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The Unintended Consequences of the Affordable Health Care Act
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Nurses in some parts of the world have been prescribing for decades. Why has this been such an elusive privilege in the United States? Nurses have too often in the past not spoken or lobbied with one voice. Name recognition for the advanced practice nurse (APN) was a huge issue in the beginning. Many people question whether APNs are nurses or mini doctors. Decades of APNs struggles with licensing, certification, scope of practice, and recognition by others in the healthcare field added to delaying and expanding prescription authority for all APNs (Berg & Roberts, 2012). Doctors have traditionally had the domain of prescribing medications. Advanced practice nurses have had some prescription authority in the United States since 1969, yet this has varied from state to state. The American Medical Association (AMA) has lobbied for years to limit the scope of practice of the APN (Kuntz, 2011). In 2009, the AMA disseminated scare tactics around the country, concerning the health and safety concerns of allowing APNs to expand their scope of practice. Finally, in 2014, the APN role is being expanded to include more autonomy and expanded prescription authority in all states. As discussed in Joel (2013), how can APNs best educate legislators and regulators about prescriptive authority? Educating legislators and regulators about prescriptive authority has been an ongoing battle for APNs. Developing curriculum guidelines for APNs to follow in pharmacotherapy has alleviated some of the fear of allowing APNs to practice with prescriptive authority (Klein, 2012). The American Medical Association can no longer use the fear that APNs do not have education in pharmacotherapy as a scare tactic. Advanced practice nurses should foll... ... middle of paper ... ...e be teaching nurse prescribers today? Journal of the American Academy of Nurse Practitioners, 24(5), 297-302. doi:10.1111/j.1745- 7599.2011.00687.x Kuntz, K. (2011). 'Deadly spin' on nurse practitioner practice. Journal of the American Academy of Nurse Practitioners, 23(11), 573-576. doi:10.1111/j.1745-7599.2011.00667.x Pearlman, S. A. (2013). The Patient Protection and Affordable Care Act: Impact on mental health services demand and provider availability. Journal of the American Psychiatric Nurses Association, 19(6), 327-334. doi:10.1177/1078390313511852 Reinhard, S. C. (2012). Money Follows the Person: Un-burning bridges and facilitating a return to the community. Generations, 36(1), 52-58. Shaffer, E. R. (2013). The Affordable Care Act: The value of systemic disruption. American Journal of Public Health, 103(6), 969-972. doi:10.2105/AJPH.2012.301180
I now that I have the knowledge to aspire to take up my role within one of the identified population foci. APRNs program developed my core competencies by allowing me to be more efficient adaptability with regards to newly emerging APRN roles or population focus. Furthermore, achieving my course objectives enable me to understand the specific APRN roles. For example, course objectives provide me with a better detail, and align my licensure goals with the responsibilities expected of each role. Licensure will provide me and my fellow APRN graduates with the full authority to practice. Also, certification is required to meet the highest possible standards as APRNs are expected to align knowledge, skills and experience with the standards of health care professionals. This field has very narrow margins for error, and it is therefore important, for APRNs to meet the highest and most stringent academic qualifications. In order to be a recognized as APRN graduate, one is required to complete formal education with a graduate degree or post-graduate certificate awarded by an academic institute and accredited by a recognized accrediting agency empowered by the relevant government education
In 2011, Barbara Safriet published an article “Federal options for maximizing the value of Advanced Practice Nurses in providing quality, cost-effective health care” from a legal perspective. The article focused on the benefits of utilizing Advance Practice Nurses to the full extent of their abilities as well as the current barriers that APNs encounter in their practice. The aim of this paper is to discuss two regulatory provisions to full deployment of APNs in current health care system, as well as three principle causes of current barriers to removal of the restrictive provisions for the APN. Furthermore, I will discuss the critical knowledge presented in the article and how it relates the APN practice. This article was incorporated into a two-year initiative was launched Institute of Medicine (IOM) and by the Robert Wood Johnson Foundation (RWJF) in 2008 which addressed the urgency to assess and transform the nursing profession.
The model discusses the impact of new regulations on education for APRN, Licensure Accreditation, Certification & Education Document, certification and practice. The model is implemented to grasp the general understanding and definition of advance practice registered nurse APRN role, inconsistencies with state by state recognition of APRN roles, and determining eligibility for APRN licensure (Consensus Model for APRN Regulation, 2015). The consensus model definition of APRN is a nurse who is educationally rounded to assume the responsibility of assessing, diagnosis, treating, teaching health promotion and disease maintenance, acquired advanced clinical knowledge and skills to provide direct patient care, has passed a national certification examination, and licensed to practice in one of the four roles (Consensus Model for APRN Regulation, 2015).
