Advanced Practice Nurses and Prescriptive Term Paper

Pages: 15 (3917 words)  ·  Bibliography Sources: 20  ·  Level: Master's  ·  Topic: Health - Nursing

SAMPLE EXCERPT:

[. . .] Political issues involving physicians, in general, also pose significant issues for the modern Nurse Practitioner. The dramatic increase in Nurse Practitioners has given rise to questions about their impact on the incomes of other health providers, including physicians. Researchers have found that in areas with greater numbers of nurse practitioners, nurse practitioner incomes are higher while the incomes of physicians in the same geographic areas are decreased (Perry, 2009, p. 509). Perhaps partially due to the economic impact of Nurse Practitioners on physicians, Nurse Practitioners face physician resistance to their quest for full practice and prescriptive authority. As Carla Mills points out, physicians "express concerns that unsupervised NPs will misdiagnose, miss less obvious and potentially life-threatening problems, and make prescribing errors. They state that NPs lack the skill to manage complex patients with multisystem diseases. They have presumed that NPs will order more tests than necessary and be quicker to send patients to the hospital, thus driving up health care costs" (Mills, 2009). Though Mills points to the fact that none of those concerns has proven to be true in the 40-year history of Nurse Practitioners, the resistance by physicians and their associations remains a major obstacle for Nurse Practitioners.

Nurse Practitioners face restrictive limitations on authority and inequitable payment/reimbursement policies. As noted in The future of nursing: Leading change, advancing health | Appendix H: Federal options for maximizing the value of advanced practice nurses in providing quality, cost-effective health care, Nurse Practitioners' efforts to provide the highest level of care are currently frustrated by two factors: "state-based limitations on the licensed scopes of practice which prevent them from practicing to the full extent of their abilities, and & #8230;payment or reimbursement policies (both governmental and private) that either render them ineligible for payment, or preclude their being paid directly for their services, or pay them at a sharply discounted rate for rendering the same services as physicians" (Safriet, 2011, p. 446). In order to fully realize their potential, Nurse Practitioners must deal with and ultimately work to change these restrictive laws and unfair payment policies.

Medical insurance is also an issue and challenge for the modern Nurse Practitioner. As Nurse Practitioners' authority increases, so do their insurance concerns. Unfortunately, insurance companies sometimes act differently in different states. Insurance companies will, for example, contract with a Nurse Practitioner in one state but not in another. Carolyn Buppert, a Nurse Practitioner and an attorney specializing in representing Nurse Practitioners, states that the differences may be due to several reasons. An insurance company's refusal to contract with a Nurse Practitioner may depend on the amount of autonomy given to a Nurse Practitioner by her state: the less autonomy given, the less likely an insurance company is to contract directly with the Nurse Practitioner (Buppert, Why do insurers refuse to contract with nurse practitioners?, 2012). In addition, California is the only state that separates "medical corporations," requiring that a physician own a percentage of the corporation, from "nursing corporations" and some insurance companies may have a policy whereby they contract only with "medical corporations" (Buppert, Nurse practitioner's business practice and legal guide, Fourth Edition, 2012). This illustrates the difficulties that some Nurse Practitioners may have in that, lacking a contract with an insurance company, there will be instances in the patient is not treated or the Nurse Practitioner is not paid.

Another challenge for the modern Nurse Practitioner, which is also related to insurance, is the greater exposure to liability in the form of a malpractice suit. With greater authority and exposure comes greater risk and the Nurse Practitioner is not immune to the possibility of a medical malpractice suit. Consequently, Nurse Practitioners must obtain medical malpractice insurance. In addition, if a Nurse Practitioner is sued for medical malpractice, even if the Nurse Practitioner wins the suit, "An NP who is sued may feel like leaving the profession, may doubt his or her ability to make decisions, may resort to over-referring and seeking unnecessary consultation, may find that his or her insurance rates are increased, may miss days of work while testifying, may have to pay some legal expenses, and may have to mount a defense before the state licensing board" (Buppert, Nurse practitioner's business practice and legal guide, Fourth Edition, 2012, p. 256). Consequently, the impact on the Nurse Practitioner and his or her ability to provide a high level of care is obvious.

