Question

In 750-1,000 words, propose a health policy change (that is currently a bill, a law, or may not exist at all) at the state or federal level that you believe needs to change and why.

The policy must not be a clinical care policy for individual care. The policy involved may include public or community health, legislative or regulatory, professional organization (nursing-oriented), advanced nursing practice, health plan, or hospital plan.

Include a specific section for the exact wording for the bill or change in wording of the law.

Include the plan for the implementation of your policy development, to lobbying for passage, to next steps after passage.

Discuss who would be the champion for the bill/law change from your state advocates (legislators, federal legislators, local or national state nursing organizations). Are these individuals also influential in making changes occur? Did you vote for the individual in office that you want to help you make this change?

Answer 1

In the healthcare scetor of nursing, several areas are need to be made serious policy changes in order to make better quality care and make more accessible and affordable. There exist a number of barriers that make the delivery of quality health care difficult and which can be eliminated by making major policy changes. An important concern among these is the limit on the scope of practice for the Advanced Practice Nurses. There are many restrictions on APNs practices which keep them from delivering to their fullest. Physician involvement with regard to the practice of the APNs becomes a very important restriction. A little degree of freedom has been achieved in this direction but there is scope for more. An important rule in this context which may need to be amended is Section 6407 of the Affordable Care Act (ACA 6407). According to this Act: an in-person or face-to-face encounter must occur within the six months preceding the written order. The most important question which is debated in this regard is that whether the visit should be conducted by the physician only or that an APN may conduct the visit. In case of the laboratory requirements also, physician’s signature becomes and important restriction on APNs practice. (Chausa, 2011)

Section 6407 of the Affordable Care Act established a face-to-face encounter requirement for certification of eligibility for Medicare home health services, by requiring the certifying physician to document that he or she, or an NPP working with the physician, has seen the patient. (Chausa, 2011) The physician’s documentation and signature is an important issue in this regard that requires change.The regulation of APNs prescriptive capabilities is quite complicated and there are variations from state to state. There are various levels of physician involvement required in this regard. There are various difficulties related to accessibility and affordability of healthcare that arise due to such restrictions on APNs practice. The laws that limit their ability to practice need to be repealed. Research conducted overtime has shown that the APNs have the capability to provide a continuum of care and services to patients. (Hader, 2011)

The first stage in the process of Lobbying is communicating with the legislator. First of all I will have to write a letter to the American Nurses Association and the key legislators involved in the process. In this regard I will have to write a letter that specifies my position in a concise, clear and courteous manner. Apart from it, the letter will contain a clear request to action. But a letter is not sufficient and a personal visit to the legislator is also required. It is also necessary to secure the legislator’s commitment on the given issue. A personal .visit can be considered most effective in this regard. For this purpose, along with the American Nurses Association, I have selected Rep. John Becker. I would have to ask the legislator clearly regarding the action I seek of him whether it is sponsoring the bill, speaking about the bill or to vote for the bill. After having paid the visit for lobbying, I shall also be required to write a follow up letter to monitor the action I had requested. The letter will talk of the promises made by the legislator and hold him accountable politely.

American Nurses Association and Representative John Becker are the champions for my policy change endeavour. Legislator John Becker has been active in various spheres bringing about important policy changes and is most suitable for the given task. American Nurses Association, represents the interests of 3.1 million nurses from America and is the only such full-service professional organization. It also lobbies the congress on various nursing rights issues and important health care policy changes. I expect that the required changes can be brought about successfully by lobbying for the current issue. I expect John Becker to sponsor the bill considering his keenness to act in such areas. Such restrictions where physician’s involvement complicates the process require change and the change will only make the whole process less time consuming. Requirements like physician’s signature and documentation only delay the process of service delivery unnecessarily and should be done away with in as many areas as possible. This change will enlarge the scope of functioning for the nurses and thus make it easier for them to deliver health care without seeking the physician’s involvement at every stage. In various states such changes have been brought but they would not be enough seeing the limits on the APNs practices which if lifted can give them eth opportunity to serve the patients better.

References:

Update on Physician Signature Requirement and Face-to-Face Encounter Requirements (2011).In Chausa. Retrieved November 10, 2014, from https://www.chausa.org/docs/default-source/advocacy/b47875bfbc7241859540f7eb53733cea1-pdf.pdf?sfvrsn=2

Hader, R. (2011). It's time: Lift restrictions on APN practice. In NursingCenter. Retrieved November 10, 2014, from http://www.nursingcenter.com/lnc/journalarticle?Article_ID=111938