Major Regulatory Restrictions on NP Practice Essay

Assignment Details
Differentiate the Major Regulatory Restrictions on NP Practice

Purpose

ORDER  HERE A PLAGIARISM-FREE PAPER HERE

NPs have scopes of practice that are regulated by state laws, boards of nursing, boards of medicine and reimbursement that may differ depending on your location. There are several sources of restrictions to NP practice such as state laws and federal regulations which include who may prescribe controlled substances and which substances NPs can prescribe, as well as the various reimbursement agencies. It is essential that the NP be fully informed of what they are allowed to do by law (state and federal) or by other regulatory organizations. These regulations vary widely from state to state. Consequences of practicing outside your scope of practice may be anything from a fine, suspension or revocation of your license, civil lawsuit, or even criminal charges.Major Regulatory Restrictions on NP Practice Essay

Directions

Use the provided template to compare and contrast the three major regulatory practice models for NPs: Supervisory, Collaborative, and Independent. Please keep this assignment in the template format provided. This Assignment requires credible and up to date resources for each category. Include in each model at least one state that represents the scope of practice you are discussing. For example, Texas requires a supervisory relationship with a physician along with a practice agreement, formulary, and protocols. In order to apply and receive a DEA license to prescribe controlled substances, you must be approved by the state you are practicing in to prescribe these medications.

Assignment Template
To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section under Course Resources.

Assignment Requirements

Before finalizing your work, you should:

be sure to read the Assignment description carefully (as displayed above)
consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary
utilize spelling and grammar check to minimize errors
Your writing Assignment should:Major Regulatory Restrictions on NP Practice Essay

follow the conventions of Standard English (correct grammar, punctuation, etc.)
be well ordered, logical, and unified, as well as original and insightful
display superior content, organization, style, and mechanics
use APA 7th Edition format for organization, style, and crediting sources. Refer to the APA Progression Ladder.

Depending on location, NPs have scopes of practice that are regulated by state laws, boards of nursing, boards of medicine and reimbursement. There are several sources of restrictions to NP practice such as state laws. Federal regulations include who may prescribe controlled substances and which substances NPs can prescribe as well as the various reimbursement agencies. It is essential that the NP be fully informed of what they are allowed to do by law (state and federal) or by other regulatory organizations. These regulations vary widely from state to state. Consequences of practicing outside your scope of practice may be anything from a fine, suspension or revocation of your license, civil lawsuit, or even criminal charges.Major Regulatory Restrictions on NP Practice Essay

Don’t use plagiarized sources. Get Your Custom Essay on
Differentiate the major regulatory restrictions on np practice.
Just from $13/Page
Directions

Use the provided template to compare and contrast the three major regulatory practice models for NPs: Supervisory, Collaborative, and Independent. This Assignment requires credible and up to date resources for each category. Include in each model at least one state that represents the scope of practice you are discussing. For example, Florida requires a supervisory relationship with a physician along with a practice agreement, formulary, and protocols. Because Florida does not allow any controlled substances to be prescribed by NPs, the DEA will not issue a license to prescribe these medications. In order to apply and receive a DEA license to prescribe controlled substances, you must be approved by the state you are practicing in to prescribe these medications.Major Regulatory Restrictions on NP Practice Essay

Assignment Template

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Home.

Assignment Requirements

Before finalizing your work, you should:

be sure to read the Assignment description carefully (as displayed above)
consult the Grading Rubric (under the Course Home) to make sure you have included everything necessary
utilize spelling and grammar check to minimize errors
Your writing Assignment should:

follow the conventions of Standard American English (correct grammar, punctuation, etc.)
be well ordered, logical, and unified, as well as original and insightful
display superior content, organization, style, and mechanics
use APA 6th Edition format for organization, style, and crediting sources. Refer to the APA Progression Ladder.Major Regulatory Restrictions on NP Practice Essay

