Practice Barriers:
APNs in New Jersey encounter diverse practice barriers as nurse practitioners, nurse midwives, and nurse anesthetists. The nurse-midwifery practice, however, has specific challenges; for example, nurse-midwifery must collaborate with physicians or be under their supervision in some areas of practice, which may hinder their independence in decision-making (Cadmus et al., 2020). On the other hand, some regulations put stringent boundaries regarding prescriptive authority, and they also face difficulties in obtaining reimbursements for their services, which poses significant obstacles to the practice of nurse midwives in the state. These barriers are similar to those at the state level, where different optimum provisions for nurse midwives’ practice dissimilarities result in the divergence of autonomy and the chances of nurse-midwives practice nationwide.
Likewise, the crutch of nurse anesthetists in New Jersey lies with the scope of practice, which obstructs all happening in clinics and other settings that are not health centers (Hansen-Turton & Rothman, 2022). State rules often incline towards prescribing physician supervision, which in turn hampers the nurse practitioner’s prerogative to fly solo. Moreover, the refunding mechanism might confine their practice areas, contributing to an underserved area. The barrier is not unique to the New Jersey area but is national. Some physician groups often endeavor for the freedom of the nurse anesthetist because they also influence the legislative process they practice.
The barriers in nurse practice include restrictive scopes of practice laws and limited prescribing power in the adult New Jersey gerontology primary care field. Pertinent state laws may require nurse practitioners to work under or with physicians, limiting the nurse practitioners’ role to providing complete care independently. However, besides financial coverage for services will be another burden, reimbursement issues would also limit their ability to practice (Cadmus et al., 2020). These barriers are seen in different states, with the country having differences in the degree of supervision allowed for nurse practitioners varying from one state to another, making the healthcare system heterogeneous and ultimately contributing to disparities in nurse practitioners’ autonomy and practice.
Another hurdle for clinic leaders in New Jersey is the need to recognize their role in the healthcare setting and the difficulties in acquiring funding for their services. State regulations might not consider their knowledge on par with the one needed for BSN holders (Hansen-Turton & Rothman, 2022). This factor may require a doctoral degree or advanced certification to be licensed independently. The lack of regulation on the national level creates more complicated conditions whereby high variations in applying and acknowledging clinical nurse specialists’ roles are observed. Indeed, these complications prevent professionals from using their skills effectively to improve patient’s condition.
Competition
On the state and national levels, the competition of various types returns as an obstacle to APNs’ ability to work independently ((Thurby-Hay et al., 2020). State-level competition may exist where physician groups push through impermissible regulatory frameworks that limit APNs’ scope of practice and authority to give healthcare services. It becomes heated, especially because practices are fighting for their market share and potentially losing their customer base, which technology controls (Cadmus et al., 2020). At the national level, competition comes from the many medical societies actively lobbying the administration to maintain their members’ roles as the primary leaders of care. This could mean cementing a physician-dominated model of care in the healthcare system. Another economic aspect to consider is the competition within the marketplace from healthcare corporations and insurance providers, which may alter the policy dynamics that have an impact on the independent practice of APNs as these stakeholders may prioritize cost containment and market dominance over increasing the scope of practice and responsibilities for nurses with advanced degrees.
Key Lawmakers:
At the state level in New Jersey, the key people who exert influence in lawmaking in health care policy of allied health professionals (APNs) are those in the Legislative branch like Senator Joseph Vitale and Assemblyman Herb Conaway, who have stepped up the health care policy 2022 legislation (Hansen-Turton & Rothman, 2022). The Governor also holds the Executive authority logarithm used to supervise the implementation and enforcement of healthcare policies that affect APNs in the state. These personalities work with other Senate members and executive staff to draft, back up, or contend legislation that shapes the APNs of each state head.
Interest Groups
on state and national levels, countless interest groups have great power in writing APN policy. In New Jersey, state-level interest groups, including the New Jersey Nurses Association and the New Jersey Coalitions of Advance Practice Nurses, advocate for policies that will broaden the scope of practice of APNs, improve reimbursement rates, and give professional autonomy to APNs. These agencies carry out the advocacy through meaningfully engaging and working with state legislators, policymakers, and regulatory organizations to advance the champions of APNs and remove the hindrances to their work (Holtzhausen et al., 2021). The national-level influential interest groups that essentially lead in advocating for nurses include the American Nurses Association, the American Association of Nurse Practitioners, and the American Association of Nurse Anesthetists. Such bodies provide lobbying services, public advocacy campaigns, and grassroots initiatives tasked to create federal policies to impact the APN practice through Medicare reimbursement policies, federal grants, and workforce development programs (Thurby-Hay et al., 2020). Moreover, organizations such as the American College of Nurse-Midwives are dealing with the details of the specialties, and the National Association of Clinical Nurse Specialists is raising the concerns and issues of the clinical nurse specialists at the state and national levels to complete the list.
Methods to Influence Change
Several forms were used to change APN policy, specifically the competition by professional lobbyists, state legislative and executive branches of government, and interest groups. The APN advocacy bodies partake in strategic communication and education activity to riposte the vested interests and cast a wider net on the utilities of APNs (Holtzhausen et al., 2021). The state legislative and executive bodies are used directly with lobbying, grassroots mobilization, and coalition building to influence political support and ensure APN-friendly policies get time on the agenda. Political action committees are the primary actors as they conduct advocacy activities, build alliances, and use their resources and amenities to influence the AFC policies at the state and national levels.
Conclusion
Finally, providential solutions for AGNP in New Jersey will be derived from a deep understanding of state and national policies and influential advocacy work that will address specific elected officials and stakeholders with peculiar interests (Holtzhausen et al., 2021). By facilitating grassroots movement, engaging in direct lobbying, and executing studies based on medical evidence, AGNPs can advance legislative reforms that generally focus on getting more jurisdiction, expanding practice span throughout the state, and selecting individuals who have access to high-quality care.
References
Cadmus, E., de Cordova, P. B., Weaver, S., & Ravichandran, A. (2020). Access to Care in New Jersey: Making the Case for Modernizing Legislation. Journal of Nursing Regulation, 11(1), 36-41.
Hansen-Turton, T., & Rothman, N. L. (2022). Health policy for advanced practice nurses: the nurse-led care evolution and policy implications for improving services for populations experiencing disproportionate health disparities. In Shaping Nursing Healthcare Policy (pp. 181-195). Academic Press.
Holtzhausen, J. D. V., Downing, C., Poggenpoel, M., & Ndawo, G. (2021). Concept analysis: The scope of practice of a nurse anesthetist in South Africa. Journal of PeriAnesthesia Nursing, 36(6), 672-677.
Thurby-Hay, L., Whitehead, P., & Nelson, K. (2020). A statewide survey of clinical nurse specialist practice: opportunities and challenges. Clinical Nurse Specialist, 34(6), 290-294.
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