Benchmark – Future Scope, Role, and Professional Obligations Paper
Grand Canyon University
Benchmark – Future Scope, Role, and Professional Obligations Paper
Nursing is a profession that is continually evolving. With the evolution of the profession, scopes of practice inherently change as well. Nurse practitioners are currently battling for an increase in their scope of practice by having all states grant full autonomy versus requiring physician oversight. This writer will discuss the scope of practice of a nurse practitioner including regulatory, certification, or accreditation agencies that define that scope, three agencies that influence the scope of practice, and controversial or evolving issues that affect the scope of practice of a nurse practitioner.
The National Council of State Boards of Nursing (NCSBN) is a national organization that provides nurses with regulatory requirements at the national level. The NCSBN is responsible for developing state licensure examinations that are consistent with current nursing practice (NCSBN, 2019). The NCSBN provides the various boards of nursing with resources and programs by collaborating with nursing educators to keep each state current with new requirements. The NCSBN also provides the boards with evidence-based practice material to guide in regulatory decisions (NCSBN, 2019). (, n.d.)
The Centers for Medicare and Medicaid Services (CMS) is a primary regulatory agency that is responsible for overseeing healthcare programs such as meaningful use and electronic health records (CMS, n.d.). The CMS has specific guidelines that an APN must follow in order to obtain reimbursement. They provide required qualifications for nurse practitioners such as obtaining medicare billing privileges as well as coverage and billing guidelines that they must follow. Nurse practitioners’ reimbursement rate according to the CMS (n.d.) is 85% of the amount that a physician is paid under the Medicare Physician Fee Schedule. A major regulation that is set forth by the CMS is that collaboration occurs when an NP:
● Work with one or more physicians to deliver health care services within the scope of their professional expertise.
● Medical direction and appropriate supervision is provided as required by the law of the State in which the services are furnished (it is not required for the collaborating physician to be present when services are furnished or to independently evaluate patients) (“Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants,” 2016).
The Arizona State Board of Nursing (AZBN) is the state regulatory agency that protects and promotes the welfare and safety of the public by regulating the competency of nurses practicing within the state (AZBN, 2018). The AZBN provides APNs with current requirements on how to obtain certification, proper scope of practice including tasks that are allowed to be delegated, and regulations for prescribing medications. One aspect that the AZBN now requires to help ensure that a nurse is practicing safely is requiring a nurse to practice for a total of 960 hours within five years in order to maintain their license (AZBN, 2018). In the past, a nurse who has not practiced within five years was only required to take a refresher course to obtain an active license.
The American Association of Nurse Practitioners (AANP) is an organization that is designed to “empower all NPs to advance quality health care through practice, education, advocacy, research and leadership” (AANP, 2019) by providing nurse practitioners with information, tools, and resources that they may need to help shape the nurse practitioner community. The AANP has over 95,000 throughout the United States.
The American Nurses Association (ANA) is an organization that was developed in 1896 with members in all 50 states. The ANA is claimed to be the largest voice of the nursing profession (ANA, n.d.). The ANA was designed to help nurses foster high standards of nursing practice, promote a safe and ethical work environment, bolster the health and wellness of nurses, and advocate for nurses when issues may arise (ANA, n.d.). The ANA helps nurses reach the highest level of potential that they can. They are there to support other nurses with any questions or concerns. The ANA also encourages nurses to join the organization to help be the face and voice of nursing and help spread awareness.
The Arizona Nurse Practitioner Council (ANPC) is a local chapter of the ANA that is also affiliated with the AANP that represents nurse practitioners in Arizona. The ANPC was established in 1992 and provides members with a networking opportunity to help promote services in Arizona. The mission of the ANPC is to “advance the practice and professional stature of Nurse Practitioners in Arizona through legislative impact, education, community outreach, and involvement” (ANPC, n.d.).
Current Scope of Practice Controversy
A controversy among nurse practitioners that continues is whether nurse practitioners should be granted full autonomy or not. There are currently 22 states plus the District of Columbia that have granted nurse practitioners the ability to practice independently without physician oversight (Chesney & Duderstadt, 2017). There are three categories of practice: full practice authority, reduced practice, and restricted practice. Full practice authority includes the ability to evaluate, diagnose, order and interpret diagnostic testing, initiate and manage treatment, and prescribe medications under exclusive licensure of the state board of nursing (Chesney & Duderstadt, 2017). Reduced practice reduces the ability of the nurse practitioner to require a career-long collaborative agreement with a physician in order to participate in patient care. Restricted practice requires a nurse practitioner to work directly under a physician who has complete control of patient care (“State Practice Environment,” 2018).
Some issues that nurse practitioners face to gain full practice authority is legislation not wanting to recognize the scope of practice of a nurse practitioner unless there is a clear and concise benefit versus having to look at the broader picture of patient care. Some legislation also may view the issue as a battle between physicians and nurse practitioners. Some physicians feel that nurse practitioners are not educationally trained to independently care for patients without oversight (Chesney & Duderstadt, 2017). In contrast, nurse practitioner programs are designed to educate the individual on how to properly diagnose a patient and what medications they should prescribe. There is also an increasing shortage of physicians as well as an increasing population of those in need of care. A nurse practitioner having the ability to practice independently can alleviate the shortage issue as well as the cost of healthcare as nurse practitioners’ salaries are substantially lower than a physician.
One solution to the issue with nurse practitioners being allowed to practice independently is requiring nurse practitioners to do programs such as a transition-to-practice program (Chesney & Duderstadt, 2017). This type of a program can help transition the newly graduated nurse practitioner the additional training beyond clinical hours that are required in an educational program. However, the transition-to-practice program is not always a favorable suggestion because some feel that due to the clinical hour requirement to graduate, they are adequately trained to transition to the field immediately (Chesney & Duderstadt, 2017).
There will always be changes among healthcare as new issues arise with illnesses, scopes of practice, and available resources. The key to a successful transition is knowing where a nurse can turn to in a time of need and what they are capable of doing for their patients without overstepping their boundaries. The healthcare industry is continually changing and people within the industry must be able to adapt. There are several organizations that are designed to keep healthcare professionals involved in current practice changes and help spread awareness of different aspects of the job such as changes in the scopes of practice for clinicians. Scope of practice limitations will always be a battle that nurse practitioners face. As long as nurse practitioners get involved and utilize the different organizations, voices will be heard and changes may be made.
Advanced Practice Registered Nurses, Anesthesiologist Assistants, and Physician Assistants. (2016). Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare-Information-for-APRNs-AAs-PAs-Booklet-ICN-901623.pdf
American Nurses Association. (n.d.). https://www.nursingworld.org/ana/
Arizona Nurse Practitioner Council. (n.d.). https://arizonanp.enpnetwork.com/page/3454-about-the-aznpc
Arizona State Board of Nursing. (2018). https://www.azbn.gov/
Centers for Medicare & Medicaid Services. (n.d.). https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html
Chesney, M. L., & Duderstadt, K. G. (2017, October 30). States’ Progress Toward Nurse Practitioner Full Practice Authority: Contemporary Challenges and Strategies . Health Policy, 31(6), 724-728. https://doi.org/https://doi.org/10.1016/j.pedhc.2017.09.002
State Practice Environment. (2018). Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment
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