Provisions of the Patient Protection and Affordable
Care Act (ACA), particularly those dealing with
Medicaid expansion and payment reform, are expected
to increase the demand for primary care within a
health care system already facing severe physician
workforce shortages. These shortages impede the capacity to deliver sufficient care to an aging and more
diverse population, with growing chronic disease
burden, particularly among poor and minority populations (Bodenheimer, Chen, & Bennett, 2009).
Although one recent state-level analysis suggested that
the current physician workforce supply in both primary care and most specialties is sufficient to meet
* Corresponding author: Ying Xue, University of Rochester, School of Nursing, 601 Elmwood Ave., Box SON, Rochester, NY 14642.
E-mail address: [email protected] (Y. Xue).
0029-6554/$ – see front matter 2016 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.outlook.2015.08.005
Available online at www.sciencedirect.com
Nurs Outlook 64 (2016) 71 e 8 5
www.nursingoutlook.org
future demand (Glied & Ma, 2015), the analysis
assumed an increase in physician workload and did
not examine potential variation in supply and demand
across local areas within states. Indeed, a within-state
small area analysis examining the impact of ACA reforms using the same source of data suggested that
about 44 million Americans live in areas where the
expected increase in demand for primary care will
exceed 5% and almost seven million reside in areas
where the expected demand will increase by more
than 10% (Huang & Finegold, 2013). The Health Resources and Services Administration (HRSA) estimates
that the supply of primary care physicians (PCPs) will
not meet future demand, with a projected shortage of
approximately 20,400 full-time equivalent physicians
by 2020 (HRSA, 2013). Within this backdrop of health
care reform and physician workforce shortages,
transforming the delivery of primary care, particularly
for newly eligible Medicaid enrollees, has become a top
priority for many state policy makers (AcademyHealth,
2015), with most state governors addressing this issue
in their State of the State speeches in 2014 (National
Academy for State Health Policy, 2015).Major Regulatory Restrictions on NP Practice Essay
One policy recommendation aimed at expanding
primary care capacity is to use nurse practitioners
(NPs) more effectively (Dower, Moore, & Langelier,
2013; Naylor & Kurtzman, 2010; Pohl, Hanson,
Newland, & Cronenwett, 2010). A projected increase
in the NP workforce (HRSA, 2013), along with the
essential and steadily growing contributions of NPs to
primary care (Druss, Marcus, Olfson, Tanielian, &
Pincus, 2003; Kuo, Loresto, Rounds, & Goodwin, 2013),
especially their historic and evolving role in improving
access to primary care for vulnerable populations
(Morgan, Everett, & Hing, 2015), offers compelling evidence for this policy recommendation.
HRSA has projected a 30% increase in primary care
NPs from 55,400 in 2010 to 72,100 NPs by 2020, which
combined with an increase in physician assistants
(PAs) could substantially reduce the projected shortage
of full-time equivalent physicians from 20,400 to 6,400
if NPs and PAs are effectively integrated into the primary care system (HRSA, 2013). Perhaps most critical to
health care reform, NPs have historically played a vital
role in improving access to primary care for vulnerable
populations (Morgan et al., 2015). NPs are key providers
in 1,202 federally funded community health centers
and 250 nurse-managed health clinics that embrace
team-based care to serve >22 million minority and
low-income patients (Hansen-Turton, Bailey, Torres, &
Ritter, 2010; National Association of Community
Health Centers, 2014). A recent analysis suggested
that increasing nurse-managed health centers and
expanding patient panel size in patient-centered
medical homes could substantially mitigate primary
care provider shortages (Auerbach et al., 2013).
In addition, expanding the role and scope of practice
(SOP) of NPs in the delivery of primary care (e.g., independent practice and prescription authority) has had
a significant impact on access to primary care and
improved management of chronic diseases among
vulnerable populations, including Medicaid enrollees
(Adashi, Geiger, & Fine, 2010; Landon et al., 2007).
Supporting an expanded SOP for NPs is an extensive
body of evidence that has consistently demonstrated
comparable performance between NPs and PCPs on
clinical outcomes, including reduction of symptoms,
improvement in health and functional status, and
mortality (Naylor & Kurtzman, 2010; Paradise, Dark, &
Bitler, 2011). In addition, patients seen by NPs generally report higher satisfaction (Jennings, Clifford, Fox,
Oconnell, & Gardner, 2015).Major Regulatory Restrictions on NP Practice Essay
However, the ability of NPs to provide essential
primary care to the fullest extent of their education is
moderated by state SOP regulation, which is governed
by state law under the state’s Nurse Practice Act and is
administered and regulated by each state’s Board of
Nursing. The National Council of State Boards of
Nursing has developed a national standard (the
Consensus Model) to provide guidance for states to
adopt uniform APRN (advanced practice registered
nurse) regulation on licensure, accreditation, certification, and education (National Council of State Boards
of Nursing, 2014), and the National Governors Association recommended that states consider expanding
SOP regulations to grant NPs authority in full practice
(National Governors Association, 2012).
Yet, among the 24 states predicted to have an increase in demand for primary care providers above the
national average due to the implementation of the
ACA, 17 have restrictive NP SOP regulations (Huang &
Finegold, 2013). To assist state policy makers in making evidence-based decisions on legislative reforms
concerning the expansion of the NP role in health care
delivery, we conducted a systematic review on the
impact of state NP SOP regulations on health care delivery, specifically focusing on the following three key
issues: (a) NP workforce, (b) access to care and health
care utilization, and (c) health care costs.Major Regulatory Restrictions on NP Practice Essay

