Barriers to Independent Practice and the Nurse Practitioner Research Proposal

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Np Barriers Proposal

Nurse Practitioner

personal professional practice barriers proposal

Legally, NPs possess the authority to practice independently. Non-recognition of the NPs authority, however, routinely hinders their ability to put that authority into practice. During the proposed *** study, "Nurse Practitioner Personal Professional Practice Barriers," the researcher will examine a number of existing barriers that may challenge and prevent the NP from establishing an independent practice.

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Background/Paradigm Statement:



Factors of physician dominance, reimbursement, and state rules and regulations have created practice environments that are detrimental to full recognition of NPs as autonomous providers, hence, to their full utilization"

Sandra a. Weiland (2008, Introduction section, ¶ 3).


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Nurse Practitioners (NP) are not capable of autonomously providing primary care. This statement, although false, nevertheless, appears to be historically supported by political, professional, and social entities as they have routinely failed to recognize NPs as providers, capable of providing primary care autonomously. In the journal publication, "Reflections on independence in Nurse Practitioner practice," Sandra a. Weiland, MSC, FNP (2008), Tri-County Family Health Clinic, Wapanucka, Oklahoma, examines numerous factors relating to nurse practitioners practicing as independent primary care providers. Legally, NPs possess the authority to practice independently. Non-recognition of the NPs authority, however, routinely hinders their ability to put that authority into practice. During the proposed study, "Nurse Practitioner Personal Professional Practice Barriers," the researcher will examine a number of existing barriers that may challenge and prevent the NP from establishing an independent practice.

Statement of the problem

TOPIC: Research Proposal on Barriers to Independent Practice and the Nurse Practitioner Assignment

As the nurse practitioner role has evolved, despite 40 years of providing documented safe practice, complex federal and state reimbursement policies continue to economically and professionally thwart the prospect for the NP to become an independent practitioner. In turn, "NPs remain in a financially dependent relationship" (Weiland, ¶ 1). On the positive side of this issue, President Clinton passed legislation passed in the Budget Act to increase and expand the role of the nurse practitioner. Recent Legislation in Massachusetts made the nurse practitioner, en masse, primary care providers. NPs possess the autonomy and prescriptive authority of physicians, as they complete about 90% of the work of physicians, yet they only receive approximately 85% of the physician fee.

Research supports the stance that the NP provides care as good as, in some instances better than, the physician to the consumer. Nevertheless, NPs en masse are not establishing their own professional practices.

Research Questions

To address a number of challenges relating NPs establishing their personal, professional practices, the proposed study will address the primary research question: How may the nurse practitioner best address and overcome barriers that may challenge and/or thwart efforts to establish an independent practice? The following five sub-questions will serve to support the answer for the study's leading question:

1. What roles/needs may Nurse Practitioners fill in healthcare?

2. How may the care nurse practitioners provide compare to that of physicians?

3. What barriers may prevent Nurse Practitioners from establishing a personal professional practice?

4. What recent legislation regarding nurse practitioners did Massachusetts pass?

5. What theoretical concept/s may contribute to addressing challenges inherent in the nurse practitioner role?

Study Relevance

In an April 26, 2009 news account, "Shortage of Doctors an Obstacle to Obama Goals," Robert Pear relates contemporary concerns regarding the quest to help ensure the supply of physicians can adequately meet the needs of America's aging population and the reported millions currently uninsured individuals who would gain coverage under legislation the president proposes. Although some sources relate negative perceptions toward the concept of NPs filling positions that physicians traditionally inherit, others heartily support this notion. From the researcher's initial review of literature relating to this current controversial subject, the researcher asserts the proposed study will prove to be significant as it enhances the understanding regarding both sides of an issue that impacts not only local NPs and physicians, but also the individuals, patients and the communities these men and women serve.


