NR510 week 6 disc 3
Discussion Part Three (graded)
Once a seamless entry into practice is achieved, it will become more likely that
independent practice will follow.
Discussion Question:
Is independent NP practice allowed in your state? Discuss your opinion regarding
independent NP practice. Provide evidence for your response.
Topic responses
Discussion
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Mijanou Marretta-Lewis
8/10/2016 7:27:53 PM
Discussion Part Three
Dr. Duncan and Classmates,
In Ohio, the nurse practitioner (NP) does not have full authority in practice. We continue to have
pushback from the Ohio Medical Association who feels we do not have the education or skill
level to be deemed worthy of full authority. In Ohio the advanced practice nurse must have a
Standard of Care Arrangement and collaborate with a physician. The physician does not have to
be on site but gets paid to review charts and do the APRNs yearly evaluations (Ohio Board of
Nursing, 2016). Ohio continues to have heavy lobbying against full authoritative practice for the
APRN, as there is ambiguity with what is scope of practice in any given area (Kleinpell,
Hudspeth, Scordo & Magdic, 2012). Due to the misconceptions and limitations of the APRN in
,Ohio there has been an increased migration of APRNs from Ohio to states that allow for
independent practice. The APRN is limited in signing death certificates but can be primary care
provider; this conflict limits the ability of the APRN to practice to their full scope of practice.
The Ohio Medical Association sides with several other state medical associations in opposition
to the proposed Independent Advanced Practice Nurse bill (American Association of Nurse
Practitioners, 2014). They cite the following reasons: differences in education between APRNs
and physicians, concerns with APRNs ability to safely prescribe controlled substances and
narcotics, shortage of physicians as primary care as APRNs stymie the increase number of
physicians in the state, shortage of nurses as the APRN will affect the future of the nursing
workforce, inability to control healthcare costs (fear that the APRN will be reimbursed as equals
to the physician), and lack of physician oversight without supervision (FMA Fact Sheet, 2014).
In a recent study (Donelan, DesRoches, Dittus & Buerhaus,2013) suggests that even through
there is a shortage of primary care providers, primary care physicians are not inclined to support
the expanded role of the APRN. The finding from this study states the majority of physicians
(70% of 505 physician respondents) believe APRNs should practice to the fullest extent of their
education and training but these same physicians did not agree that APRNs should get equal pay
for doing the same work.
The IOM (2011) and Patient Protection and Affordable Care Act have identified the demand for
primary care providers in the redesign of healthcare system. There is a need to create a new
model to prepare the APRN for this advanced practice. Through competency based models the
APRN can demonstrate that they are skilled to meet the challenges of this new healthcare system
(Sroczynski & Dunphy, 2012). For this to work the best outcome would be for professionals to
engage in collaborative non-hierarchical team approaches. APRNs are able and ready to take on
the challenges of the healthcare system and make a substantial impact to improve the outcome of
their patients (Aleshire & Wheeler, 2012). The current legislation that opposes and puts up
obstacles and restrictions impedes the APRN to fully realize their practice with their training and
education in Ohio. The focus of health has shifted from treating diseases to education of health
which is not a new concept for nurses. The country needs to address these barriers to practice by
rallying professional organization, legislators, payers and educators to allow the role of the
APRN to practice to their fullest extent of their education and training.
Mijanou
References
,Aleshire, M. E. & Wheeler, K. (2012). The future of nurse practitioner practice: A world of
opportunity. Nursing Clinics of North America, 47(2), 181-191. doi:10.1016/j.cnur.2012.04.002
AANP (2014) Issues at-a-glance: Full practice authority. Retrieved
from www.aanp.org/images/documents/policy-toolbox/fullpracticeauthority.pdf
Donelan, K., DesRoches, C. M., Dittus, R. S., & Buerhaus, P. (2013). Perspectives of physicians
and nurse practitioners on primary care practice. New England Journal of Medicine, 368(20),
1898-1906. doi: 10.1056/NEJMsa1212938
FMA Fact Sheet (2014) Retrieved
from www.pinellascma.org/system/medias/367/original/ARAPRN_Ind_Practice_ver_2_FINAL.
pdf?1392315360.
