NURS 682 Care Coordination and Role of The Advanced Practice Nurse

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What trends or issues do you consider to be the most important for APRNs with regards to
credentialing and licensure?
Scope of practice laws establish the legal framework that controls the delivery of medical
services. Scope of practice laws govern which services each category of the licensed health
professional can provide and the settings they may do so. With few exceptions, the scope of
practice statutes is set by state governments. State legislatures consider and pass the statutes that
govern health care practices. Regulatory agencies, such as medical and other health professions
boards, implement the statutes by writing and enforcing rules and regulations. Such laws and
regulations vary widely from state to state. Some states allow individual professions broad
latitude in the services they may provide, while others employ strict limits. The nature of the
limitations can either facilitate or hinder patients’ ability to see a particular type of provider,
influencing health care costs, access, and quality (California Health Care Foundation, 2018).
One specific area of regulation concerns prescribing buprenorphine for the treatment of opioid
use disorder in office settings. Since 2002, buprenorphine can be prescribed in office-based care
settings by a provider who has a waiver under the Drug Addiction Treatment Act of 2000 (Burns
et al.,2016). This prescribing was limited to physicians until the passage of the Comprehensive
Addiction and Recovery Act (CARA) in 2016, which allows NPs and physician assistants (PAs)
to obtain waivers (Tierney et al.,2015). CARA stipulates that if a state requires physician
oversight of NP/PA prescribing, the physician must be board certified in addiction psychiatry or
addiction medicine, have completed training in medication-assisted therapy, or meet other
specific qualifications. These restrictions may impact the potential for NPs to support treatment
for opioid use disorder (California Health Care Foundation, 2018).
State regulations regarding NP scope of practice vary widely. To encourage greater consistency
across states, the National Council of State Boards of Nursing has developed a Model Act, which
provides consensus-based recommendations regarding how an ideal nurse practice act should be
written (NCSBN Model Act, 2014). The Model Act explicitly defines the scope of practice of
APRNs. To include conducting assessments, ordering and interpreting diagnostic procedures,
establishing diagnoses, prescribing, administering, dispensing, and furnishing therapeutic
measures, delegating to assistive personnel, consulting with other disciplines, and providing
referrals. The Model Act recommends that APRNs be licensed independent practitioners
(California Health Care Foundation, 2018). In 22 states and the District of Columbia, NPs can
practice and prescribe without physician collaboration or supervision; however, some barriers are
to accomplishing this act.
What barriers or challenges have slowed the progress of advanced practice registered
nursing?
Barriers to APRN practice environment reported in the literature were policy restrictions on
APRN practice, poor APRN– administration relations, physician opposition to independent
APRN practice free from physician oversight or supervision, lack of understanding of the APRN
role, and lack of professional recognition (Schirle et al.,2020).
Organizational factors that affect the APRN practice environment were categorized as facilitators
of or barriers to APRN practice. Major organizational characteristics facilitate the APRN
practice environment where high levels of autonomy/ independent practice and positive APRN–
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physician relations. Barriers to the APRN practice environment reported in the literature were
policy restrictions on APRN practice, poor APRN– administration relations, physician
opposition to independent APRN practice free from physician oversight or supervision, lack of
understanding of the APRN role, and lack of professional recognition.
Additional domains of a practice environment are unique to APRNs, including organizational
policies directed by outside forces, state legislation and third-party payers, and lack of
understanding regarding the APRN role. Barriers to practice identified in this review contributed
to lower job satisfaction, supporting the concern that barriers to APRN practice environments
may negatively impact APRN satisfaction and retention (Schirleet al.,2020).
Which legislative issues at the local, state, or national level influence policies related to
APRN practice?
Federal regulations place additional barriers on NP practice despite some small victories. The
Balanced Budget Act of 1997 included the Primary Care Health Practitioner Incentive Act, the
most important payment reform to affect NPs. Although the Primary Care Health Practitioner
Incentive Act allowed NPs to bill for services, one of the remaining challenges is the continued
existence of the two-level fee structure. Nurse practitioners can receive 100% reimbursement for
an incident to services, but they cannot do so independently, thereby placing another barrier for
forming independent practices and access to health care (Peterson, 2017).
A study revealed several facilitators of and barriers to positive APRN practice environments.
Evidence surrounding APRN practice environments has steadily increased and revealed the
influence of relations with physicians and administration, the importance of knowledge of the
APRN role, and organizational-level policies that may hinder or restrict the APRN practice.
Efforts to promote a positive APRN practice environment, especially through organizational
policy reform, are recommended to utilize this increasingly vital workforce (California Health
Care Foundation, 2018) efficiently and effectively.
References
Burns, R. M., Pacula, R. L., Bauhoff, S., Gordon, A. J., Hendrikson, H., Leslie, D. L., & Stein,
B. D. (2016). Policies related to opioid agonist therapy for opioid use disorders: The evolution of
state policies from 2004 to 2013. Substance abuse, 37(1), 63–69.
https://doi.org/10.1080/08897077.2015.1080208
California Health Care Foundation (2018). California’s Nurse Practitioners: How Scope of
Practice Laws Impact Care,
https://www.chcf.org/wp-content/uploads/2018/09/NursePractitionerScopePracticeLaws.pdf
NCSBN Model Act (2014), National Council of State Boards of Nursing.
https://www.ncsbn.org/3867.htm
Peterson M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner
Focus. Journal of the advanced practitioner in oncology, 8(1), 74–81.
Schirle, L., Norful, A. A., Rudner, N., & Poghosyan, L. (2020). Organizational facilitators and
barriers to optimal APRN practice: An integrative review. Health care management
review, 45(4), 311–320. https://doi.org/10.1097/HMR.0000000000000229
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Tierney, M., Finnell, D. S., Naegle, M. A., LaBelle, C., & Gordon, A. J. (2015). Advanced
Practice Nurses: Increasing Access to Opioid Treatment by Expanding the Pool of Qualified
Buprenorphine Prescribers. Substance abuse, 36(4), 389–392.

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