Nursing advocacy essay
Select and clearly describe an issue facing advanced practice nurses related to scope of practice. After describing the issue, please answer the following questions.
What ethical impact does the issue have on direct patient care? Please provide specific examples.
Describe any law or legal issue surrounding this policy issue.
Decide how this policy would affect your specific role as an advanced practice nurse.
Describe any changes you would make to your selected health policy issue. Please provide rationale for each cited change.
Nursing Advocacy Example- Addressing Scope of Practice Limitations for Advanced Practice Nurses
Nursing advocacy plays a crucial role in shaping healthcare policies, ensuring patient safety, and promoting the professional rights of nurses. Advanced practice nurses (APNs), including nurse practitioners (NPs), nurse anesthetists, and clinical nurse specialists, are pivotal in delivering high-quality healthcare. However, one significant issue that APNs face is the limitation of their scope of practice in certain states. These limitations, governed by state laws, can restrict APNs from practicing independently, negatively impacting patient care and the ability of nurses to provide efficient healthcare services. This essay will explore the issue of restrictive scope of practice laws, their ethical implications, relevant legal considerations, and the potential policy changes necessary to resolve these challenges.
Issue: Restrictive Scope of Practice for APNs
The scope of practice for APNs varies across the United States, with many states requiring APNs to practice under the supervision or collaboration of a physician. These regulations prevent APNs from independently diagnosing, prescribing medications, and managing treatment plans. In states with full practice authority, APNs can practice to the full extent of their education and training, which improves patient access to care, especially in rural and underserved areas (Barnes, 2015). However, in states with restricted practice laws, APNs are limited, which can result in delays in care, increased healthcare costs, and reduced patient autonomy.
Ethical Impact on Direct Patient Care
The restrictions on APNs’ scope of practice raise significant ethical concerns, particularly in relation to patient autonomy, justice, and beneficence. Patient autonomy, the right of individuals to make informed decisions about their care, can be compromised when APNs are unable to provide timely treatment without physician oversight. For instance, in rural or medically underserved areas, where physicians may not be readily available, patients may experience unnecessary delays in receiving care, which infringes on their right to access healthcare in a timely manner (Poghosyan et al., 2018). This delay can have dire consequences, especially for patients with chronic or acute conditions.
From an ethical standpoint, these restrictions also affect the principle of justice, which promotes equitable access to healthcare. When APNs are not allowed to provide care autonomously, patients in low-resource areas may have limited access to healthcare services, exacerbating health disparities. Additionally, the principle of beneficence, which requires healthcare providers to act in the best interests of their patients, is compromised when APNs are restricted in their ability to fully manage patient care. Limiting APNs’ practice can result in suboptimal care and longer wait times, thus negatively impacting patient outcomes (Kooienga & Carryer, 2015).
Legal Considerations
The legal framework surrounding the scope of practice for APNs is defined primarily by state laws and regulations. These laws determine whether APNs have full, reduced, or restricted practice authority. The Nurse Practice Act in each state outlines the specific responsibilities and limitations for APNs (Buppert, 2018). In states with full practice authority, APNs are allowed to evaluate, diagnose, and treat patients independently. However, in states with restrictive laws, APNs must work under a supervisory or collaborative agreement with a physician, which limits their autonomy in clinical decision-making and restricts the services they can provide.
Efforts to modify restrictive scope of practice laws have been met with resistance from some physician groups, who argue that physician oversight is necessary to ensure patient safety. However, research consistently shows that APNs provide care that is comparable in quality to that provided by physicians, particularly in primary care settings (Martsolf et al., 2015). Despite these findings, legal battles over expanding the scope of practice for APNs continue, with patient care and healthcare access hanging in the balance.
Impact on My Role as an APN
As an advanced practice nurse, the scope of practice limitations would directly impact my ability to provide comprehensive care to patients. In a state with restrictive practice laws, I would be unable to diagnose and treat patients without a physician’s involvement, potentially causing delays in care and limiting the effectiveness of my clinical skills. This would be especially problematic in settings where physician availability is limited, such as rural healthcare facilities. The necessity to rely on physician supervision would also hinder my ability to build trusting relationships with patients, as they may perceive me as having limited authority to manage their care independently.
Additionally, working under a restrictive practice model could undermine my professional autonomy and limit opportunities for career advancement. It would also increase healthcare costs for patients, as the need for physician oversight adds an additional layer of bureaucracy to patient care, leading to increased costs and longer wait times.
Recommended Policy Changes
To address the limitations posed by restrictive scope of practice laws, I would advocate for expanding full practice authority for APNs nationwide. This change would eliminate the need for physician supervision or collaborative agreements, allowing APNs to practice independently and to the full extent of their training. Expanding full practice authority is supported by research showing that APNs deliver high-quality, cost-effective care, and it would improve healthcare access in underserved areas (Newhouse et al., 2011).
Additionally, I would recommend that interdisciplinary collaboration between physicians and APNs be encouraged rather than mandated. Collaboration should be based on the needs of the patient rather than legal requirements. This would foster a more team-based approach to healthcare while still allowing APNs to maintain autonomy in clinical decision-making.
Lastly, I would advocate for greater public awareness of the role and capabilities of APNs. Many patients are unaware that APNs can provide high-quality care, and increasing public education on this matter would help build trust in APNs’ ability to manage patient care independently.
Conclusion
Restrictive scope of practice laws for advanced practice nurses present significant ethical, legal, and practical challenges. These limitations not only affect patient care by reducing access and increasing wait times but also undermine the autonomy and professional development of APNs. By advocating for expanded practice authority and promoting interdisciplinary collaboration, APNs can continue to provide high-quality care, reduce health disparities, and ensure that patients have access to timely, comprehensive healthcare services.
References
Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183.
Buppert, C. (2018). Nurse practitioner’s business practice and legal guide. Jones & Bartlett Learning.
Kooienga, S., & Carryer, J. (2015). Globalization and advancing primary health care nurse practitioner practice. The Journal for Nurse Practitioners, 11(8), 804-811.
Martsolf, G. R., Auerbach, D. I., Arifkhanova, A., & Gordon, L. (2015). The impact of full practice authority for nurse practitioners in primary care. Health Services Research, 50(5), 1347-1369.
Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., … & Weiner, J. P. (2011). Advanced practice nurse outcomes 1990-2008: A systematic review. Nursing Economics, 29(5), 1-22.
Poghosyan, L., Norful, A. A., & Martsolf, G. (2018). Full scope of practice for nurse practitioners is associated with higher quality of care. Health Affairs, 37(4), 584-591.
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