Posted: June 14th, 2023

The barriers to practice as an Advanced Practice Registered Nurse (APRN) in United States

The barriers to practice as an Advanced Practice Registered Nurse (APRN) in United States
As healthcare continues to evolve, the role of the Advanced Practice Registered Nurse (APRN) has become increasingly important in the United States. However, despite the growing need for these skilled professionals, barriers to practice as an APRN persist. In this article, we will explore the various barriers to APRN practice in the United States and their impact on patient care. We will also examine possible solutions to overcome these barriers and improve access to high-quality healthcare.

Overview of APRN Practice in the United States

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APRNs are highly trained healthcare professionals who have completed advanced education and clinical training in their respective fields. The four types of APRNs include nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists. APRNs are authorized to perform a wide range of medical services, including diagnosis, treatment, and prescribing medication.

Barriers to Practice as an APRN in the United States

Despite the critical role APRNs play in healthcare delivery, they face several barriers to practice in the United States. These barriers can be categorized as legislative, regulatory, educational, and financial.

Legislative Barriers:

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The lack of uniformity in state laws governing APRNs is a significant obstacle to APRN practice. The variations in laws across states make it challenging for APRNs to practice across state lines, limiting their mobility and potential to serve areas with a shortage of healthcare providers. Furthermore, the scope of practice restrictions can limit APRNs' independence in providing healthcare services to their patients. In some states, APRNs can only practice under the supervision of a physician, which can create challenges in providing timely and efficient care to patients in need.

Regulatory Barriers:

In addition to legislative barriers, regulatory barriers can also hinder APRN practice. APRNs are subject to various regulations, including those related to physician supervision, prescriptive authority, and liability insurance, which can limit their ability to provide care. For instance, some states require APRNs to have a collaborative agreement with a physician, limiting their ability to practice independently. In some cases, the regulations related to prescriptive authority can be restrictive, limiting the types of medication APRNs can prescribe, as well as the dosage and duration of treatment.

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Educational Barriers:

Advanced education is necessary for APRNs to gain the skills and knowledge required to provide high-quality healthcare services. However, the cost of obtaining an advanced degree in nursing can be a significant barrier for many individuals, especially those from underrepresented communities. The financial burden of tuition fees, textbooks, and other educational expenses can discourage many aspiring APRNs from pursuing their careers. Moreover, the time-consuming nature of obtaining advanced degrees can pose a challenge for APRNs already working in the field, as well as those seeking to enter the workforce.

Financial Barriers:

Financial barriers can limit access to APRN care for many patients. Many insurance plans do not cover services provided by APRNs, making it difficult for patients to afford the care they need. This lack of insurance coverage can be particularly challenging for individuals with low incomes or those living in underserved areas. Additionally, the lower salaries earned by APRNs compared to physicians can be a significant challenge for attracting and retaining talented healthcare professionals. As a result, some APRNs may seek other employment opportunities or choose to practice in states where they can earn higher salaries, exacerbating the shortage of APRNs in underserved areas.

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Impact of Barriers on Patient Care

The barriers to APRN practice in the United States can have a significant impact on patient care. Patients in areas with limited access to healthcare providers may not be able to receive the care they need if APRNs are not allowed to practice independently. Additionally, delays in care caused by regulatory and administrative burdens can lead to negative health outcomes for patients.

Possible Solutions to Overcome Barriers

To overcome the barriers to APRN practice in the United States, several solutions have been proposed. These solutions include:

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Standardizing State Laws
Standardizing state laws governing APRN practice would help to create consistency and reduce confusion for healthcare providers and patients. Additionally, creating uniformity in APRN scope of practice would enable APRNs to practice to the full extent of their training and education.

Reducing Regulatory Burdens
Reducing regulatory burdens on APRNs could help to improve access to care for patients. This could include reducing the requirement for physician supervision, expanding prescriptive authority, and reducing administrative burdens for APRNs.

Increasing Education Opportunities
Increasing education opportunities for APRNs could help to reduce the financial burden of obtaining advanced degrees. This could include offering scholarships and loan forgiveness programs to APRN students.

Improving Insurance Coverage
Improving insurance coverage for services provided by APRNs could help to increase access to care for patients. This could include expanding the types of services that insurance plans cover when provided by APRNs, as well as increasing reimbursement rates for these services.

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Advocacy and Lobbying Efforts
Advocacy and lobbying efforts can also play a significant role in overcoming the barriers to APRN practice. APRNs can work with professional organizations and interest groups to advocate for legislative and regulatory changes that support their ability to practice to the full extent of their education and training.

Conclusion

In conclusion, the barriers to APRN practice in the United States are significant and impact both healthcare providers and patients. Standardizing state laws, reducing regulatory burdens, increasing education opportunities, improving insurance coverage, and advocacy and lobbying efforts are all potential solutions to overcome these barriers and improve access to high-quality healthcare. It is crucial that policymakers, healthcare organizations, and APRNs themselves work together to identify and address these barriers to ensure that all patients have access to the care they need.

References sources
American Association of Nurse Practitioners. (2020). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment

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American Nurses Association. (2021). APRN Consensus Model. https://www.nursingworld.org/practice-policy/aprn-consensus-model/

Buppert, C. (2018). The legal guide for nurse practitioners. Jones & Bartlett Learning.

National Council of State Boards of Nursing. (2018). APRN regulatory model. https://www.ncsbn.org/aprn.htm

National Institute of Nursing Research. (2020). Advanced practice registered nurses. https://www.ninr.nih.gov/researchandfunding/trainingandcareerdevelopment/diversityandinclusion/institutes/programs/aprn

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Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., Wilson, R. F., Fountain, L., Steinwachs, D. M., & Heindel, L. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal of Nurse Practitioners, 9(8), 492-500. https://doi.org/10.1016/j.nurpra.2013.07.004

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