Kleinpell, R. M., Hudspeth, R., Scordo, K. A., & Magdic, K. (2012). Defining NP scope of
practice and associated regulations: Focus on acute care. Journal of the American Academy of
Nurse Practitioners, 24(1), 11-18.doi:10.1111/j.1745-7599.2011.00683.x
Ohio Board of Nursing. (2016). Chapter 4723-8 advanced practice registered nurse. Lawriter
Ohio Laws and Rules. Retrieved from http://codes.ohio.gov/oac/
Sroczymski, M. & Dunphy, L.M. (2012) Primary care nurse practitioner clinical education:
Challenges and opportunities. Nursing Clinics North America, 47(4), 463-479. doi:
10.1016/j.cnur.2012.08.001.
Show Less
Instructor Duncanreply to Mijanou Marretta-Lewis
8/14/2016 1:15:10 AM
RE: Discussion Part Three
Mijanou,
The medical association is the largest and strongest opponent to independent practice legislation
in any state. Fortunately, with the correct preparation, we will soon be able to overcome that
barrier.
Dr. Duncan
Show Less
, Mijanou Marretta-Lewisreply to Instructor Duncan
8/14/2016 2:51:36 PM
RE: Discussion Part Three
Dr. Duncan,
I look forward to the day we will have a national consensus for APNs. I am involved with the
AAPN and the ONPA and attend meeting to help with the grass roots movement. I am hopeing
for change within the next two years.
Mijanou
Show Less
Molly McIntyre
8/11/2016 6:03:11 PM
Part 3
According to the American Association of Nurse Practitioners (AANP) (2016) Indiana unfortunately has
Nurse Practitioners (NP) that do not function independently and they function in reduced practice which is
between full practice and restricted practice. The reduced practice indicates that the NPs in Indiana inhibit
practice through at least one element of NP practice (AANP, 2016). The law states that there must be an
agreement in place with an outside health discipline for the NP to practice and limits the this practice
through at least one element (AANP, 2016). As we learned through this week's discussion and reading, it
is discouraging knowing that the state I may practice in upon graduation isn't going to allow me to function
in my whole capacity. Hain and Fleck (2014) stated that by restricting our practice this indirectly affects
patient care and is the most serious barrier to accessible care and in my opinion this needs to become
and stay a top priority for nursing policy and major nursing organizations until there is a standardized
licensure across the nation.
Discussion Part Three (graded)
Once a seamless entry into practice is achieved, it will become more likely that
independent practice will follow.
Discussion Question:
Is independent NP practice allowed in your state? Discuss your opinion regarding
independent NP practice. Provide evidence for your response.
Topic responses
Discussion
Expand All
More
Sort By:
Mijanou Marretta-Lewis
8/10/2016 7:27:53 PM
Discussion Part Three
Dr. Duncan and Classmates,
In Ohio, the nurse practitioner (NP) does not have full authority in practice. We continue to have
pushback from the Ohio Medical Association who feels we do not have the education or skill
level to be deemed worthy of full authority. In Ohio the advanced practice nurse must have a
Standard of Care Arrangement and collaborate with a physician. The physician does not have to
be on site but gets paid to review charts and do the APRNs yearly evaluations (Ohio Board of
Nursing, 2016). Ohio continues to have heavy lobbying against full authoritative practice for the
APRN, as there is ambiguity with what is scope of practice in any given area (Kleinpell,
Hudspeth, Scordo & Magdic, 2012). Due to the misconceptions and limitations of the APRN in
,Ohio there has been an increased migration of APRNs from Ohio to states that allow for
independent practice. The APRN is limited in signing death certificates but can be primary care
provider; this conflict limits the ability of the APRN to practice to their full scope of practice.
The Ohio Medical Association sides with several other state medical associations in opposition
to the proposed Independent Advanced Practice Nurse bill (American Association of Nurse
Practitioners, 2014). They cite the following reasons: differences in education between APRNs
and physicians, concerns with APRNs ability to safely prescribe controlled substances and
narcotics, shortage of physicians as primary care as APRNs stymie the increase number of
physicians in the state, shortage of nurses as the APRN will affect the future of the nursing
workforce, inability to control healthcare costs (fear that the APRN will be reimbursed as equals
to the physician), and lack of physician oversight without supervision (FMA Fact Sheet, 2014).
In a recent study (Donelan, DesRoches, Dittus & Buerhaus,2013) suggests that even through
there is a shortage of primary care providers, primary care physicians are not inclined to support
the expanded role of the APRN. The finding from this study states the majority of physicians
(70% of 505 physician respondents) believe APRNs should practice to the fullest extent of their
education and training but these same physicians did not agree that APRNs should get equal pay
for doing the same work.
