The advanced practice registered nurse (APRN) role has emerged recently and has been developing into a prominent clinical position. However, not all states demonstrate the same degree of acceptance for the area. This disparity is reflected in the differences between the developments of different local legislation on the matter. Some APRNs can operate independently and with adequate authority, fulfilling the various purposes of the role autonomously. However, in many states, there are stringent restrictions on the role’s ability to practice and reach positions where it can produce superior results. Particular examples include a lack of prescription authority, the need for physician supervision, as well as others. However, as the benefits of the role are recognized further, members of the profession are working to address these barriers. This discussion post will elaborate on the specific obstacles to APRN work and the methods that can be used to change policy on the matter.
The first matter that should be discussed is prescription authority, which defines the practitioner’s ability to supply their patients with controlled substances. Webb and McKinnon-Howe (2018) note that in some states, physicians have to approve protocols for Schedule II controlled substance prescribing, and others require oversight over any prescriptions. This policy damages the ability of APRNs to operate independently, like many conditions that they are equipped to address require the usage of prescription medicine. Their inability to access it harms the patient and forces the advanced practice nurse to send them to a physician for help, which is often unnecessary and incurs extra costs. Moreover, other frequently applied restrictions compound the problem and functionally cripple the independence of APRNs.
The most prominent examples of such a policy are requirements for physician oversight, which hamper the role’s ability to work independently. In many states, the APRN cannot operate unless they enter a supervision contract with a physician, who then has to be physically present at the nurse’s office at mandated times. As a result, the requirement is inconvenient for clinical workers who intend to operate away from physician offices, as many physicians will be unwilling to spend time away from their practice. The rural areas where APRNs may otherwise work are underserved, as they have to go to more populated areas even if their conditions are minor. O’Grady and Tracy (2018) note that the practice creates inefficiencies in the system as a whole rather than only these isolated cases. However, many states retain the restrictions despite efforts to change policy toward removing such restrictions.
There are several reasons for the resistance to change in the APRN role’s status, most of which stems from the refusal to recognize the role’s competence. O’Grady and Tracy (2018) claim that this view stems from the failure to acknowledge the evolution of the nurse’s role in filling the niche of general competence as physicians increasingly specialized in recent decades. Webb and McKinnon-Howe (2018) note how, despite the extensive education and experience of APRNs, many states refuse to see them as competent at their tasks and in need of physician oversight. To overcome this lasting view, members of the profession will have to demonstrate their competence and the benefits of being able to operate independently. For that purpose, they have to excel at their work and prove their ability through evidence, but doing so is not enough for success.
To deliver the knowledge of their success to lawmakers throughout the United States, APRNs will have to engage in advocacy activities and influence the development of policy that affects them. As Joel (2017) describes, members of the role are expected to use their experience in the local and medical community and translate them into political systems-level action. To that end, many educational programs for the role, particularly those that aim to help the students attain the DNP qualifications in the future, list the ability as a requirement and assist in mastering the required skills. By collecting the necessary evidence and discussing it with politicians on the local, state, and federal levels, the APRN can contribute to the removal of barriers that impede beneficial practice. Through the combined efforts of members of the role throughout the United States, it is possible to realize the necessary changes and improve patient outcomes.
Overall, while the development of the theoretical, practical, and legal frameworks for the APRN role is ongoing, they are not yet in a state where its members can achieve the intended results. Their ability to operate as intended, providing high-quality care for conditions that do not require physical intervention and working in underserved areas, is hampered by restrictions that limit their independence. These problems mostly stem from the perception that nurses are not competent to handle patients alone, which is inconsistent with the reality of the evolution of the nurse’s and the physician’s roles. To resolve this lack of understanding, nurses have to present their point of view and evidence of the role’s effectiveness to lawmakers. For this purpose, APRNs must engage in widespread advocacy and learn how to promote positive change in various legislatures.
Joel, L. A. (2017). Advanced practice nursing: Essentials for role development (4th ed.). F.A. Davis.
O’Grady, E. T., & Tracy, M. F. (2018). Hamric & Hanson’s advanced practice nursing: An integrative approach (6th ed.). Elsevier Health Sciences.
Webb, J., & McKinnon-Howe, L. (2018). Finding our voices: defining ourselves. In S. W. Ahmed, L. C. Andrist, S. M. Davis, & V. J. Fuller (Eds.), DNP education, practice, and policy: Redesigning advanced practice for the 21st century (2nd ed.) (pp. 177-196). Springer Publishing Company.