Question

State Practice Agreements For NPs This week you will have an opportunity to evaluate state practice agreements in your state and examine issues related to NP practice. To prepare: Review practice agreements in your state (Virginia) Identify at least two physician collaboration issues in your state (Virginia) By Day 3 Post a brief description of the practice agreements for NPs in your state and the two physician collaboration issues that you identified. Explain what you think are the barriers to NPs practicing independently in your state. Finally, outline a plan for how you might address NP practice issues in your state.

Answer 1

Nurse Practitioner (NP):

Nurse practitioners are healthcare professionals educated and trained to provide health promotion and maintenance through the diagnosis and treatment of acute illness and chronic conditions.

Today, NP practice is impacted by four significant policy and regulation initiatives:

1) The Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education

2) The Doctor of Nursing Practice movement

3) The IOM report (2011)

4) The Patient Protection and Affordable Care Act (PPACA).

There are many positive expansions to the NP role but on the other hand, there are many barriers requiring attention of national and state leaders in order to achieve the Triple Aim of healthcare:

1) better care

2) better health

3) lower healthcare cost.

* Barriers to NP practice:

• State Practice and Licensure: NP practice is regulated by state licensure...only about one-third of the nation has adopted full practice authority licensure and practice laws for NPs. ?IOM report has recognized that overly restrictive scope-of-practice regulations of NPs in some states as one of the most serious barriers to accessible care.
• Physicians related issues: At a time when healthcare reform is rapidly evolving, it is critical that NPs and physicians collaborate to achieve best practices.
• Payer Policies: Restrictive scope-of-practice may lead to stricter payer policies limiting NPs ability to practice independently. State insurance mandates are important to NP practice because they affect nurse practitioners’ ability to independently practice and bill for services.
• Other Barriers: Another barrier to NP practice is job satisfaction and intent to leave.

The ability of nurse practitioners to work to the full extent of their training and education is an issue which affects NPs nationwide. So the fight for full practice authority (FPA) is crucial to help meet the growing demand for qualified providers (particularly in rural areas) and to keep costs down with safe, effective healthcare services. “The biggest challenge in this fight is getting the physician groups to understand that we are not in competition with them; as NPs, we are members of a healthcare team, which includes our physician colleagues and other healthcare professionals the patient may need. As a team, we need to work collaboratively in order to improve the health of our patients.”

The first step toward granting NPs full authority nationwide is to understand the current state practice environments. The American Association of Nurse Practitioners (AANP 2017) broadly defines three practice authority statuses nationwide:

• Full practice: “State practice and licensure law provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state Board of Nursing:.”
• Reduced practice: “State practice and licensure law reduces the ability of nurse practitioners to engage in at least one element of NP practice. State law requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care or limits the setting or scope of one or more elements of NP practice.”
• Restricted practice: “State practice and licensure law restricts the ability of a nurse practitioner to engage in at least one element of NP practice. It requires supervision, delegation, or team-management by an outside health discipline in order for the NP to provide patient care.”

The tireless efforts of NP legislative advocacy, the state practice environments are continually evolving and great efforts will be made to keep this information up-to-date.