DNP prepared leaders must address removing the barrier of full practice authority for APRNs. This is one area that, while improving, can add to improving quality outcomes for patients. For example, rural areas in the United States have experienced a shortage of primary providers (Ortiz, Hofler, Bushy, Lin, Khanijanhi, and Bitney, 2017). Scope of practice regulations varies from state to state and range from full autonomy to direct oversight by the physician ( Otiz, 2017). The authors studied quality of patient outcomes in states with “reduced practice” levels compared to those with restricted practice, and although there was no statistical difference in quality of care outcomes, access to providers, utilization, provider supply and overall quality of care is improved with an expanded scope of practice (Ortiz, et al., 2017). Iowa is a state which provides full practice authority to its APRNS but continues to have significant barriers such as 85% reimbursement for services compared to the physician (Lofgren, et al., 2017). The Iowa APRNs created a task force to address obtaining full practice authority and continue to work towards removing all remaining barriers such as full reimbursement for services (Lofgren, et al., 2017). The Iowa APRNs advise it essential to stay connected and partner with RN colleagues and critical for nurse leaders and executives to be aware and involved in APRN performance evaluations and provide input in the scope of authority privileging (Lofgren, 2017). DNP prepared leaders efforts to improve quality outcomes for patients must include advocating for full practice scope for APRNs as health care partner providers ensuring patients, particularly those with complex health needs, have access to qualified providers (Lofgren,2017). DNPs are uniquely prepared for leadership in organizational systems, develop and evaluate health policy, and integrate evidence-based practice.
Lofgren MA, Berends SK, Reyes J, Wycoff C, Kinnetz M, Frohling A, Baker L, Whitty S, Dirks M, OʼBrien M. (2017). Scope of practice barriers for Advanced Practice Registered Nurses: A state task force to minimize barriers. Journal of Nursing Administration, 47(9):465-469. Doi: 10.1097/NNA.0000000000000515.
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of Nurse Practitioner Practice Regulations on Rural Population Health Outcomes. Healthcare (Basel, Switzerland), 6(2), 65. doi:10.3390/healthcare6020065
Respond to Angela
The DNP is in a unique role in that the DNP has a different perspective of healthcare and identifying barriers that may prevent a change in practice. In order to create a change in practice, there needs to be improvement in quality outcomes. However, there remains certain barriers in place that may prevent the DNP from reaching the full anticipated outcome. One of the barriers is state licensure regulations because it prevents the DNP from using their education and training to the fullest extent (Hain, & Fleck, 2014). There is a full practice authority law in place that would allow DNPs to practice to their fullest across then nation; however, only a third of the states have recognized this law; meaning that the rest of DNPs in the remaining 2/3 of the states are not protected by this law so they are unable to practice to their fullest. This then hinders improving quality outcomes because they are not legally protected to enact changes that may have been implemented elsewhere (Hain & Fleck, 2014).
One of the biggest issues facing the field of nursing is inconsistency. In speaking about other medical providers such as MDs and DOs, the schooling is standard across the nation with standard requirements that must be met in order to practice medicine. However, nursing began with certificates, then progressed to LPNs, RNs which is then further differentiated into BSN prepared and not BSN prepared, MSNs with many different sub-specialty areas, and then DNPs also with different areas of specialty. Then on top of that each degree is contained into each state’s regulation and what they can or cannot do. If there was more consistency across each state and more standardization then the DNP could accomplish more change and improve quality outcomes.
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