| Today people are living longer than ever. The | | | | (2007), 23 states possess sole authority from the |
| discovery of new technology, innovative medicines, | | | | board of nursing; whereas other states possess joint |
| science, and research all play apart of that. An | | | | authority with the board of medicine, the board of |
| increase in aging population is one of the most | | | | pharmacy, or both (Hamric, Spross, and Hanson, |
| dramatic demographic trends in the world today. | | | | 2009, p. 606). The outcome of this disagreement |
| Many elders present many complex diseases and | | | | affects the role and practice of APNs greatly |
| require complex care and disease management. The | | | | especially when they attempt to provide the best |
| challenge also presents many opportunities in the | | | | care possible in a timely manner. |
| healthcare field and a shortage of providers in rural | | | | Top Two Issues |
| areas. The roles for advanced practice nursing (APN) | | | | The chosen top two issues are reimbursement and |
| have been introduced since the late nineteenth | | | | prescriptive authority. As a new graduate APN, she |
| century till the present (Hamric, Spross, and Hanson, | | | | or he must get educated well about different |
| 2009, p. 3). These roles include certified registered | | | | payment options such Medicare and Medicaid, third |
| nurse anesthetists (CRNAs), certified nurse-midwives | | | | party payers, and more to ensure proper |
| (CNMs), clinical nurse specialists (CNSs), and nurse | | | | reimbursement. The second strategy is to encourage |
| practitioners (NPs) (Hamric, Spross, and Hanson, | | | | schools throughout the country to incorporate this |
| 2009, p. 3). Building credibility and defining practice of | | | | valuable lesson as part of the standard curriculum. |
| APN roles did not firmly establish until in late 1970s | | | | The nursing profession as a whole should continue to |
| (Hamric, Spross, and Hanson, 2009, p. 17). | | | | flight aggressively for equal service for equal pay |
| In 1992, the American Nurse Association (ANA) | | | | because nursing profession should not be assumed as |
| established Healthcare Reform which focused on | | | | inferior to other independent health providers despite |
| restructuring the United States healthcare system to | | | | different styles of caring approach. As an individual |
| reduce costs and improve access to care (Hamric, | | | | APN, one must continue the education to doctorial |
| Spross, and Hanson, 2009, p. 23). Today APNs face | | | | level in order to try to resolve the unfair |
| many challenges as they strive to be recognized by | | | | disadvantage of prescriptive authority across the |
| members of the society. The current issues faced by | | | | nation. The second strategy is APNs should continue |
| APNs are discussed below and this information is | | | | to promote the recognition of APN as safe and |
| based on Advanced Practice Nursing: An Integrative | | | | cost-effective alternative provider throughout the |
| Approach (4th ed.). | | | | healthcare systems. |
| The Key Issues | | | | Regulatory Barriers |
| The identified key issues are education, scope of | | | | The current regulatory barriers for APNs are |
| practice, specialty practice, reimbursement, titling, | | | | prescriptive authority, reimbursement schemes, |
| prescriptive authority, legal status, regulation, and | | | | nursing education, and scope of practice and titling. |
| credentialing issues. The similarities among these | | | | The variance in board regulations from state to state |
| issues are all embedded in regulatory languages which | | | | is a problem facing APNs who highly mobile (Hamric, |
| make it difficult for APNs to benefit from | | | | Spross, and Hanson, 2009, p. 610). Even though |
| development of nursing role. The differences occur | | | | prescriptive authority exists over the years and |
| when one failed to collaborate and to address these | | | | becomes fairly standard for APN prescribers, but the |
| above issues as a whole and to promote | | | | requirements still vary from state to state (Hamric, |
| collaborative relationships with other regulated health | | | | Spross, and Hanson, 2009, p. 607). For those APNs |
| disciplines both at the national and state level. And, | | | | who love to travel and work at another state to |
| indeed these issues are still importance to the | | | | make sure to check the scope of practice for that |
| practice of advanced practice nurses. | | | | state as it varies significantly (Hamric, Spross, and |
| Three Chosen Issues | | | | Hanson, 2009, p. 607). The professional nursing |
| The three chosen issues are scope of practice | | | | organizations and the National Council of State Boards |
| specialty practice, reimbursement, and prescriptive | | | | of Nursing (NCSBN) have been working on a new |
| authority. Like never before, the profession for APNs | | | | regulatory model for APNs in order to promote some |
| has emerged into different era which presents many | | | | uniformity on credentialing and licensure (Hamric, |
| different opportunities and challenges for newcomers. | | | | Spross, and Hanson, 2009, p. 610). A system of |
| Today APNs can be found working anywhere from | | | | mutual regulatory recognition between states is |
| the family practice, cardiology office, urgent care | | | | needed and remains to be done. |
| always to emergency medicine. As a new graduate | | | | Conclusion |
| APN, the role can present many challenges and | | | | Even though most of the hard work was done to |
| obstacles especially when she or he tries to adjust to | | | | promote the path to independency and uniformity |
| the new role while attempting to comply with several | | | | for advanced practice nursing, but several issues |
| clinical practice guidelines. | | | | remain to be solved especially in the areas of |
| Even though the title of APN is recognized as a | | | | credentialing and regulation. Many nursing organization |
| valuable asset to the community and other | | | | is working aggressively to put a new regulatory |
| healthcare team member, many of them are still | | | | model in place to promote a system of mutual |
| struggled to get reimbursed properly. The holistic | | | | regulatory recognition. The field in advanced practice |
| caring approach provided by APNs is not inferior to | | | | nursing is evolving and changing rapidly, especially in |
| the medical model provided by physicians. The | | | | the areas of advanced practice nursing specialties. As |
| education requirement for both professions will be | | | | a result of this complex change, policymakers and |
| soon about the same especially with the new | | | | regulators face many challenges and obstacles to |
| requirement of a doctoral degree for APNs. This is | | | | ensure development of broad-based practice |
| the reason APNs still debate for equal pay for equal | | | | standards. At the same time this challenge also |
| service when care is compared between both health | | | | presents many new opportunities for advancing |
| providers. | | | | practice nursing; thus APNs continue to prove |
| After reading Advanced Practice Nursing: An | | | | themselves as safe and cost-effective providers to |
| Integrative Approach (4th ed.) page 606 and 607, | | | | the members of society and to move forward to a |
| the reality becomes clear that APNs have to prove | | | | better professional future. |
| so much in order to gain sole authority in scope of | | | | Reference |
| practice. The Board of Medicine continues to find | | | | Hamric, A. B., Spross, J. A., & Hanson, C. M. (2009). |
| ways to limit the scope of practice for APNs. | | | | Advanced practice nursing: An integrative approach |
| According to Lugo, O'Grady, Hodnicki, & Hanson | | | | (4th ed.). St. Louis, MO: Elsevier. |