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Chamberlain College of Nursing NR 506 NP Week 1 Discussion
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Discuss barriers to practice as an APN in one’s state from both a state and national perspective.Research methods to influence policy change from various forms of competition,state legislative and
executive branches of government and interest groups.
1. Identify and describe practice barriers for APNs in your state and discuss thesebarriers
on a state and national level.
2. Identify forms of competition on the state and national levels that interfere withthe
APN’s ability to practice independently.
3. Identify the lawmakers at the state level (i.e., key members of the state’s
legislative branch and the executive branch of government)
4. Discuss interest groups that exist at the state and national levels that influenceAPN
policy.
5. Discuss methods used to influence change in policy in forms of competition, state legislative and
executive branches of government and interest groups.
Dr. Sibel and fellow classmates,
There have always been barriers for advanced practice nurses (APN) on the state and national level.
Family nurse practitioners (FNP) are faced with challenges involving licensure, prescription privileges,
and payment from insurance companies. Each state varies when it comes to practicing guidelines and
prescribing privileges. In my home state of Kentucky, FNPs can practice fully but must have an
agreement with an overseeing physician before being able to prescribe narcotics (Kentucky Board of
Nursing, 2020). From what I gather from fellow nurses from different states, a few other states are not
so lax. On the state level and nationally, family nurse practitioners also get reimbursed less by insurance
companies than that of a doctor. In fact, nurse practitioners receive an average of 29% less
reimbursement than that of a doctor for the same exact procedure when reimbursed by Medicare
(Perloff, DesRoches, & Buerhaus, 2016).
Within the state and national level, nurse practitioners must compete with doctors and physician
assistants. Despite millions in need of healthcare, there seems to be a misconception that doctors provide
better care than that of an FNP. Because of this public belief, some healthcare offices only hire doctors
and do not rely on mid-levels to see patients. Nurse practitioners must also compete against physician
assistants who apply for many of the same mid-level positions available to APNs. My whole life I have
heard people say that they would rather see a doctor or physician assistant over an FNP. While I never
understood this, it became apparent to me that nurse practitioners may have a harder time finding
employment and locating providers to oversee them in order to have privileges to write narcotics. While
FNPs may practice independently, in Kentucky I have noticed that many chose to work in offices with
large client bases that also have a doctor on staff because many patients prefer to go to a practice where
a physician is available. Wyoming received backlash for introducing emergency nurse practitioner
certification in 2017 due to individual’s perceptions that FNPs are not properly educated to work in the
emergency care setting (Davis, 2019). Davis (2019) states that instead of defending the nurse
practitioners and educating the public on the roles of APNs, some hospitals simply replaced emergency
care nurse practitioners with physician assistants and physicians. Instead of promoting the use of FNPs,
many complied with the suggestions of the public and reinforced the misconception that physicians and
physician assistants provide better care than nurse practitioners, making it hard for FNPs to practice
independently.
Lawmakers in Kentucky that play key roles in healthcare legislation include the legislative and
executive branches of government. According to the Commonwealth of Kentucky (2020), Kentucky’s
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