Scope of Practice Barriers for Advanced Practice Registered Nurses

Löfgren, Maria; Berends, Susan K.; Reyes, Jimmy; Wycoff, Carmen; Kinnetz, Meghan; Frohling, Ami; Baker, Laura; Whitty, Sue; Dirks, Mary; O’Brien, Mary

doi:10.1097/nna.0000000000000515

“…Although state practice barriers are most commonly referenced, APRNs face other practice barriers. Even in FPA states, organizational bylaws and insurance and reimbursement issues continue to be barriers ( Lofgren et al, 2017 ). Federal statutes from the Centers for Medicare and Medicaid Services (CMS) impede APRN practice.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

Impact of COVID-19 pandemic on APRN practice: Results from a national survey

Kleinpell¹,

Myers²,

Schorn³

et al. 2021

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Background The impact of the COVID-19 pandemic on Advanced Practice Registered Nurse (APRN) practice is not well known. Purpose This study aimed to describe state practice barriers and explore the effects of the COVID-19 pandemic on APRN practice. Methods A descriptive study design used a 20-item web-based survey open from June 1 through September 23, 2020. Findings A total of 7,467 APRNs responded from all 50 states, including nurse practitioners (n = 6,478, 86.8%), certified registered nurse anesthetists (n = 592, 7.9%), certified nurse-midwives (n = 278, 3.7%), and clinical nurse specialists (n = 242, 3.2%). A number of barriers to practice prior to the pandemic were identified. Most respondents (n=6334, 84.8%) identified that practice barriers limited the ability of APRNs to provide care during the pandemic. Discussion Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with FPA, during the COVID-19 pandemic and with state executive orders waiving practice restrictions. The study findings can be used to advocate for policy changes to support APRN practice authority.

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“…In addition to state practice regulations that restrict practice authority in reduced and restricted practice states, there are other practice barriers that restrict APRN practice, even in FPA states ( Bosse et al, 2017 ; Hain & Fleck, 2014 ; Hastings-Tolsma et al, 2018 ; Lofgren et al, 2017 ; Peterson, 2017 ). These barriers include federal regulations, such as those from the Centers for Medicare & Medicaid Services (CMS), as well as institutional and organizational policies that inhibit APRN-provided care and services ( Hastings-Tolsma et al, 2018 ; Lofgren et al, 2017 ).…”

Section: Aprn Practice Barriersmentioning

confidence: 99%

“…In addition to state practice regulations that restrict practice authority in reduced and restricted practice states, there are other practice barriers that restrict APRN practice, even in FPA states ( Bosse et al, 2017 ; Hain & Fleck, 2014 ; Hastings-Tolsma et al, 2018 ; Lofgren et al, 2017 ; Peterson, 2017 ). These barriers include federal regulations, such as those from the Centers for Medicare & Medicaid Services (CMS), as well as institutional and organizational policies that inhibit APRN-provided care and services ( Hastings-Tolsma et al, 2018 ; Lofgren et al, 2017 ). Institutional and organizational barriers include bylaws that limit APRN roles and authority, including lack of hospital privileges; issues with provider credentialing; limited clinical, admitting, and/or staff privileges; insurance; and reimbursement issues ( Hastings-Tolsma et al, 2018 ; Lofren et al, 2017 ; Robert Wood Johnson Foundation, 2017 ).…”

Section: Aprn Practice Barriersmentioning

confidence: 99%

Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19

Kleinpell

¹

,

Myers

²

,

Schorn

³

2023

Journal of Nursing Regulation

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“…Non-regulatory barriers to practice also inhibit APRN-provided care and services (Hastings-Tolsma et al, 2018; Lofgren et al, 2017). These barriers relate to hospital privileges, organizational bylaws, insurance and reimbursement issues, and required practice agreements (Hastings-Tolsma et al, 2018; Lofgren et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Non-regulatory barriers to practice also inhibit APRN-provided care and services (Hastings-Tolsma et al, 2018; Lofgren et al, 2017). These barriers relate to hospital privileges, organizational bylaws, insurance and reimbursement issues, and required practice agreements (Hastings-Tolsma et al, 2018; Lofgren et al, 2017). Martin and Alexander (2019) found that APRNs working in rural areas and in APRN-managed private clinics were one and a half to six times more likely to be assessed collaborative practice agreement fees, often exceeding $6,000 and up to $50,000 annually.…”

Section: Introductionmentioning

confidence: 99%

Results of a National Survey: Ongoing Barriers to APRN Practice in the United States

Schorn

¹

,

Myers

²

,

Barroso

³

et al. 2022

Policy, Politics, & Nursing Practice

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Limited information is available on the barriers to practice for advanced practice registered nurses (APRNs) among states with full, restricted, and reduced practice. The purpose of this study is to identify practice barriers in relationship to United States (U.S.) state practice authority, APRN type, area of practice (rural, suburban, urban), and nature of practice (outpatient, inpatient, and both). An electronic survey of a convenience sample of APRNs was conducted to assess barriers to practice. Identified barriers were examined based on state practice environment, APRN role, practice setting, and location. Data were analyzed using thematic analysis for qualitative data and descriptive analysis for quantitative data. Over 7,000 APRNs representing all 50 states participated. Themes that were identified and reported by respondents, included licensure and administrative barriers, therapy restrictions, physician signature requirements, a lack of collegiality, prescribing barriers, uneven reimbursement, physician only procedures, and telehealth issues. Barriers were identified in all states, regardless of the type of practice authority. All four APRN role types identified practice barriers, some of which were more frequent for some roles than others. Restrictions for home health approval and the requirement for a physician signature for durable medical supply orders were identified by over 40% of respondents practicing in rural areas. Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with full practice authority. Continued efforts to reduce barriers to APRN practice are needed to ensure patient access to care, especially in rural areas.

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Scope of Practice Barriers for Advanced Practice Registered Nurses

Cited by 10 publications

References 1 publication

Impact of COVID-19 pandemic on APRN practice: Results from a national survey

Impact of COVID-19 pandemic on APRN practice: Results from a national survey

Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19

Results of a National Survey: Ongoing Barriers to APRN Practice in the United States

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