Responses by Nurse Practitioners

In response to current legal, ethical, role acquisition and political issues, Nurse Practitioners are seeking ways to expand Nurse Practitioners' authority, prescriptive and otherwise, on Federal and State levels. On the Federal level, Nurse Practitioners note that the profession has been "stymied…by the many regulatory obstacles and restrictions that currently impede the full realization of their potential," particularly by "conflicting and restrictive state provisions governing scope of practice and prescriptive authority… as well as the fragmented and parsimonious state and federal standards for their reimbursement" (Safriet, 2011, p. 444).

On the national level, for example, nursing organizations and the National Council of State Boards of Nursing are devising a model for regulations governing Nurse Practitioners to encourage consistency in licensure and credentialing (Knight, 2010). State nursing associations are also working to advance and expand the roles of Nurse Practitioners and their equitable financial treatment. For example, the Florida Coalition of Advanced Practice Nurses, which faces one of the most restrictive and inequitable state systems, authored a white paper detailing barriers to excellent patient care and outlining the Coalition's plan for future health care in Florida. The Coalition's recommended solutions include: granting Florida's Nurse Practitioners the authority to prescribe controlled substances, Schedules II -- V; identifying medical services traditionally provided by physicians that could appropriately be furnished by Nurse Practitioners; supporting increasing access to payer panels for Nurse Practitioners; amending Florida Insurance Acts to mandate inclusion of Nurse Practitioners as health care providers; supporting the extension of medical staff privileges to Nurse Practitioners; strengthening the statutory provisions regarding Nurse Practitioners' applications for clinical privileges; and passing regulations allowing Nurse Practitioners to provide evidence of financial responsibility in order to use state-regulated mechanism currently available to other health care providers (Florida Coalition of Advanced Practice Nurses, 2008, p. 2)

Fortunately, the large number of American Nurse Practitioners brings the most political clout that Nurse Practitioners have wielded in history. Though there are several associations of Nurse Practitioners, the "American College of Nurse Practitioners" has molded a determined and pointed mission "to ensure a solid policy and regulatory foundation that enables nurse practitioners to continue providing accessible, high quality health care" (American College of Nurse Practitioners, 2012). To support that mission, the ACNP "encourages Congress and the Administration to ensure that nurse practitioners are enfranchised in legislative and regulatory policymaking efforts, including membership on all relevant policymaking panels, committees, and other entities" (American College of Nurse Practitioners, 2012), and has outlined its 2012 Health Policy Agenda:

"• Acknowledge the central role of nurse practitioners in the design and implementation of an optimal U.S. healthcare delivery system;

• Provide full reimbursement and empanelment for all nurse practitioners in all settings;

• Include provider-neutral language in all federal legislation, regulation, and other policies;

• Recognize nurse practitioner's authority to order home health and hospice services and to admit patients to skilled nursing facilities;

• Support development of a national nurse practitioner database and tracking mechanism;

• Support policies that recognize nurse practitioners as primary care providers in all settings including medical homes;

• Appropriate increased funding for nursing faculty, advanced practice nursing and basic nursing education and research;

• Assure inclusion of nurse practitioners in the development of health IT policy and system infrastructure; and • Incorporate the nurse practitioner perspective in national healthcare reform strategy" (American College of Nurse Practitioners, 2012).

Educational Challenges Regarding Prescriptive Authority Facing Advanced Nursing Practice

One major educational challenge regarding prescriptive authority involves the varying regulations of the 50 states and the District of Columbia. The variety of regulations puts a greater demand on the educational system and on the Nurse Practitioner to understand and competently follow those regulations. As of 2012: Florida and Alabama allow their Nurse Practitioners to prescribe only legend drugs; Arkansas, Georgia, Louisiana, Michigan, Missouri (pending DEA approval), Ohio, Oklahoma, South Carolina, Texas and West Virginia allow Nurse Practitioners to prescribe drugs only under Schedule III and IV; Alaska, California, Illinois, Indiana, Kansas, Kentucky, Maine, Mississippi, Montana, Nevada, New Jersey, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, Virginia, Washington and Wyoming allow Nurse Practitioners to prescribe drugs under Schedule II, III or IV (Nursing License Map, 2012). The variety of regulations and allowed medications make it incumbent on the educational system and the Nurse Practitioner to be consistently aware of the applicable state's regulations.

A second educational challenge involves ongoing education about medications. Due to… [END OF PREVIEW]

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