A myriad of obstacles, whether the regulatory, state, or institutional rules, limit APRNs’ ability to authenticate the level of education and training they have obtained, which impedes healthcare costs, availability of care, and the quality of careoffered. These facts are, however, the barriers of the limited prescription of autocratic health care professionals, the stringent collaboration of physicians, and the restrictions on where their services and payment policies are regarded.
Healthcare Costs
The restrictive regulations can give APRNs the additional burden of administration, and the lead costs increase (Scorn et al., 2022). Therefore, requirements for direct care agreements with physicians increase the expenses by additional fees, e.g. collaboration costs. As a result, it is likely that, ultimately, patients will bear the cumulative impact of the high medical bills. Also, prescriptive limitations could mean a decrease in delivery efficiency and an increase in unnecessary health service use, which finally leads to extra healthcare expenses, a relevant factor.
Access to Care
Regulations will gradually lead to a provider gap, particularly in regions with a shortage of providers. The enforced restriction on APRNs to work independently in certain circumstances where they are isolated or secluded stands a high chance of limiting patients’ access to timely and holistic health care services. The results of studies show that states with more rigid APRN rules have decreased the availability of primary care services, particularly in rural regions (Salako, 2019). What may eventually appear as a consequence is prolonged appointment delays and physical obstacles to care every single time, resulting in suboptimal results.
Quality of Care
Administrative restrictions are a problem for APRNs in providing patients with excellent, comprehensive care based on scientific data. Incorporating by-laws in which self-reliance or supervision is imposed may restrict APRNs’ autonomy and prevent their ability to practice clinical judgment. Simultaneously, the restrictions on referral capacity to providers may make the medication or other treatments later available to needy patients. The evidence indicates that APRNs who work autonomously or with a lesser extent of constraints can provide care which is equal in quality to that of physicians (Carrenza et al., 2021). This will be done by removing regulatory barriers and allowing nurse practitioners to practice to the fullest extent of their educational capacity and the CNN of their work to enhance the quality of healthcare and, ultimately, patient outcomes.
State Implementation of the APRN Consensus Model
In Virginia, registered nurses who have received further education and preceding training are called Advanced Practice Registered Nurses (APRNs). In Virginia, there are Nurse Practitioner (NP), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse Midwife (CNM), and Clinical Nurse Specialist (CNS) roles, which are the roles that the recognized APRN authorizes. “Licensure” is used because of APRN roles in Virginia.
An advanced practice nurse in Virginia is required to have postgraduate or graduate education degrees. In the US, VirginiaVirginia’s certification is also compulsory for tortie APR in the
ing fieRN roles in Virginia, enabling some level of independent practice. However, the degree of independence may differ depending on whether the role is a CRNA or a CNM.
APRN roles in Virginia do enable some level of independent practice, but the degree of independence may be different depending on whether the role is a CRNA or a CNM.
APRN roles in Virginia support independent and autonomous practice, yet the levels of independence differ depending on the role.
APRN jobs in Virginia include independent practice but varying extents depending on the job.
The scope of APRN practice in Virginia allows for independent practice, but the availability may depend on the role type.
In Virginia, APRN roles do allow for the provision of independent care, but the extent of this may depend on the role.
For example, other NPs may also begin independent practice after meeting the required criteria, such as work experience requirements and other qualifying conditions noted in the code of Virginia (§ 54.1-2957). Collaterally, CRNAs can also obtain an independent medical practice with the supervision of an MD, DO, DPM or DDS (Virginia Code § 54.1-2957). At the same time, The Virginia NP states that it is permissible to practice with physicians in consultation if the NP has prescriptive authority (Virginia Code § 54.1-2957(J)).
Provision of independent prescribing services is among the scope areas where APRN roles are authorized in Virginia to some extent. Virginia NPs can issue prescriptions for Schedule II to Schedule VI controlled medications and apparatuses. For example, Virginia Code § 54.1-2957.01 provides them the authority to do the same. Also, the CRNAs in Virginia obtained the authority to prescribe drugs required by their patients undergoing anaesthesia before a procedure (VA Code § 54.1-2957.01(H)).
Current State APRN Legislation:
APRNs in Virginia face much legislation, and the relationship between that is proposals, passes or fail in recent years (Moore, 2020). Senate Bill 1216 is one of the practical legislation examples of the present time, as it specifies the violation of the practice agreement for some medications. The Bill specifies the right of Advanced Practice Registered Nurses to prescribe and dispense controlled substances independently of patient care team physicians. Nevertheless, the Bill should still be enshrined into an operational law.