The IOM (2011) and Patient Protection and Affordable Care Act have identified the demand for
primary care providers in the redesign of healthcare system. There is a need to create a new
model to prepare the APRN for this advanced practice. Through competency based models the
APRN can demonstrate that they are skilled to meet the challenges of this new healthcare system
(Sroczynski & Dunphy, 2012). For this to work the best outcome would be for professionals to
engage in collaborative non-hierarchical team approaches. APRNs are able and ready to take on
the challenges of the healthcare system and make a substantial impact to improve the outcome of
their patients (Aleshire & Wheeler, 2012). The current legislation that opposes and puts up
obstacles and restrictions impedes the APRN to fully realize their practice with their training and
education in Ohio. The focus of health has shifted from treating diseases to education of health
which is not a new concept for nurses. The country needs to address these barriers to practice by
rallying professional organization, legislators, payers and educators to allow the role of the
APRN to practice to their fullest extent of their education and training.
Mijanou
References
,Aleshire, M. E. & Wheeler, K. (2012). The future of nurse practitioner practice: A world of
opportunity. Nursing Clinics of North America, 47(2), 181-191. doi:10.1016/j.cnur.2012.04.002
AANP (2014) Issues at-a-glance: Full practice authority. Retrieved
from www.aanp.org/images/documents/policy-toolbox/fullpracticeauthority.pdf
Donelan, K., DesRoches, C. M., Dittus, R. S., & Buerhaus, P. (2013). Perspectives of physicians
and nurse practitioners on primary care practice. New England Journal of Medicine, 368(20),
1898-1906. doi: 10.1056/NEJMsa1212938
FMA Fact Sheet (2014) Retrieved
from www.pinellascma.org/system/medias/367/original/ARAPRN_Ind_Practice_ver_2_FINAL.
pdf?1392315360.
Kleinpell, R. M., Hudspeth, R., Scordo, K. A., & Magdic, K. (2012). Defining NP scope of
practice and associated regulations: Focus on acute care. Journal of the American Academy of
Nurse Practitioners, 24(1), 11-18.doi:10.1111/j.1745-7599.2011.00683.x
Ohio Board of Nursing. (2016). Chapter 4723-8 advanced practice registered nurse. Lawriter
Ohio Laws and Rules. Retrieved from http://codes.ohio.gov/oac/
Sroczymski, M. & Dunphy, L.M. (2012) Primary care nurse practitioner clinical education:
Challenges and opportunities. Nursing Clinics North America, 47(4), 463-479. doi:
10.1016/j.cnur.2012.08.001.
Show Less
Instructor Duncanreply to Mijanou Marretta-Lewis
8/14/2016 1:15:10 AM
RE: Discussion Part Three
Mijanou,
The medical association is the largest and strongest opponent to independent practice legislation
in any state. Fortunately, with the correct preparation, we will soon be able to overcome that
barrier.
Dr. Duncan
Show Less
, Mijanou Marretta-Lewisreply to Instructor Duncan
8/14/2016 2:51:36 PM
RE: Discussion Part Three
Dr. Duncan,
I look forward to the day we will have a national consensus for APNs. I am involved with the
AAPN and the ONPA and attend meeting to help with the grass roots movement. I am hopeing
for change within the next two years.
Mijanou
Show Less
Molly McIntyre
8/11/2016 6:03:11 PM
Part 3
According to the American Association of Nurse Practitioners (AANP) (2016) Indiana unfortunately has
Nurse Practitioners (NP) that do not function independently and they function in reduced practice which is
between full practice and restricted practice. The reduced practice indicates that the NPs in Indiana inhibit
practice through at least one element of NP practice (AANP, 2016). The law states that there must be an
agreement in place with an outside health discipline for the NP to practice and limits the this practice
through at least one element (AANP, 2016). As we learned through this week's discussion and reading, it
is discouraging knowing that the state I may practice in upon graduation isn't going to allow me to function
in my whole capacity. Hain and Fleck (2014) stated that by restricting our practice this indirectly affects
patient care and is the most serious barrier to accessible care and in my opinion this needs to become
and stay a top priority for nursing policy and major nursing organizations until there is a standardized
licensure across the nation.
