January 10th, 2018
Nurse Practitioner’s Scope of Practice – Importance of Problem and Impact on Nursing
Nurse practitioners (NPs) have progressively become key players in the provision of healthcare services in the last few decades. They have leveraged their capabilities and skills to provide high-quality yet economical health care to enhance patients’ satisfaction with care (De Milt, Fitzpatrick &McNulty, 2009). The benefits of engaging NPs in the provision of care are well documented; they increase access, ensure early disease diagnosis through early presentation and decrease number of hospital admissions (Dierick-Van et al., 2009). Imminent shortages of physicians in rural regions limit access to healthcare services and the timeliness of provision of such services. Fiscal policy analyses indicate that healthcare reforms seeking to enhance availability and access to quality care can meet their objectives by permitting accredited nurse practitioners to offer services autonomously and directly to patients in various clinical settings (Bauer, 2010). NPs offer equal or higher-quality services at cheaper rates compared to similarly qualified health specialists. Therefore, NPs have critical roles to play in bridging the gap in the increasing demand and limited access to healthcare.
The scope of practice and level of autonomy depends on individual state legislations, organizational constraints, public opinions and collaboration from other healthcare professionals. NPs perform a wide range of activities undertaken by physicians including taking patient’s history, examining patients, diagnosing ailments and ordering laboratory tests when necessary, prescribing medications and making medical decisions regarding the treatment. Studies have shown that they offer comparable quality care and services to physicians at cost-effective rates (Paniagua, 2011). Nevertheless, practicing NPs often encounter hierarchical barriers and restrictions with physicians being ranked in a superior position and the NP in a subordinate role. State regulations that stipulate the scope of practice of NPs further determine the extent of autonomy in NP practice. Where the state legislation demand NPs’ supervision by a physician instead of collaboration, the NPs’ autonomy becomes greatly compromised.
State regulations differ extensively in the medications NPs can prescribe, the level of autonomy and scope of practice. Additionally, the regulations differ in the medical procedures they are allowed to carry out and the number of NPs each physician can supervise. For instance, NPs are not allowed to prescribe controlled medications in the states of Alabama and Florida (Keough et. al., 2011). One category of controlled medications that NPs are not allowed to prescribe in various states are schedule II substances, which refer to medications with high abuse potential and severe physical or psychic dependence side effects e.g. opium, morphine and codeine (Brown, 2010). In other states, NPs cannot practice without full supervision of physician while in some states they can perform minor surgeries independently (Keough et. al., 2011). Such state variations may be a source of differential care outcomes in the states.
A challenge facing NP education and programs is the confusion that exists among various health care organizations concerning the different NP titles concerning their scope of practice and autonomy. Across the U.S., many different titles exist for NPs depending on the program and education level attained by the individual. Consequently, the scopes of practice vary with such differences. For instance, advanced practice nurses (e.g. CRNPs, CNMs, CRNPs and CNSs) typically have autonomy in conducting basic care services such as assessing patients’ health, diagnosing patients conditions and managing the cases (Brown, 2010). However, autonomy beyond such care services is determined by “nurses’ title, qualifications and the scope of … collaborative agreements with practicing physicians” (Brown, 2010, p. Vi). The confusion concerning NP titles also arises because – in contrast to the norm in other healthcare professionals such as psychiatrists, doctors, psychologists, pharmacists and physiotherapists – nursing practitioners do not start their practice with a general accreditation (Garder et. al., 2010). Instead, NPs are viewed as specialists who should deliver services to patients only categorized into their area of accreditation. Based on this model of caring for specific populations, NPs practice is classified into six foci; mental health NPs, family NPs, pediatric NPs, adult NPs, neonatal NPs and gender associated NPs (Dierick-Van et. al., 2011). Nevertheless, requirements and needs that patients seek nursing practitioners’ services go beyond the six classes.
The limitation on the scope of practice and autonomy has several implications for nursing. Research findings indicate that most NPs are only minimally contented with the rate of professional advancement, collaboration and collegiality in the profession (Maylone et. al., 2011). Owing to the limitations on scope of practice and autonomy, substantially deleterious relationship can exist concerning nurses’ satisfaction with their work. For instance, in the study by Malyone et al. (2011), 27% of NPs indicated that they planned to quit their present positions, 5.5% planned to quit from the roles of direct care provider while 5.5% planned to quit the nursing profession altogether due to dissatisfaction with their work. The limitations also reduce the access to and timeliness of health care services. For instance, in the state of Alabama, when a patient presents with acute pain, NPs cannot treat him/her appropriately because of the state restrictions on their scope of practice (Keough et. al. 2011). The patient must thus seek care from a physician to prescribe medication for the pain. These delays are unnecessary where the NPs can satisfactorily provide the required care. Such restrictions on scope of practice and autonomy hinder qualified NPs from playing their part effectively in the delivery of health care services thus limiting the access to quality care.