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Hello Dr. B and Class,
Describe the APN scope of practice in your state.
The scope of practice and the prescribing authority of advanced practice nurses (APNs) varies widely from state to state. The agencies that are impacted by the varied APN practice regulations are the Centers for Medicare and Medicaid, the Board of Medicine, and the Board of Pharmacy (Chamberlain College., 2023). Some states have full practice authority while others have restricted and reduced practicing privileges (American College of Nurse Practitioners [AANP]., 2021). In New York State where I Practice as a nurse practitioner, we have full practice privileges. This means that NPs can assess patients, diagnose their conditions, order and interpret diagnostic tests, and initiate, and manage treatments both in inpatient and outpatient settings independently without physician supervision. We also can prescribe all categories of controlled substances and other medications (except while prescribing chemo, which needs a physician’s supervision), under the exclusive licensure authority of the state board of nursing. This practice model is approved by the National Academy and the National Council of State Boards of Nursing (AANP., 2021). As a matter of fact, due to the shortage of physicians in the primary care sector, NPs with full practice privileges, can provide better access to care, and address health disparities while delivering quality care to the patients. This motivates many nurses to take up a nurse practitioner role, thus building a more provider workforce (AANP., 2021). The standard of practice for CNS, CRNAs, and Nurse midwives differs from the NPs, but they also function independently.
In New York State, CRNAs also have full practicing privileges, which enable them to be independent without physician supervision (CRNA Scope of Practice., n.d).
Clinical Nurse Specialists (CNS)- coordinate and provide supportive and preventative nursing services for patients and their families (in various age groups and various specialties) in a variety of healthcare settings. They provide clinical consultation to other healthcare personnel. CNS may be involved in health care management, health systems improvement, clinical research, and health care policy development. Clinical nurse specialists do not determine medical diagnoses and do not prescribe or order medical treatments or diagnostic tests. For example, a clinical nurse specialist does not prescribe medications or order CT scans (New York State Education Department [NYSED]., 2023).
Examine how APN practice restrictions impact access to healthcare.
APNs which include NPS, CRNAs, CNS, and nurse midwives make a significant contribution in meeting national health needs. Yet, they are challenged by regulatory barriers limiting their full-fledged function despite their educational qualifications, especially in certain states where they do not have full practice authorities (Kleinpell et al., 2023). Some states do not allow NPs to prescribe all categories of controlled substances.
The scope of APNs is widely accepted to provide increased patient access to high-quality and safe healthcare, reduce emergency room admissions, reduce healthcare costs, and care for the underserved. Enabling full practice authority to APNs will be an excellent way to cover up physician shortages and health disparities (AANP., 2021). The COVID era opened an increase in the need for NPs. So the Medicare reimbursement policy for nurse practitioners (NPs) should be mandated to allow 100% reimbursement for the care provided by NPs. However, despite the need for NPs, they are only reimbursed 85% for their services. (Bischof & Greenberg., 2021). This regulation must be modified by the CMS, to favor better job opportunities for them. It is worth mentioning that CRNAs, CNS, NPs, and Nurse midwives play a vital role in the healthcare dynamics of our country. Hence, the respective state boards of each state need to remove restrictions on their practicing authority.
References
The American Association of Nurse Practitioners. (2021). AANP advocacy: Championing the NP role and amplifying the NP voice.Links to an external site.Links to an external site. https://www.aanp.org/advocacyLinks to an external site.
Bischof, A., Greenberg, S.A., (May 31, 2021) “Post COVID-19 Reimbursement Parity for Nurse Practitioners” OJIN: The Online Journal of Issues in Nursing Vol. 26, No. 2, Manuscript 3.
Chamberlain College. (2023). Advanced Practice Nurse as Leader: Scope of Practice and Regulation
https://chamberlain.instructure.com/courses/134019…
CRNA scope of Practice (n.d). Practicing in NYSFAQs.pdf
https://nysana.memberclicks.net/assets/docs/Practicing%20in%20NYS%20FAQs.pdfLinks to an external site.
New York State Education Department (December 12., 2023). Practice information for clinical nurse specialist
https://www.op.nysed.gov/professions/clinical-nurse-specialists/practice-information-for-clinical-nurse-specialists#:~:text=Clinical%20Nurse%20Specialists%20(CNSs).,%2FMental%20Health%3B%20and%20Oncology.
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. https://doi.org/10.1016/S2155-8256(23)00064-9
