Assignment: National healthcare issues

Assignment: National healthcare issues

Assignment: National healthcare issues

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

· Review the Resources and select one current national healthcare issue/stressor to focus on.

· Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

The Assignment
Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

National healthcare Issue I selected= Removing restrictions on nurse practitioners’ scope of practice in New York State: Physicians’ and nurse practitioners’ perspectives

The Journal/Reading below

Journal of the American Association of Nurse Practitioners

Issue: Volume 30(6), June 2018, p 354-360

Copyright: (C) 2018 American Association of Nurse Practitioners

Publication Type: [Qualitative Research]

DOI: 10.1097/JXX.0000000000000040

ISSN: 2327-6924

Accession: 01741002-201806000-00010

Keywords: Nurse practitioners, scope of practice, primary care, policy

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Removing restrictions on nurse practitioners’ scope of practice in New York State: Physicians’ and nurse practitioners’ perspectives

Poghosyan, Lusine PhD, RN, FAAN1; Norful, Allison A. PhD, RN, ANP-BC2; Laugesen, Miriam J. PhD3

Author Information

1Columbia University School of Nursing, New York, NY

2Columbia University School of Nursing, Columbia University Medical Center Irving Institute for Clinical and Translational Research

3Department of Health Policy & Management, Columbia University Mailman School of Public Health

Correspondence: Lusine Poghosyan, PhD, RN, FAAN, Columbia University School of Nursing, 630 W. 168th Street, Mail Code 6, New York, NY 10032. Tel: 212-305-7081; Fax: 212-305-0722; E-mail:

Funding: The study was funded by the Robert Wood Johnson Foundation, the National Institute of Nursing Research (T32NR014205), and the National Institute of Health (TL1TR001875).

Presentation: The study was presented as a poster at Annual Research Meeting at AcademyHealth in June 2017.

Competing interests: The authors report no conflict of interests.

Authors’ contributions: Lusine Poghosyan (data analysis; manuscript writing; editing and revisions); Allison A. Norful (interviewer; data analysis; manuscript writing; editing and revisions); Miriam J. Laugesen (manuscript writing; editing and revisions).

Received August 9, 2017

Received in revised form October 30, 2017

Accepted November 20, 2017


Background and purpose: In 2015, New York State adopted the Nurse Practitioners Modernization Act to remove required written practice agreements between physicians and nurse practitioners (NPs) with at least 3,600 hours of practice experience. We assessed the perspectives of physicians and NPs on the barriers and facilitators of policy implementation.

Methods: Qualitative descriptive design and individual face-to-face interviews were used to collect data from physicians and NPs. One researcher conducted interviews, which were audio-taped and transcribed. Twenty-six participants were interviewed. Two researchers analyzed the data.

Results: The new law has not yet changed NP practice. Almost all experienced NPs had written practice agreements. Outdated organizational bylaws, administrators’ and physicians’ lack of awareness of NP competencies, and physician resistance and lack of knowledge of the law were barriers. Collegial relationships between NPs and physicians and positive perceptions of the law facilitated policy implementation.

Conclusions: Policy makers and administrators should make efforts to remove barriers and promote facilitators to assure the law achieves its maximum impact.

Implications for practices: Efforts should be undertaken to implement the law in each organization by engaging leadership, increasing awareness about the positive impact of the law and NP independence, and promoting relationships between NPs and physicians.

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Physicians, nurse practitioners (NPs), and physician assistants currently provide the bulk of primary care in the United States (U.S.) to meet the demands of an aging population and expansion of insurance coverage ( Agency for Healthcare Research and Quality, 2014 ; Colwill, Cultice, & Kruse, 2008; DeVol & Bedroussian, 2007; Patient Protection and Affordable Care Act of, 2010 ). One projection suggests an additional 52,000 physicians will be needed by 2025 to meet the primary care demand (Petterson et al., 2012); however, the supply of these providers is expected to decrease ( Association of Medical Colleges Center for Workforce Studies, 2015 ). Conversely, NP workforce is expected to grow. In 2013, NPs comprised about 19% of the U.S. primary care provider workforce, and the number of NPs will increase by 93% by 2025 ( Health Resources and Services Administration, 2016 ), potentially expanding the primary care capacity ( Auerbach, et al., 2013 ; Green, Savin, & Lu, 2013 ). Assignment: National healthcare issues

However, the ability of NPs to care for patients has been limited by state-level scope of practice (SOP) regulations that determine the services NPs provide. Nurse practitioner state-level scope of practice laws vary across states. In 2017, 22 states and the District of Columbia authorize NPs to deliver care according to their competencies ( Robert Wood Johnson Foundation, 2017 ). The remaining states impose restrictions, including the requirement of NPs to have supervisory or collaborative relationships with physicians. Some states require NPs to have such relationships both for delivering care and prescribing medication and services, other states impose restrictions only on one aspect. The Federal Trade Commission, the National Governors Association, and the National Academy of Medicine have criticized these laws and recommend removal of these restrictions to improve access to care ( Federal Trade Commission, 2014 ; Institute of Medicine, 2010 ; National Governors Association, 2012 ). Indeed, states granting NPs greater SOP authority experience expanded health care utilization (Kuo, Loresto, Rounds, & Goodwin, 2013; Xue, Ye, Brewer, & Spetz, 2016).

In 2015, New York State (NYS) implemented the Nurse Practitioners Modernization Act ( New York State Department of Education, 2015 ). The law removed the required written practice agreement between NPs and physicians for experienced NPs with more than 3,600 hours of practice. New NPs with less than 3,600 hours of practice still are required to have this agreement. The outdated policy requiring NPs to have a written practice agreement with physicians limited NPs’ ability to independently care for their patients and practice in underserved areas with shortage of primary care physicians. This policy change aimed to promote NP independent practice and address the misdistribution of primary care services across NYS by allowing experienced NPs to practice independently in underserved areas ( Center for Health Workforce Studies, 2013 ). In this study, we assessed the perspectives of physicians and NPs on the barriers and facilitators of implementing the NP Modernization Act 18 months after the policy adoption. Assignment: National healthcare issues


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