Future of Nursing: Leading Change, Improving Health Care Delivery - Research Paper

Introduction

Institute of Medicine (2011) shows that The Future of Nursing: Leading Change, Advancing Health affirms that the varying sets of health care and fluctuating profile of the US population need significant shifts in the health care delivery system. Precisely, it notes some of the concerns regarding the scarcity of the primary care health care practitioners in many states along the United States, especially when considering the expansion of the health care insurance coverage under the Patient Protection and Affordable Care Act (ACA). The research confirms that if the advanced practice registered nurses (APRNs) are allowed to exercise their profession without restriction of their training and education, they could be of help in firming the workforce needed to fulfill the country's demand of primary care and contribute their skills to the delivery of community-based and patient-centered health care (National Academies of Sciences, Engineering, and Medicine, 2016). While the Institute of Medicine (IOM) report gives a superior mention of the roles for APRN in primary care, the report further gives recommendations which are not limited to those sets but involves the full range of health services in many community settings and health care organization. The Future of Nursing (2016) finds that even though APRNs are highly trained and capable of giving different services, they are disallowed from exercising their duties due to the state laws, out-dated insurance reimbursement models, federal policies, together with the institutional practices and culture.

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American Nurses Association (ANA) represent the welfares of all ARP, which comprises of the Clinical Nurse Specialists (CNS), and Certified Nurse Midwives (CNMs), Certified Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse Midwives (CNMs). The different medical professional bodies such as the Institute of Medicine (IOM), the National Governors Association (NGA), the Federal Trade Commission (FTC), the Bipartisan Policy Centre, and the Veteran's Health Administration (VHA) teams (ANA, 2019), among others, have set a national call to advocate for a cost-effective and safe provision of care by APRNs. Elimination of regulation barriers aligns with the work that the ANA and its Constituent-State Nurses Association have been involved for several years. The term "Full practice authority" basically refers to the APRN's ability to use skills, knowledge, and judgment exercise to full capacity of their training and technology teams (ANA, 2019).

As the future APRN, the restriction to exercise to practice my skills and education will devastate the health sector in the US especially in my state South California. Nieminen, Mannevaara, and Fagerstrom, (2011) show that several non-physician health care providers are skilled and willing at assisting in fulfilling this need, though they are not allowed to practice due to the restriction as per their scope of practice. Lack of adequate primary care providers influences 1 in 5 Americans. As per the shortage of primary care physicians, permitting non-physician professions, like the APRNs, to practice to the full potential of their training and education offer the patients more options and more types of services. ANA has established Associate of the Coalition for Patients' Rights, which was established to tackle the AMA's Scope of Practice campaign devoted to restricting the scope of practice for licensed professionals as well as the advanced practice nurses, this will benefit future APRN like me in the future.

On May 25th, 2015, the Department of Veterans Affairs (VA) published a proposed rule to regulate the advanced practice registered nurses (APRNs) in the VA system (ANA, 2019). The analysis on the database ANA (2019), the proposed rule is aimed at allowing APRNs to exclusively practice training and certification regardless of individual's State practice regulations based on the requirements like the clinical supervision or compulsory collaboration with physicians. Also, Veterans Affairs (VA) proposed to fulfill this standardization through federal pre-emption of State nursing licensure laws to the degree that the State laws wrangles with the full practice authority as stated by VA (Nieminen, Mannevaara, & Fagerstrom, 2011).

Safeguarding the scope of practice for nurses is the main goal at ANA. And for this reason, ANA is currently cooperating with other Constituent Member (State) Associate to ensure that the geographical boundary is eliminated and practice setting limitation for APRNs. Some of the projects that ANA supports and collaborates on to maintain APRNs working without restrictions of their training include the following:

• Team-Based Care: the tool is meant in regards to the organized medicine campaign of "Physician-led team-based care," which has been aimed at stop Full Practice Authority (FPA) legislation teams (ANA, 2019).
• Legal Engagements: ANA considers the legal elements to safeguard nurses' capacity to offer a complete range of services as stipulated by the law.
• Agreement model for APRN regulation: The agreement model is quoted in the Future of Nursing Report on Appendix D and referenced respectively all through the report. ANA is active in plans to apply the Consensus Model that defined APRN teams (ANA, 2019).
• To have an "independent practitioner," without regulation for supervision, direction or collaboration teams (ANA, 2019).
• Advocate for Coalition for Patient's Rights (CPR) that will construct effective patient-centered interdisciplinary teams (ANA, 2019).

Conclusion

To wind up, there is a need to have a common ground around the scope of practice and other issues in practice and policy that will promote the delivery of health care service in South California. The campaign for the action needs to extend its coalition to incorporate more diverse stakeholders. The campaign needs to base on its work and success with APRN, community, and policymakers to come up with a common ground with the elimination of the scope of practice restrictions, and promote, inter-professional collaboration together with tackling other challenges to advance health care practice. I believe with the significant changes that are being made, will promote my ability to practice my healthcare professionalism as APRN without any barriers, and benefit people South California towards a healthy living.

References

ANA. (2019). APRN. Retrieved from https://www.nursingworld.org/practice-policy/aprn/

Institute of Medicine (US). Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

National Academies of Sciences, Engineering, and Medicine. (2016). Assessing progress on the Institute of Medicine report The Future of Nursing. National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK350160/#

Nieminen, A., Mannevaara, B., & Fagerstrom, L. (2011). Advanced practice nurses' scope of practice: a qualitative study of advanced clinical competencies. Scandinavian Journal Of Caring Sciences, 25(4), 661-670. doi: 10.1111/j.1471-6712.2011.00876.x

The Future of Nursing. (2016). Nursing Critical Care, 11(3), 4. doi: 10.1097/01.ccn.0000482518.50906.58