In the United States, depending upon the state in which they work, nurse practitioners may or may not be required to practice under the supervision of a physician, frequently referred to as a “collaborative practice agreement”. However, in consideration of the shortage of primary care/internal medicine physicians, many states are eliminating or lessening the restrictive authority which allows and nurse practitioners the ability to function more autonomously (AANP 2015).
APRNs lead staff with professionalism and provide education to patients and family members designed to engage them in patient care. Providing education to staff, patients, and family members ensures a high level of quality of care is delivered. Maintaining a balance between the patient’s autonomy and the duty to do no harm can result in an ethical dilemma at times. As patients continue to be fully involved in their care, staff must remain patient advocates and maintain professional responsibility.
I had a Political science professor that once said “Political survey answers depend more on how a question is asked than on what the question is asking.” I read and reread the above question. I have to admit that even after 15 weeks of topic discussions, PowerPoint, text chapters and Google; I am still confused about how tax expenditure works. The nearest I can figure out and in plain English, it is simply a tax break. That being said, this question is very methodically asked. The term “anti-poverty programs” is a gentle, non threatening term that will be met with compassion and kindness among more than 85% of (surveyed) US citizens. Second “tax expenditures” is a confusing term associated with the mean IRS that must have something to do with the government taking hard earned money and doing something with it, but what? Who knows? The final term is the big, bad anti-conservative term that only about 11% of surveyed Americans actually greet with any positivity. So the question in our subconscious mind flows something like: “What are the advantages and disadvantages of helping people who need it with your tax money instead of giving it to people who don’t want to work?” But that’s not what the question is asking. Because I know that my subconscious takes into consideration, the information it believes is true. First anti-poverty programs, such as Medicaid, are in most people’s minds still welfare. Before the New Deal many of the anti-poverty programs, as well as welfare (utility assistance, help purchasing groceries, etc.) were funded completely through private charities....
Sullivan-Marx, E. M., McGivern, D. O., Fairman, J. A., & Greenberg, S. A. (2010). Nurse practitioners: The evolution and future of advanced practice. (5th ed.). New York: Springer Publishing Company.
Most APNs or NPs posses a master’s degree; however the American Association of Colleges of Nursing (AACN) member institutions voted to change the current level of preparation for advanced nursing practice from a masters degree to a doctorate level by 2015”. “An individual who wished to apply for a license must meet the following requirements; a complete application, pass the NCLEX, provide any felony or misdemeanor conviction information, any drug related behavior, functional ability deficit and license fee to Virginia State Board of Nursing”. Most RNs gain their clinical experience by working a staff nurse before entering into a graduate program for their nurse practitioners, but once they gain a significant of experience as a nurse t...
Currently, there are multiple challenges to the US healthcare system like the nation’s aging population and the staggering reports of alarming rates of increase in chronic diseases in both pediatrics and adults (Stanley, 2012). While the need for more healthcare providers who can take care of these populations increases, a study by Peterson et al. (2012) states that there is a foreseen shortage primary care physician due to new physicians opting to specialize. Coincidentally, the availability of Advanced Practice Registered Nurses (APRNs) has been increasing throughout the years. APRNs, specifically Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs), can fill in the shortage of primary care providers (Stanley, 2012).
The American Nurses Association (2008) has defined the FNP, under the broader title of Advanced Practice Registered Nurse (APRN), as one “who is educationally prepared to assume responsibility and accountability for health promotion and/or maintenance as well as the assessment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologic i...
Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O'Shea 1999). So as a student nurse this has become my duty and something that I need to practice and become competent in carrying it out. Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC 2008). Accountability also goes for students, if at any point I felt I was not competent enough to dispensing a certain drug it would be my responsibility in speaking up and let the registered nurses know, so that I could shadow them and have the opportunity to learn help me in future practice and administration.
The first key message that is discussed is that nurses should practice to the fullest extent of their education and training. Most of the nurses that are in practice are registered nurses. Advanced nurse practitioners are nurses that hold a master’s or doctoral degree and include nurse midwifes, clinical nurse specialists, nurse practitioners, and nurse anesthetists and consist of about two hundred and fifty thousand of the nurses currently working today. Advanced practice nurses are limited to what
The role of an advanced practice nurse will allow to collect the evidence and propose the necessary alterations. Once the project in place an APN involved in acute care setting can assist in advocating and instituting the EBP into the current
The advanced practice nurse is well positioned to be a leader and catalyst for change. “There is a huge opportunity for nurses to step up, provide leadership and make clear nursing’s unique set of contributions to people who need palliative care” (RWJF, 2010). Working with state boards of nursing and nursing organizations to develop plans and advocate for legislative change. The advanced practice nurse ability to practice to the full scope of practice and training requires the removal of restrictions and barriers.