different professional boundaries of medicine and blending two different approaches. Physicians may feel their roles are being encroached upon; other nurses may feel what is special about nursing may be lost.
Additionally, academic institutions and nursing associations and professional organizations must acknowledge the new roles and responsibilities nurses are fulfilling in many states and set clear standards for APRNs working in the field and for student nurses regarding the needed preparation to perform high-level tasks. “Education, certification and licensure of an individual must be congruent in terms of role and population foci” (The new APRN regulatory model, 2013, AACN). State boards, certification, and accreditation bodies must likewise be vigilant that the needed requirements for practice are rigorous enough given the expanded duties of APRNs. “Advanced practice registered nurses will be licensed independent practitioners who are expected to practice within standards established or recognized by a licensing body. Licensure will be required because these APRNs will be practicing in a role beyond that of the Registered Professional Nurse” (The new APRN regulatory model, 2013, AACN). State representatives, legislators and lobbyists must balance the needs of patients, providers, and also the justice system in framing legislation. Because Utah’s allowances are so broad for APRNs, APRN responsibilities are particularly great and may expand in the future, thanks to the needs of the healthcare profession.
Variables which may impact the implementation process of APRNs taking on the roles of primary care providers may include the influence of lobbying as well as logistical concerns about adequate requirements for the profession. Academic institutions and regulatory agencies must take on additional responsibilities in clearly defining the boundaries of practice and ensuring there is congruence between the newly expanded role of the APRN and academic and legal oversight.
Even if Utah is relatively pioneering in the trust in which it invests in APRNs, the role of the APRN is likely to expand nationwide. “Consumer demand for APRN-provided care is growing thanks to a shortage of primary care physicians, the soaring cost of health care, and a population that is aging and living longer with more acute and chronic conditions. Demand is projected to intensify in a few short years; in 2014, more than 30 million Americans will be able to access health care coverage under last year’s health reform law and are predicted to flood health care markets” (APRNs a “big part of the solution” to the primary care provider shortage, 2011, RWJF). Recent data compiled by the Institute of Medicine (IOM) in their report The Future of Nursing: Leading Change, Advancing Health suggests that APRNs can fill the gaps in primary care, given that fewer and fewer physicians are entering the field and that nurses with the graduate-level education of an can provide comparable care. “Nurses should practice to the full extent of their education and training; achieve higher levels of education and training through an improved education system that promotes seamless academic progression; and be full partners, with physicians and other professionals, in redesigning health care” (APRNs a “big part of the solution” to the primary care provider shortage, 2011, RWJF). Although the state of Utah does not place substantial restrictions upon APRN practice, by continuing to support legislation that reflects the advanced education and knowledge or APRN while setting clear standards for nursing education, high-quality and cost-effective care can continue to be enjoyed by state residents.
APRNs a “big part of the solution” to the primary care provider shortage. (2011). RWJF.
The new APRN regulatory model: Defining the future of Advanced Practice Nursing. (2013).
AACN. Retrieved: http://www.aacn.org/wd/certifications/content/newaprnregulatorymodel.pcms?menu=certification
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