ORDER  HERE NOW

Methods
Search Strategy
We searched the electronic databases PubMed,
CINAHL, PsycINFO, and Cochrane library for the period
up to January 31, 2015. In addition, we manually
searched Google Scholar and the references of published studies. The search in title or abstract comprised
the terms SOP, legislation, regulation, NP(s), advanced
practice nurse(s), or APRN(s). As health care system
and regulatory issues are different across countries, we
restricted the publications to those that addressed
these issues in the United States. Additional inclusion
criteria were (a) published in English, (b) empirical
quantitative study, (c) directly examined the effect of
state SOP regulations on health care delivery, and (d)
acceptable risk of bias in methodological approach. We
72 Nurs Outlook 64 (2016) 71 e 8 5
included studies with both time-series and crosssectional research designs. Although studies with
cross-sectional designs may be less desirable for
assessing regulatory effects, they can nonetheless
provide valuable insights if confounding factors were
conceptually sound and controlled for in the analysis.
Studies with bivariate analysis were therefore
excluded, as results are inconclusive without adjusting
for potential confounding factors.
Study Screening and Data Extraction
Two authors independently screened the retrieved
studies for eligibility by title and abstract. Screening
was not blinded to authors, institutions, or manuscript
journals. If an abstract did not provide sufficient information, evaluation of the full text was performed
and study eligibility was determined. Data on study
characteristics and key findings of individual studies
were also independently extracted by two authors.
Disagreements in study screening and data extraction
were resolved by consensus.Major Regulatory Restrictions on NP Practice Essay
Assessment of Risk of Bias
Two authors independently assessed risk of bias in
study methods that might threaten internal validity,
including study design, data sources, measurement,
and statistical analysis. Disagreements between the
two reviewers were resolved through discussion.
Data Synthesis
Meta-analysis was not performed because the studies
included in the review are heterogeneous in topic and
methodology. Thematic summaries were conducted
independently by two authors to extract the common
themes across studies with disagreements resolved by
consensus.
Results
Characteristics of Studies
Our search identified 529 published articles, which
were screened initially for eligibility by title and abstract. Of these, 22 were selected for further assessment for eligibility by examining the full articles. Seven
of the 22 articles were excluded because of potential
high risk of bias in the methodological approach,
leaving 15 articles in the present review and synthesis.
A flow diagram of search and study selection is shown
in Figure 1. Characteristics of the selected studies are
summarized in Table 1. These studies were published
from 1997 to 2015. Findings were generally consistent
across study periods. Nine studies used a time-series
design, and six employed a cross-sectional design.
Most studies used national data sets and employed
multiple regression analysis; a few studies adjusted for
clustering effects, and one study used multilevel
modeling to examine factors on state and individual
levels simultaneously.Major Regulatory Restrictions on NP Practice Essay
SOP regulation was measured in two ways in the
reviewed studies. Some studies employed an index
measure based on a scoring system for various SOP
regulation components, such as practice status, prescription authority, and independent reimbursement.
However, most studies used categorical coding for
presence or absence of the same or similar components. To compare and synthesize results across
reviewed studies more effectively, we used a threelevel classification for NP SOP regulation defined by
the American Association of Nurse Practitioners: (a)
full SOP regulation (independent practice and prescriptive authority), (b) reduced SOP regulation (requires a collaborative agreement with physicians for at
least one practice component such as prescription),
and (c) restrictive SOP regulation (requires supervision,
delegation, or team management by physicians;
American Association of Nurse Practitioners, 2015).
Risk of Bias