For instance, the effective legislature in Virginia is House Bill 793, which is “Nurse Practitioners; scope of practice”. This Bill was promoted and adopted. The Bill aimed to increase the scope of the nurse practitioners’ field, making them able to practice independently without needing to agree on an agreement. Various prerequisites, such as clinical experience, were stipulated to be met by the nurse practitioners. This law acts as a rung on the ladder that aims to provide better access to healthcare and healthcare improvement for patients in Virginia.
In contrast, the previous Bill in Virginia where the legislation failed is House Bill 548 (HB 548), titled ‘Healthcare Practitioners: Prescribing of Opioids’. HB 548 is a bill aiming to restrict healthcare practitioners, including APRNs, from prescribing opioids as the opioid epidemic is getting worse. Besides, the Bill did not meet opposition through the process of scrutinizing.
APRNs as Policy Advocates
Health policy is essential for the health care system, and nurses have also assisted in this sector through the activities of the American Nurses Association. For example, the organization supported the Affordable Care Act. Through their efforts, nurses were instrumental in the passage of the ACA, which would include access to healthcare coverage for more than 30 million Americans. It also positively changed the US healthcare system, including minimizing the rate of uninsured Americans, ensuring that unborn children are covered under health insurance plans and reforming Medicare and Medicaid.
Nurses nationwide approached grassroots movements, visited government advocacy groups, and conducted awareness campaigns for the Act of Congress (Act) (Rees, 2022). They focused on the need to supply healthcare at a low price and to make this service easily attainable to every resident regardless of how much they earn and their diagnosis. Because of these advocacy efforts, the ACA lawACA law was approved by the president in 2010, bringing about a historically evitable achievement in healthcare reform in the United States of America.
Personal Reflection on Resilience and Motivation
I realize that there is an ever-present feeling of challenge in my life – whether studying for exams, dealing with patients, or managing my personal affairs – and overcoming them takes a delicate balancing act. The extreme academic stress and clinical practice in the context of the pandemic have sometimes brought about a state of daunting mental exhaustion and depression.
Through resiliency, I have realized the significance of maintaining ties with fellow students, mentors, and psychiatric nurses. Alongside this, the proposition of tuning into oneself has helped stretch the resilience needed throughout the challenges. Moreover, I have taught myself to be practical, prioritize my job, and use time-management skills properly, which have positively affected me in dealing with stress.
Despite various setbacks, I am driven to journey for myself and become someone I would be proud of. Unfortunately, I am passionate about addressing the inequity in healthcare delivery by advocating for the right to contribute to improving nursing practice. Achieving desired patient outcomes and attempting to resolve the system shortcomings set deep in the healthcare system motivates me to further my nursing career.
References
Carranza, A. N., Munoz, P. J., & Nash, A. J. (2021). Comparing the quality of care in medical specialities between nurse practitioners and physicians. Journal of the American Association of Nurse Practitioners, 33(3), 184-193.https://journals.lww.com/jaanp/fulltext/2021/03000/comparing_quality_of_care_in_medical_specialties.2.aspx
Moore, C., Kabbe, A., Gibson, T. S., & Letvak, S. (2020). The pursuit of nurse practitioner practice legislation: a case study. Policy, Politics, & Nursing Practice, 21(4), 222–232.https://journals.sagepub.com/doi/full/10.1177/1527154420957259
Rees, K., Early, J., & Hampton, C. (Eds.). (2022). Be the Change: Putting Health Advocacy, Policy, and Community Organization Into Practice in Public Health Education. Oxford University Press.https://books.google.com/books?hl=en&lr=&id=9KSIEAAAQBAJ&oi=fnd&pg=PP1&dq=Nurses+across+the+country+engaged+in+grassroots+organizing,+lobbying+efforts,+and+public+education+campaigns+to+support+the+ACA&ots=uLQTsD2tj1&sig=SjUq1R2PKN1wlalKsuanW0o2kiI
Salako, A. (2019). The impact of state nurse practitioner scope-of-practice regulations on access to primary care in health professional shortage areas (Doctoral dissertation, The University of Iowa).https://www.researchgate.net/profile/Abiodun-Salako/publication/342480312_The_impact_of_state_nurse_practitioner_scope-of-practice_regulations_on_access_to_primary_care_in_health_professional_shortage_areas/links/5ef657b34585155050751eb1/The-impact-of-state-nurse-practitioner-scope-of-practice-regulations-on-access-to-primary-care-in-health-professional-shortage-areas.pdf
Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a national survey: Ongoing barriers to APRN practice in the United States. Policy, Politics, & Nursing Practice, 23(2), 118–129.https://journals.sagepub.com/doi/abs/10.1177/15271544221076524
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