The American Nurses Association (ANA) believes strongly in the value of advanced practice registered nurses (APRNs) and their contribution to improving access to healthcare services. ANA represents the interests of all APRNs: Certified Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), Clinical Nurse Specialists (CNS), and Certified Nurse Midwives (CNMs) APRNs in each role have a rich history of providing effective and essential care to patients and the public.
Currently we are in the process of implementing three landmark documents: the APRN Consensus Model, the Affordable Care Act, and The Future of Nursing: Leading Change, Advancing Health. The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education, released in 2008, is well on the way to meeting its implementation goal of 2015. The APRN Consensus Model standardizes each aspect of the regulatory process for APRNs, increasing state-to-state mobility for practicing APRNs and will provide increased access to APRN care nationwide. Increased access to APRN care is critical, as the Affordable Care Act, signed into law in 2010, provides health insurance to many through the marketplaces and expanded Medicaid coverage, with better access to primary care, chronic care, and preventive services for all.
The APRN authors are practicing clinicians in each of the four APRN roles. Foster and Flanders discuss Challenges in Clinical Nurse Specialist Education and Practice. Hain and Fleck lay out some of the Barriers to NP Practice that Impact Healthcare Redesign. Malina and Izlar describe Education and Practice Barriers for Certified Registered Nurse Anesthetists. Midwifery Practice and Education: Current Challenges and Opportunities are detailed by Walker, Lannen, and Rossie. The final article in this issue by Kleinpell and her international nursing colleagues expands the focus beyond the United States. Addressing Issues Impacting Advanced Nursing Practice Worldwide summarizes barriers to APRN practice in several countries and concludes with strategies that can be adapted internationally.
Returning to the United States, as the numbers of APRNs and their utilization in all healthcare settings rapidly expands, two landmark national reports are facilitating the removal of state and federal barriers to APRN practice.
The 2012 National Governors Association report, The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care, includes an extensive literature review which raised no concerns about the quality or safety of NP-provided primary care (NGA, 2012). The report recommends that states amend scope of practice restrictions and modify reimbursement policies to remove barriers to APRN practice and care. Expanded use of NPs has the potential to increase access to healthcare, particularly in historically underserved areas.
The March 2014 Federal Trade Commission (FTC, 2014) policy paper, Competition and the Regulation of Advanced Practice Nurses, also concluded that decades of research and on-the-ground experience demonstrate that APRNs provide safe and effective care. The FTC found that mandatory physician supervision and collaborative practice agreements are not justified by health and safety concerns, but in fact lead to higher costs, less innovation, reduced quality of care, and decreased access to services. The FTC concluded that removing barriers to APRN practice is good for competition and consumers.
ANA and its constituent and state nurses associations (C/SNAs) have been instrumental in working with licensing boards, legislatures and regulatory agencies to bring quality, affordable and accessible care to the public through the full utilization of APRNs. Opportunities for APRNs to practice in a reformed healthcare system will continue to increase.
The journal editors invite you to share your response to this OJIN topic addressing APRN Roles: Opportunities and Challenges either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.
Andrea Brassard PhD, FNP-BC, FAANP
© 2014 OJIN: The Online Journal of Issues in Nursing
Article published May 31, 2014
Federal Trade Commission. (2014). Policy perspectives: Competition and the Regulation of advanced practice nurses. Retrieved from www.ftc.gov/policy/reports/policy-reports/commission-and-staff-reports
National Governors Association. (2012). The role of nurse practitioners in meeting increasing demand for primary care. Retrieved from www.nga.org/cms/home/nga-center-for-best-practices/center-publications/page-health-publications/col2-content/main-content-list/the-role-of-nurse-practitioners.html