A total of seven studies were excluded because of risk
of bias after full-article review. Six studies were
excluded because they used bivariate analyses without
adjusting for potential confounders, and one study was
excluded because a substantial amount of missing data
considerably diminished the validity of study findings.
The risk of bias among the included studies was
deemed acceptable.Major Regulatory Restrictions on NP Practice Essay
The Impact of State SOP Regulation on NP Workforce
Eight studies included in this review examined the effects of state SOP regulations on the NP workforce,
including supply, mobility, and geographic distribution. Consistent evidence has shown that the number
of NPs and growth of the NP workforce were highest in
states with greater practice authority. Evidence from
four studies indicates that states with more favorable
NP practice environments have higher per capita NPs
(Auerbach, 2000; Kuo et al., 2013; Reagan & Salsberry,
2013; Stange, 2014). By 2010, states with full SOP regulations had an average of 25 more NPs per 100,000
population (95% confidence interval [1.2, 48.3])
compared with states with the most restrictive SOP
regulations (Kuo et al., 2013).
One study found that growth of the NP workforce
from 2001 to 2008 was significantly higher in states
with full SOP regulations: 100% growth in states with
full SOP regulations, 92% in states with reduced regulations, and 73% in states with restrictive regulations
(Reagan & Salsberry, 2013). Another study found that
growth in the number of NPs per capita was 14.8%
higher in states with the least restrictive SOP regulations compared with states with the most restrictions
between 2006 and 2010 (Kuo et al., 2013). Consistent
Nurs Outlook 64 (2016) 71 e 8 5 73
with these findings, states with regulations granting
NPs independent practice or prescription authority had
30% and 13% higher enrollments in APRN programs,
respectively (Kalist & Spurr, 2004). In addition, state
SOP regulation has been associated with NPs’ migration, with NPs more likely to move from states without
controlled substances prescription authority to states
with this authority (Perry, 2012).Major Regulatory Restrictions on NP Practice Essay
Two studies reported moderate effects of state SOP
regulations on the geographic distribution of NPs.
States that granted independent practice and thirdparty reimbursement had a more equitable distribution of NPs per capita across counties than states that
did not (Lin, Burns, & Nochajski, 1997). Moreover, in a
study examining the distribution of NPs in urban and
rural areas, a trend was observed in which NPs were 1.5
times more likely to practice in rural areas in states
with full SOP regulations compared with states with
restrictive regulations (Kaplan, Skillman, Fordyce,
McMenamin, & Doescher, 2012).
The Impact of State SOP Regulation on Care Provision
by NPs
Five studies provide evidence indicating that states
with expanded practice authority showed the greatest
growth and advancement of NP primary care provision. NPs had more authority in prescribing selected
medications in states with less restrictive SOP regulatory environment (Pan, Straub, & Geller, 1997). From
1998 to 2010, the number of NPs providing primary care
for Medicare fee-for-service patients increased from
0.6% to 5.3% in states with full SOP regulations, from
0.2% to 3% in states with reduced SOP regulations, and
from 0.2% to 2.5% in states with restrictive SOP regulations. These differential growth rates resulted in a
sizable gap in NP care provision across states by 2010;
the odds of Medicare fee-for-service beneficiaries
having an NP as a primary care provider was 2.5 times
higher in states with the least restrictive NP SOP
regulation than those in states with the most restrictive regulation (Kuo et al., 2013).
Evidence further suggests that less restrictive SOP
regulation was linked with promoting care provision by
NPs in rural and medically underserved areas. Rural
hospitals located in states granting prescriptive authority to NPs were 30% more likely than rural hospitals in states without this authority to establish a
provider-based rural health clinic, which are designed
to stimulate the use of NPs and PAs to improve access
to primary care in underserved rural areas (Krein,
1999).  Major Regulatory Restrictions on NP Practice Essay