Name
Chamberlain University
NR-506: Healthcare Policy
Prof. Name
Date
Advanced practice nurses (APNs) continue to face barriers that hinder their ability to provide care to the fullest extent of their education and training. These barriers exist at both the state and national levels, impacting licensure, prescriptive authority, reimbursement, and public perception. Policies differ across states, creating inconsistency in scope of practice and ultimately influencing the delivery of patient-centered care.
In Kentucky, nurse practitioners can practice independently; however, prescriptive authority is restricted. Specifically, APNs must maintain a collaborative agreement with a supervising physician to prescribe controlled substances such as narcotics (Kentucky Board of Nursing, 2020). This limits their autonomy and delays patient care in rural and underserved areas where physicians may be scarce.
Nationally, APNs face challenges related to insurance reimbursement and recognition. Medicare reimbursement for nurse practitioners is approximately 29% lower than that for physicians, even when performing identical services (Perloff, DesRoches, & Buerhaus, 2016). This payment disparity not only undervalues the role of nurse practitioners but also influences hiring decisions made by healthcare organizations.
Public perception is another barrier. Many patients prefer physicians over APNs, based on the misconception that physicians provide superior care. Such beliefs limit the opportunities for APNs to work independently, despite evidence that patient outcomes are comparable or even superior under nurse practitioner-led care.
Competition also plays a significant role in restricting APNs’ ability to practice independently. On both the state and national levels, APNs face competition from physicians and physician assistants. Physicians often resist expanding APN practice authority, citing concerns about patient safety, despite research supporting APNs’ ability to deliver high-quality care (Davis, 2019).
Additionally, some hospitals and clinics prefer hiring physicians or physician assistants due to patient demand or professional hierarchies. This perpetuates the cycle of limited recognition for nurse practitioners. Misconceptions about nurse practitioners’ education and training further exacerbate these barriers, particularly in specialized fields such as emergency care, where APNs have faced skepticism about their preparedness (Davis, 2019).
The ability of APNs to practice is largely shaped by legislative and executive authorities. In Kentucky, the executive branch is led by Governor Andy Beshear. Under his administration, the Cabinet for Health and Family Services plays a vital role in regulating healthcare access and supporting vulnerable populations (Commonwealth of Kentucky, 2020).
The legislative branch includes both the Kentucky House of Representatives and Senate, which are responsible for enacting laws that affect APN scope of practice, Medicaid regulations, and prescriptive authority. Collaborative efforts between legislators, healthcare providers, and advocacy groups are essential to reducing practice barriers for APNs.
Interest groups significantly influence healthcare policy by advocating for or against legislation affecting APNs. At the state level, the Kentucky Nurses Association actively participates in legislative hearings and promotes policies that support nurse autonomy and safe working conditions.
At the national level, the American Association of Nurse Practitioners (AANP) serves as a powerful advocate for nurse practitioners. The AANP engages in legislative lobbying, public education, and coalition-building to expand practice authority and recognition of nurse practitioners. They have been instrumental in promoting full practice authority laws across various states (Kopanos, 2020).
APNs and their supporters utilize multiple methods to influence policy, including advocacy, lobbying, coalition-building, and public education. The strategies can be summarized in the following table:
| Area of Influence | Methods Used to Influence Change |
|---|---|
| Competition | Public education campaigns to counter misconceptions about NP care; research dissemination showing comparable patient outcomes. |
| Legislative Branch | Direct lobbying of state legislators; testimony during hearings; drafting bills that expand NP practice. |
| Executive Branch | Collaboration with governors and health departments; working with executive agencies such as Medicaid and health service cabinets. |
| Interest Groups | Mobilizing nurse advocacy organizations (KNA, AANP); grassroots efforts such as petitions and rallies; building alliances with patient advocacy groups. |
Through these methods, nurse practitioners can counteract resistance from competing professionals and ensure that laws reflect their training, competence, and contribution to healthcare.
The barriers faced by APNs at both the state and national levels primarily involve prescriptive restrictions, reimbursement disparities, and persistent misconceptions about their clinical competency. Competition from physicians and physician assistants further limits opportunities for APNs, even in areas with significant provider shortages. Lawmakers, both at the legislative and executive levels, alongside powerful interest groups, play a pivotal role in shaping healthcare policy. By engaging in education, advocacy, and coalition-building, APNs can influence policy change and work toward achieving full practice authority across the United States.
Commonwealth of Kentucky. (2020). General government. Retrieved from https://transparency.ky.gov/accountability/gengov/Pages/default.aspx
County Health Rankings and Roadmaps. (2018). Explore rankings. Retrieved from http://www.countyhealthrankings.org/app/kentucky/2019/rankings/knott/county/outcomes/overall/snapshot
Corso, K. A., Dorrance, K. A., & LaRochelle, J. (2018). The physician shortage: A red herring in American health care reform. Military Medicine, 183(1-2), 220–224.
Davis, W. D. (2019). Moving the emergency nurse practitioner specialty from resistance to acceptance: The Wyoming experience. Advanced Emergency Nursing Journal, 41(4), 279–283.
Kentucky Board of Nursing. (2020). APRN prescriptive authority. Retrieved from https://kbn.ky.gov/practice/Pages/APRNPresAuth.aspx
Kopanos, T. (2020). AANP forum. Journal for Nurse Practitioners, 16(2), A13–A15.
Perloff, J., DesRoches, C. M., & Buerhaus, P. (2016). Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians. Health Services Research, 51(4), 1407–1423.
Renshaw, A. (2019). The nurse practitioner role within the rehabilitation context: Barriers to its acceptance. Journal of the Australasian Rehabilitation Nurses’ Association, 22(3), 16–19.