Dr. Patricia E. Benner adapted the Dreyfus model to clinical nursing practice. Ann Marriner-Tomey and Martha Raile Alligood (2006) explain in the book, Nursing Theorists and their Work, that after the Dreyfus brothers studied the performance of chess masters and pilots in emergency situations, they developed the skill acquisition mode. The overview of the work, From Novice to Expert: Excellence and Power in Clinical Nursing Practice, by Benner (1984), Professor Emerita, Dept. Of Social and Behavioral Sciences, University of California, San Francisco, relates Brenner's adaptation of the Dreyfus five levels of skill acquisition. Benner contends that while acquiring and developing a particular skill, the student passes through five levels of proficiency. These levels include" novice, advanced beginner, competent, proficient, and expert" (Sonoma State University, 2001, Benner's Stages…section). In the book, Expanding Nursing Knowledge: Understanding and Researching your Own Practice, Gary Rolfe (1998), explains that Benner advocates " the nurse's own professional judgment, consisting of a combination of personal and experiential knowledge in addition to the knowledge obtained from scientific research, is just such an epistemology of practice…" (p. 40). Benner significantly influenced the notion of expertise.

During the next section of the proposed study, the Literature Review, the presents relevant information to enhance the understanding of existing barriers that may challenge and prevent the NP from establishing an independent practice. This information, in time, will relate answers to how the NPs may counter those challenges to establish a personal professional practice.



The key aspects of a research proposal include conducting an extensive literature survey, Dr. Henry N. Kemoni (2008), Senior Lecturer at the School of Information Sciences, Moi University, Kenya, explains. In the report, "Theoretical framework and literature review in graduate records management research," Kemoni stresses that as the researcher must become familiar with the study phenomenon, the literature helps the researcher gain a valid understanding of the selected research problem. During the literature review for the forthcoming study, the researcher plans to address the following themes to support the proposed study:

Roles/Needs Nurse Practitioners Fill

Nurse Practitioners and Physician Care Compared

Barriers to Establishing Professional Practice

Recent Massachusetts Legislation

Theoretical Concepts to Address Challenges

Roles/Needs Nurse Practitioners Fill

The number of nurse practitioners in the U.S. during 2006 was estimated to be at least 145,000. The publication, "Frequently asked questions about nurse practitioners," (2006) contends that NPs, registered nurses prepared, through advanced education and clinical training, provide a broad range of preventive and acute health care services to individuals of all ages.

NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; prescribe and manage medications and other therapies; provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance; and refer patients to other health professionals as needed. NPs are authorized to practice across the nation and have prescriptive privileges, of varying degrees, in 49 states. (Frequently asked…, 2006, p.1).

The article, "Frequently asked questions about nurse practitioners," (2006) further contends that nurse practitioners have provided a healthy partnership with their patients for more than 40 years. The nurse practitioner role had its inception in the mid-1960s in response to a nationwide shortage of physicians. The first NP Program was developed as a master's degree curriculum at the University of Colorado's School of Nursing in 1965, founded by Loretta C. Ford, a nursing faculty member and Dr. Henry K. Silver, a pediatrician. Programs were developed across the country to provide additional education for experienced nurses to enable them to provide primary health care services to large underserved populations. The first programs were in pediatrics and they soon spread to many other health care specialties (Frequently asked…, 2006, p.1).

Dr. Jenny Carryer, Clinical Chair of Nursing, Massey University, New Zealand, Dr. Glenn Gardner, Professor Clinical Nursing, Queensland University, Dr. Sandra Dunn, Professor Clinical Nursing Practice, Flinders University/Medical Centre, Melbourne and Dr. Anne Gardner (2007), Associate Professor Nursing, Deakin University and Cabrini Health, Melbourne, predict that due to the increasing need to manage chronic illness, to deliver effective primary health services, and to effectively manage workforce challenges, NPs will constitute a vital component of the future health workforce. In the journal publication, "The capability of nurse practitioners may be diminished by controlling protocols," Gardner, Dunn and Gardner note that the NP role historically originated in the United States during the 1960s to help improve primary health care to under-serviced communities. The NP provides a "flexible, accessible and much needed service, which easily spans the boundaries of health maintenance and illness management" (Carryer, Gardner, Dunn & Gardner, 2007, Workforce flexibility section, ¶ 2). Not utilizing NPs to their fullest potential, due to constraining protocols, these authors contend, wastes human resource that could contribute to the well-being of patients who need their care.

Nurse Practitioners and Physician Care Compared

Under the supervision of physicians, according to Weiland (2008), NPs serving as physician extenders improved physician productivity and income. Emphasizing the medical role of the NP as a physician substitute,… [END OF PREVIEW] . . . READ MORE

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