The ethical implications of the removal of the scope of practice barriers recommendation .

Introduction

In 2011, the IOM released a report which contained eight recommendations concerning the way the nursing workforce can best deliver health care and meet health care needs in an era of the aging population and health care reform. One of the most outstanding recommendations was that scope of practice barriers should be removed. The paper discusses the ethical implications of this recommendation and what it means to the nurse, the patient, and the health care environment and system.The ethical implications of the removal of the scope of practice barriers recommendation .

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The ethical implications of the removal of the scope of practice barriers recommendation and what it means to the nurse, the patient, the health care environment, and the system

One of the eight recommendations in the IOM report was that scope of practice barriers should be removed to enable nurses to practice to the full extent of their training and education. Restrictive scope of practice laws in combination with strict payer policies limits nurses to working as employees of hospitals, physician practices, and other health care organizations instead of their own independent practices.  Bosse et al. (2017) given that nurses have the necessary qualifications and skills to act as primary care providers, removal of barriers that restrict nurses’ scope of practice might address some of the increasing concerns about access to care.The ethical implications of the removal of the scope of practice barriers recommendation .

Removal of scope of practice barriers can enable nurses to practice to the full level to which their training and education have prepared them and increase patients’ access to care. According to Bosse et al. (2017), removing the scope of practice barriers and granting APRNs full practice authority can be beneficial to patients, payers, and the health care system. In states when nurse practitioners have full practice authority, there are considerably fewer visits to the emergency room for non-emergency health care, lower rates of hospitalization,  and expanded utilization of health care, especially among the most vulnerable. Also, care is provided at a reduced cost than medical doctors, including preventative care and there is increased teamwork between physicians and nurse practitioners in primary care organizations.The ethical implications of the removal of the scope of practice barriers recommendation .

Ethical principles are at stake and who are the stakeholders

Access to care is a major challenge for patients. This access is adversely impacted when nurse practitioners with qualifications are able and willing to deliver cost-effective, quality care, yet governmental entities s continue ignoring legislation that would revise laws and renovate health care. Nurse practitioners, policymakers/ legislators, medical organizations, and professional nursing organizations are stakeholders in working on removing scope of practice barriers. Peterson (2017) several state nurse practitioner organizations have employed lobbyists to assist take their efforts to revise the restrictive scope of practice laws to lawmakers, even though the medical boards have considerable financial power and influence to push their agendas through.The ethical implications of the removal of the scope of practice barriers recommendation .

Conclusion

The IOM report recommends the removal of scope of practice barriers to enable nurses to practice at the top of their training and education. Nurse practitioners have the qualifications and will to provide safe and cost-effective care by restrictive scope of practice laws limit their ability to run independent practices. Implementation of this recommendation can increase patient’s access to care and reduce the cost for the health care system since nurses provide less costly care compared to physicians. The ethical implications of the removal of the scope of practice barriers recommendation .

The Future of Nursing: Leading Change, Advancing Health observes that the changing landscape of health care and the changing profile of the U.S. population will require fundamental shifts in the care delivery system (IOM, 2011). In particular, the report notes concerns about a shortage of primary care health professionals in the United States, particularly given the expansion of insurance coverage under the Patient Protection and Affordable Care Act (ACA).The ethical implications of the removal of the scope of practice barriers recommendation . It suggests that advanced practice registered nurses (APRNs), if permitted to practice to the full extent of their education and training, could help build the workforce necessary to meet the country’s primary care needs and contribute their unique skills to the delivery of patient-centered, community-based health care. While the Institute of Medicine (IOM) report makes special mention of the role for APRNs in primary care (see Box 2-1), the report’s recommendations are not limited to those settings, but encompass the full continuum of health services in many health organization and community settings.The ethical implications of the removal of the scope of practice barriers recommendation .

The Future of Nursing notes that although APRNs are highly trained and able to provide a variety of services, they are prevented from doing so because of barriers, including state laws, federal policies, outdated insurance reimbursement models, and institutional practices and culture (IOM, 2011). The report includes several specific policy recommendations for overcoming these barriers and providing APRNs with licensure, privileges, and reimbursement consistent with their education and training.The ethical implications of the removal of the scope of practice barriers recommendation .

In particular, the report encourages policy makers to be guided by the National Council of State Boards of Nursing’s (NCSBN’S) Model Nursing Practice Act and Administrative Rules in efforts to change state scope-of-practice laws (NCSBN, 2009).The ethical implications of the removal of the scope of practice barriers recommendation . An understanding of the provisions of this act may be useful for understanding how “full practice authority” has been defined and measured by NCSBN, the American Association of Nurse Practitioners (AANP), and the Future of Nursing: Campaign for Action (the Campaign) in their assessments of progress toward implementation of the report’s recommendations. The NCSBN act includes a detailed set of guidelines. In summarizing the status of scope-of-practice authority in the U.S. states and territories, the Campaign (CCNA, 2015) and AANP (2015) track progress in three categories: full, reduced, and restricted practice.The ethical implications of the removal of the scope of practice barriers recommendation .