Implementation of the Affordable Care Act (ACA) enabled more than 30 million people to have new access to primary care services (Dillon & Gary, 2017). Several barriers prevent Advanced Practice Registered Nurses (APRNs) from being able to respond effectively to rapidly changing health care settings and an evolving health care system. The Institute of Medicine (IOM) made the recommendation in its 2010 landmark report, The Future of Nursing, that scope-of-practice (SOP) barriers should be removed to allow APRNs to practice to the full extent of their education and training (IOM, 2010). Removing barriers to practice will empower NPs to effect positive change in our struggling health care system, in addition to providing additional access to care for minorities and underserved patient populations (Dillon & Gary, 2017). Results of a study by the United States (U.S.) Department of Health and Human Services (2015), suggest that SOP is an important driver of many practice outcomes for ARNPs. States could take better advantage of the broad capacities of ARNPs by loosening SOP restrictions and considering other policy levers available including addressing organizational practices, education and training, and evaluating billing practices and the rates at which ARNPs are reimbursed compared to their physician colleagues. Current policy for ARNP SOP is fragmented, Oklahoma is one of only 12 states that requires cumbersome physician oversight of ARNPs. SOP regulations at the state level limit the range of health care services that APRNs can deliver and the extent to which they can do so without physician supervision or collaboration (Dillon & Gary, 2017).
What are the possible effects on the state of Oklahoma if the state legislature were to expand scope of practice (SOP) to full practice authority (FPA) for advanced practice registered nurses (APRNs)?
Key characteristics of the problem include:
What information do systematic reviews provide about three viable options to address the problem?
What key implementation considerations need to be borne in mind?
American Association of Nurse Practitioners. (2015). Quality of nurse practitioner practice. https://www.aanp.org/images/documents/publications/qualityofpractice.pdf.
Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120–130. https://doi.org/10.1097/JXX.0000000000000023
Dillon, D., & Gary, F. (2017). Full Practice Authority for Nurse Practitioners. Nursing Administration Quarterly, 41(1), p.86-93. DOI:10.1097/NAQ.0000000000000210
Institute of Medicine. (2010). Report brief: The future of nursing: Leading change, advancing health. https://www.nap.edu/resource/12956/Future-of-Nursing-2010-Report-Brief.pdf
Martsolf, G. R. & Kandrack, R. (2017). The Impact of Establishing a Full Scope of Practice for Advanced Practice Registered Nurses in the State of Indiana. Santa Monica, CA: RAND Corporation. https://www.rand.org/pubs/research_reports/RR1864.html
U.S. Department of Health and Human Services. (2015). Impact of State Scope of Practice Laws and Other Factors on the Practice and Supply of Primary Care Nurse Practitioners. https://aspe.hhs.gov/system/files/pdf/167396/NP_SOP.pdf
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