NR 510 Barriers to Practice
NR 510 Barriers to Practice
The barriers to APN practice that were identified in the article are state practice and licensure, physician related issues, job satisfaction, payer policies and not being allowed to follow patients who are admitted to acute care facilities (Hain &Fleck, 2014).
These barriers to me mean that APN are restricted in their practice. They do not get to practice to the best of their education. I do feel that in the beginning there does need to be some guidance from a physician. The barriers can cause dissatisfaction with the job because of the amount of control taken from the APN regarding their decisions with their patients. This should be done in the first five years or so of practice. This would give the ANP the guidance needed while caring for patients. These barriers also mean the ANP does not get the same compensation as does a physician and payers will not pay at the same rate as they would for a patient being seen by a physician.
These barriers are not new to me nor do they come as a surprise. I have spoken with a few FNPs who have mentioned the fact that they are restricted to a certain extent. When working in the emergency room a lot of times the APNs would only be allowed to work on the lower acuity patients. In the event that there was someone who ended up being a higher acuity the APN would have to go to the physician for their opinion. This I did not see as a bad thing. It is always good to have the extra resource which can provide an additional set of eyes and knowledge for a situation. These restrictions do not concern me currently. I feel my motivation is seeing how certain physicians welcome the APN and are willing to work with them. Many I have seen give the APN more room to do their thing once they gain confidence in the APN.
These barriers do represent restraint of trade. They do not allow the APN to see patients and prescribe medications without restrictions. They have rules and regulations that restrict them and only allow them to practice in certain ways.
Nurses can influence these barriers by forming organizati0ons to appeal to their states about the way they are allowed to practice. To do this they will need to research and provide data stating the care they give, and the care given by physicians. They will need evidence about practices to be able to change the minds and get regulations changed. This will not be an overnight process, so they will also need to be willing to commit to making a change over years.
Hain, D., & Fleck, L. (2014, May). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, Vol. 19, No. 2, Manuscript 2, doi: 10.3912/OJIN.Vol19No02Man02
I agree that one must reach out to all available resources when necessary, even if it is just a small question or
thought. It is critical for medical professionals to see the full picture when it comes to diagnosing and treating patients, if that full picture includes consulting another provider it is pertitent all providers are not too proud to do so. An established nurse practitioner should be taken seriously and looked upon as a vital resource to ones co workers including physicians. A small study from Canada analyzed the referrals between physicians and nurse practitioners in a primary care setting showing 16% were made by NP’s to physicians and a minute 2% for physicians to nurse practitioners (Fatima, 2009). Nurse practitioners and physicians are trained differently and bring different positive assets to the team evaluating patients and physicians must become more aware of everything they have to offer.
Faria, C. (2009). Nurse practitioner perceptions and experiences of interprofessional collaboration with physicians in primary health care settings (Order No. MR65171). Available from ProQuest Dissertations & Theses Global. (760998386). Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/760998386?accountid=147674
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The barriers identified in the articles include state practice licensure issues, physician related issues, payer policy issues, and prescriptive issues (Hain, Fleck, 2014). These issues do not come as a surprise as physicians have dominated the medical field for a very long time. It is the same concept to the work field with male dominance and women fighting for equality. We have been living in a world that aims to maintain dominance, we are seeing it today in the financial world with the United States and their protectionist views by implementing trade tariffs. If we go all the way back in time, there has been wars and attempted genocides to ensure one’s beliefs dominate the world. So, for physician dominance to occur in the medical field is not a surprise to me. On the positive note, we do have organizations that fight for nurse practitioner equality in the medical field such as the American Association of Nurse Practitioner (Hain, 2014).
I believe these barriers are occurring naturally in a world that aims to maintain dominance. But we live in a time where change needs to occur, because the fact is we are short in primary care physicians in an aging population and a work force that will be reduced with baby boomers retiring, which will only add to the shortage in primary care physicians in a world where people are requiring more medical attention. The healthcare cost is also increasing at such a fast rate, where it will not be sustainable in the future. I believe these restraints will be resolved. The main driver of this resolution will be cost.
Hain, D., & Fleck, L. M. (2014). Barriers to NP Practice that Impact Healthcare Redesign. Online Journal Of Issues In Nursing, 19(2), 5. doi:10.3912/OJIN.Vol19No02Man02
I am aware of patient barriers. My father had an MI a few years back and he was following up with a cardiac NP for his routine follow up appointments. At first he was skeptical of his treatment plans and knowledge in medicine. I had to educate him and inform him that NPs are knowledgeable and are fully educated with medicine as much as doctors. They might even be more compassionate with patients, which can greatly improve their care. I provided him examples and had him rethink some of his past experiences with doctors on how some of them lack compassion. After this he was able to compare the difference and he did mention how the NP actually talks to him like a regular person and explains things in ways where he can understand.
I believe educating the population is extremely important to break these barriers. The population is not informed of the education NPs have to achieve in order to become providers. One way to do this is to inform the population with research in how effective NPs can be in treating common and chronic illnesses. Throughout this NP program, I have come across many scholarly articles that proved NPs are more effective in managing chronic illnesses compared to MDs, such as diabetes mellitus type 2. Therefore, we must do a better job in educating the population in the role of NPs and the extensive education and training they go through to become providers.
I think it is interesting how we are looking into physical appearances and how they can affect the patient’s perception of a healthcare personnel. I have also noticed that when one comes in with a lab coat or maybe the hat OR doctors wear, all of a sudden, the patient may change outlook. I have told a patient information or advice and the patient may appear weary of my advice. However, the medical doctor will say the same advice I would say and the patient would trust what the medical doctor said. For example, I have heard one of my family members state that they do not want a FNP to take care of them when they go to a PCP. I asked why and there was no definite reason but besides that they felt more comfortable with an medical doctor. Medical doctors appear to hold such a high prestige. A study commissioned by the American Academy of Family Physicians shows 72% patients prefer physicians over nurse practitioners for their medical care. However, on the opposite end of the spectrum, the American Association of Nurse Practitioners, conducted their own study of what kind of care patients request. Their own study show that healthcare consumers are in favor and open to expanding responsibility for NPs. The two surveys do not contradict each other but display the unwritten tug-of-war of power. As the baby boomers age and and the surge in newly insured Americans grow, it places a strain in primary care providers. According the AAFP survey, only 7% of respondents said they would prefer a nurse practitioner over a physician while 16% indicated no preference and 5% said they didn’t know. It is interesting to see how perception of a profession can change the outlook of how a patient perceives a medical doctor or a nurse practitioner. (Read & Mayberry, 2015)
Read, A. M., & Mayberry, J. F. (2015). Doctor or nurse? The patients’ choice. Postgraduate Medical Journal, 212.