1. Identify and describe practice barriers for all four APNs roles in your state
and discuss these barriers on a state and national level. The four roles
include the nurse midwife, nurse anesthetist, nurse practitioner and
clinical nurse specialist.
One major practice barrier for nurse midwives and clinical nurse is
professional regulation, including regulation of the nurse midwife role and
education (Fealy et al, 2018). Nurse midwives have varying jobs in different
settings which makes it difficult to specify the nurse midwife's role.
Education also varies across the country making it difficult to regulate as
well. For example, a nurse may go to school in Missouri to become an APN
and be a nurse midwife, but they may eventually work in Illinois.. The laws
in Missouri will be much different than they are in Illinois. It is important to
always research the state laws where you receive your degree and where
you plan to practice. The same practice barrier applies to clinical nurse
specialists (CNS). The CNS role can sometimes be difficult to distinguish
from other job positions in the medical setting (Thurby-Hay, Whitehead, &
Nelson, 2020) . The amount of CNS programs is also far lower than the
other APN specialites. This makes it difficult for registered nurses seeking
the CNS speciality to find and be accepted into a program.
A practice barrier for nurse practitioners at the state and national
level is the inability to prescribe medications without a prior prescriptive
agreement with a collaborating/overseeing physician (Illinois Nurse Practice
Act). As a new nurse practitioner, an overseeing physician must collaborate
with the nurse practitioner for medication administration. This becomes
more complicated with Schedule II narcotics. In order to prescribe Schedule
II narcotics, the prescription must be delegated by an overseeing physician.
For Nurse Anesthetist, one major practice barrier the CRNA scope of
practice. Although pain management is within the scope of practice of a
nurse anesthetist, the state of Illinois has challenged the ability for nurse
anesthetist to provide chronic pain management services (Malina & Izlar,
2014). Illinois is one of four states to challenge this scope of practice. This
would affect CRNAs at the state and national level because it will affect
where CRNAs apply for jobs. States that limit the scope of their CRNAs will
eventually face a CRNA shortage.
2. Identify forms of competition on the state and national level that
interfere with APN's ability to practice independently.
At the state and national level, APNs have competition with other mid-
level providers, such as physcian assistants, and doctors. Although APNs are
more cost- effective in most practices, many patients prefer to see doctors
compared to mid-level providers (Abraham et al, 2019). Maybe this is
because of their educational background or a pre-concieved notion that the
patient may have. APNs also have to compete with physcian assistants who
are also considered mid-level providers. Although APNs are able to work
independently in some states, finding a job working in the established
practice of a doctor ensures that they will have a continuous flow of
patients.
, 3. Identify the specific lawmakers by name at the state level (i.e., key
members of the state's legislative branch and executive branch of
government)
The current govenor of Illinois is J. B. Pritzker of the Democratic party,
who took office in 2019. Dick Durbin and Tammy Duckworth, both
Democrats, are the Illinois
and discuss these barriers on a state and national level. The four roles
include the nurse midwife, nurse anesthetist, nurse practitioner and
clinical nurse specialist.
One major practice barrier for nurse midwives and clinical nurse is
professional regulation, including regulation of the nurse midwife role and
education (Fealy et al, 2018). Nurse midwives have varying jobs in different
settings which makes it difficult to specify the nurse midwife's role.
Education also varies across the country making it difficult to regulate as
well. For example, a nurse may go to school in Missouri to become an APN
and be a nurse midwife, but they may eventually work in Illinois.. The laws
in Missouri will be much different than they are in Illinois. It is important to
always research the state laws where you receive your degree and where
you plan to practice. The same practice barrier applies to clinical nurse
specialists (CNS). The CNS role can sometimes be difficult to distinguish
from other job positions in the medical setting (Thurby-Hay, Whitehead, &
Nelson, 2020) . The amount of CNS programs is also far lower than the
other APN specialites. This makes it difficult for registered nurses seeking
the CNS speciality to find and be accepted into a program.
A practice barrier for nurse practitioners at the state and national
level is the inability to prescribe medications without a prior prescriptive
agreement with a collaborating/overseeing physician (Illinois Nurse Practice
Act). As a new nurse practitioner, an overseeing physician must collaborate
with the nurse practitioner for medication administration. This becomes
more complicated with Schedule II narcotics. In order to prescribe Schedule
II narcotics, the prescription must be delegated by an overseeing physician.
For Nurse Anesthetist, one major practice barrier the CRNA scope of
practice. Although pain management is within the scope of practice of a
nurse anesthetist, the state of Illinois has challenged the ability for nurse
anesthetist to provide chronic pain management services (Malina & Izlar,
2014). Illinois is one of four states to challenge this scope of practice. This
would affect CRNAs at the state and national level because it will affect
where CRNAs apply for jobs. States that limit the scope of their CRNAs will
eventually face a CRNA shortage.
2. Identify forms of competition on the state and national level that
interfere with APN's ability to practice independently.
At the state and national level, APNs have competition with other mid-
level providers, such as physcian assistants, and doctors. Although APNs are
more cost- effective in most practices, many patients prefer to see doctors
compared to mid-level providers (Abraham et al, 2019). Maybe this is
because of their educational background or a pre-concieved notion that the
patient may have. APNs also have to compete with physcian assistants who
are also considered mid-level providers. Although APNs are able to work
independently in some states, finding a job working in the established
practice of a doctor ensures that they will have a continuous flow of
patients.
, 3. Identify the specific lawmakers by name at the state level (i.e., key
members of the state's legislative branch and executive branch of
government)
The current govenor of Illinois is J. B. Pritzker of the Democratic party,
who took office in 2019. Dick Durbin and Tammy Duckworth, both
Democrats, are the Illinois
