Healthcare Issue Identified
One of the issues affecting Nurse Practitioners (NPs) across the country is their ability to work fully in accordance with their training and education, also known as full practice authority (FPA) (Dillon and Gary, 2017). The ability of NPs to provide services in accordance with their certification and training levels is not guaranteed in all states across America. In California, which has the most people, NPs are restricted to limited practice authority and must have agreements with supervising physicians in order to provide essential services such as prescribing medications or interpreting diagnostic tests. Such environments limit NPs’ ability to provide healthcare services by creating unnecessary bureaucracy and patient confusion about nurse practitioners’ roles. In practice, such restrictions aggravate the situation for the millions of California residents whose healthcare personnel numbers have been found to be significantly lower than the federal recommendations. According to reports, the number of primary doctors in California ranges from 35 to 49 for every 100,000 Medicare patients (Yee et al., 2013).
Health Care Policy Must Change
According to the IOM’s Future of Nursing report, the changing healthcare landscape, as well as the changing profile of the American population, necessitate fundamental changes in the healthcare delivery system. It emphasizes the issue of primary care shortages, particularly after the ACA’s expanded coverage, and advocates for NPs to be allowed to provide care to the full extent of their training and education (Salsberg, 2015). This would allow the healthcare system to acquire the workforce required to meet the citizens’ primary care needs, while also allowing NPs to contribute their skills in delivering community-based, patient-centered care. Despite extensive training that allows NPs to provide a variety of services, various barriers such as federal policies and state laws prevent them from doing so. The necessary change is for NPs to be granted full practice authority, allowing them to diagnose, examine, and prescribe medication without the need for physician oversight or supervision. Change is especially needed in the California Nursing Practice Act, which states that NPs require doctor approval when managing care, prescribing pharmaceuticals, certifying disability, or ordering basic medical tests. Extensive research has demonstrated that nurse practitioners are capable of providing high-quality care with outcomes that are better or comparable to physician-provided care (Altman et al., 2016). Relaxing restrictions on NP practice scope will not only strengthen primary care capacity, but will also increase patient access and free up physicians to handle more complex cases.
Legacy and Future as an NP
My long-term goal as a nurse practitioner is to one day run my own independent practice and be recognized as a primary care provider by combining nursing care with medicine. I want to understand and develop my contributions in a healthcare team while performing my role autonomously and recognizing the roles of other team members through collaboration. My legacy will be to advocate for change in bureaucratic and unnecessary policies in my practice as a nurse practitioner, such as restrictive scope of practice policies, which act as a barrier preventing NPs from practicing to the full extent of our training and education. Such a change will benefit the community by allowing NPs to provide safe, affordable, and high-quality healthcare, thereby promoting social change.
S. H. Altman, A. S. Butler, and L. Shern (Eds.). (2016). Monitoring progress on the Institute of Medicine’s The Future of Nursing report. National Academy of Sciences.
Dillon, D., and F. Gary (2017). Nurse practitioners have full practice authority. 86-93 in Nursing Administration Quarterly, 41(1).
E. S. Salsberg (2015). Is there a physician shortage? Implications for the Institute of Medicine committee’s recommendations on the governance and financing of graduate medical education. 1210-1214 in Academic Medicine, 90(9).
T. Yee, E. Boukus, D. Cross, and D. Samuel (2013). Nurse practitioner scope-of-practice laws and payment policies contribute to primary care workforce shortages. Research Brief 13, 1-7, National Institute for Health Care Reform.