discussion response to following post
The United States is seeing changes in healthcare practices that are rapidly moving to affect cost of healthcare, growing number of older adults, and increasing prevalence of chronic conditions and diseases. Health care varies considerably in its safety, effectiveness, quality and cost based on such competing needs. As hospitals focus more and more on reducing costs and shifting care from hospital care to home care, RNs and APRNs often feel the impact of changes in practice more immediately than other healthcare professionals since they are on the front lines of patient care.
How competing needs may impact the development of policy
The RNs and APRNs are professionals who have the responsibility and capacity to influence the existing and prospective healthcare delivery programs. The major role of the RNs and APRNs is to promote quality health and patient safety and through their workplace, they stand a chance of influencing policy review by ensuring that policies promoted are effective in their places of work. They are participating by getting involved with professional organizations and contacting legislators who support programs to provide nursing opinion and perspective to improve program outcomes.
For example, the bills S.1357 and H.R. 2581 – Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019 by Jan Shakowsky and Senator Sherrod Brown aimed at setting a minimum nurse-to-patient staffing ratio requirements in every hospital throughout the country. The bill recognizes that adequate nurse-to-patient ratio is critical in improving the quality outcomes of patient care, reducing preventable adverse events, and helping hospitals to attract and retain quality direct care nurses (Schakowsky, 2019). By becoming involved at this level, nurses influence program planning committee discussions about needs for modification of the programs to make them more successful.
Competing needs that may impact the national healthcare issue/stressor you selected
The national healthcare issue/stressor I chose is how APRNs are still underutilized and underrecognized in healthcare organizations even within states that grant full practice authority (FPA). The growing and aging population is contributing to increased rates of chronic illness and health insurance expansion that can possibly lead to demand for health care to exceed the capacity of existing healthcare workforce (Kandrack, Barnes, & Martsolf, 2019). Policymakers, clinicians, and researchers have agreed that increasing the utilization of Nurse Practitioners (NPs) is one strategy to overcome this demand. Currently, there are 248,000 licensed NPs in the United States and 90% are certified to work in primary care populations (AANP, 2017a). The fulfillment of the â€œQuadruple Aimâ€ has yet to reach its full potential even in states that have FPA due to variations in how NPs are utilized in health care organizations. Federal and state level legislative efforts continue to push forward with increasing practice authority for NPs. It is equally important to understand how NPs are being used within the healthcare systems. Despite the state policy change, it appears that administrators are not prepared to support the expanded NP role as they may still lack clarity and knowledge on the value of expanding NP scope of practice (SOP).
As an example, the Veterans Health Administration is Americaâ€™s largest integrated healthcare system serving 9 million enrolled Veterans each year through 1,225 health care facilities (Rugs, Toyinbo, Barrett, Melillo, Chavez, Cowan, Jensen, Engstrom, Battaglia, Thorne-Odem, Sullivan, Powell-Cope, 2020). The Department of Veterans Health Affairs authorized FPA for APRNs in 2017 with recommendation from the National Academy of Medicine due to increased need for healthcare providers (Rugs, et al., 2020). With such competing needs, the authorization of FPA for APRNs was identified and implemented. APRNs with FPA have increased the number of appointments to educate and manage Veterans while maintaining quality of care. This VHA FPA legislation for VHA nurse practitioners allows them to treat and manage patients without the clinical supervision or mandatory collaborations of physicians.
Greater efforts are needed to improve the relationship between NPs and administrators by increasing awareness about NP competencies and SOP within healthcare organizations. A healthcare organizationâ€™s structure along with local bureaucracy and work environments of institutions that are restricting NP scope of practice despite full practice authority regulations at the state level should be a prime focus. Organizations need to empower NPs by providing access to information, support, and resources to enhance collegiality, and good relationships between clinicians and leadership resulting in better quality of care with enhanced patient outcomes (Poghosyan, L., Shang, Poghosyan, H., Liu, & Berkowitz, 2015). Administrators and leaders need to understand the role of NP as a PCP to create a productive NP practice environment. A proactive approach needs to be made to identify practice environment issues. Managers must focus on improving relationships between NPs and administrators by creating mechanism of information dissemination, involving NPs in decision making process, providing avenues for NPs to become involved in the organizational governance by becoming members of committees. With efforts to implement law in organizations through engaging leadership, increasing awareness about the positive impact of the law, and promoting collegiality between NPs and physicians, can greatly assist organizations to address issues in a timely manner (Poghosyan, Norful, & Laugesen, 2018).
American Association of Nurse Practitioners. (2017a). NP certification. AANP.org. https://aanp.org/student-resources/np-certification
Kandrack, R., Barnes, H., & Martsolf, G. R. (2019). Nurse practitioner scope of practice
regulations and nurse practitioner supply. Medical Care Research and Review, 78(3),
208â€“217. Retrieved from https://doi.org/10.1177/1077558719888424
Phillips, S. J. (2020). 32nd annual aprn legislative update. The Nurse Practitioner, 45(1), 28â€“55.
Poghosyan, L., Norful, A. A., & Laugesen, M. J. (2018). Removing restrictions on nurse practitioners’
scope of practice in new york state: Physicians’ and nurse practitioners’ perspectives. Journal of the American Association of Nurse Practitioners, 30(6), 354â€“360. https://doi.org/10.1097/jxx.0000000000000040
Poghosyan, L., Shang, J., Liu, J., Poghosyan, H., Liu, N., & Berkowitz, B. (2015). Nurse practitioners as primary care providers: Creating favorable practice environments in New York State and Massachusetts. Health Care Management Review, 40(1), 46â€“55. https://doi.org/10.1097/HMR.0000000000000010
Rugs, D., Toyinbo, P., Barrett, B., Melillo, C., Chavez, M., Cowan, L., Jensen, P., Engstrom, C., Battaglia, C., Thorne-Odem, S., Sullivan, S., & Powell-Cope, G. (2021). A preliminary evaluation of full practice authority of advance practice registered nurses in the veterans health administration. Nursing Outlook, 69(2), 147â€“158. https://doi.org/10.1016/j.outlook.2020.11.005
Shakowsky, J. (2019, May 8). Schakowsky, Senator Brown reintroduce bill to improve patient care, empower nurses. United States Congresswoman Jan Shakowsky. Retrieved from https://schakowsky.house.gov/media/press-releases/schakowsky-senator-brown-reintroduce-bill-improve-patient-care-empower-nurses
Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.
For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?
In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.