Removing Practice Barriers for Nurse Practitioners

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Nurse practitioners provide Americans with important services in healthcare. Unfortunately, NPs face many barriers restricting them from full practice authority. Also known as autonomous practice, full practice authority includes the practice and licensure laws allowing nurse practitioners to practice to the full extent of their education.

To learn more, checkout the infographic below created by Duquesne University’s Online Doctor of Nursing Practice degree program.

Removing Practice Barriers Infographic

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Advocating Autonomy for Nurse Practitioners

A monumental report from the Institute of Medicine in 2010 clarified the reasons for giving nurse practitioners full practice authority, which will increase their ability to bring more health services to others. At this time, only one-third of U.S. states give full practice authority to nurses.

Key Points from the 2010 Institute of Medicine Report

According to this report, nurse practitioners should be permitted to practice within the full scope of their education and training. Nurses should also take advantage of recent improvements in today’s education system to pursue higher education and training. And they should be equal partners with other healthcare providers in the industry’s redesign.

However, effective planning and policy creation in the healthcare work environment require improvement in data collection and information infrastructure.

Barriers that Limit Nurse Practitioners

Even though nurse practitioners are allowed to order skilled nursing care, under Medicare, they are not authorized to conduct assessments and admit patients to nursing facilities. And while nurse practitioners are permitted to recertify patients’ eligibility and serve as attending providers, under Medicare, they are not authorized to provide the initial certification for hospice care. A physician is required to document a completed certification evaluation even if the nurse practitioner was the one responsible for conducting a face-to-face examination to certify for home healthcare.

Physicians and other healthcare professionals lack the full knowledge of the nurse practitioners’ scope. And strict payer policies linked to state practice and licensure limit the ability of nurse practitioners to practice independently, forcing them to be in practice as employees of physicians, hospitals or other entities.

The regulatory structure and practice environment for nurse practitioners vary from state to state. Some states allow full practice, but others are severely restricted and require full physician oversight.

Currently, 22 states allow full practice for nurse practitioners, 16 states allow reduced practice, and 12 states restrict practice and require full physician oversight.

Legislation Evolves to Enable Change

As the push for nurse practitioners to work autonomously continues, federal and state legislation is being passed to grant nurses full practice authority.

Medicare, Medicaid and Nurse Practitioners

While some states pay nurse practitioners the same Medicaid fee-for-service (FFS) rate that they pay physicians, at least 20 states pay them 75 percent to 95 percent of the physician fee for the same service. Medicare pays nurse practitioners 85 percent of the rate physicians receive. However, 75 percent of HMOs now credential nurse practitioners as primary care physicians, which is a significant increase.

Department of Veteran Affairs

On December 14, 2016, the Department of Veterans Affairs granted veterans direct access to care by nurse practitioners, certified nurse midwives and clinical nurse specialists working in the VA health system.

The Benefits of Full-Practice Nurse Practitioners

Nurse practitioners are prepared to give high-quality care through a combination of training and experience. Removing restrictions to the care they provide will benefit patients, nurses and healthcare as a whole.

Education of Nurse Practitioners

Students training to be nurse practitioners receive education and clinical experience before entering graduate school. This includes building physical assessment skills, interpreting diagnostic test results, and evaluating the appropriateness of medications and patient response to treatments.

Nurse practitioner students determine their patient population focus at the beginning of their education in order to match their knowledge and skills with the needs of their patients. A nurse practitioner’s education is based on competency, not time.

Benefits of Removing Barriers to Full Practice

There are numerous benefits that can come from removing barriers that prevent nurse practitioners from full practice. Doing this can improve access to essential healthcare services, especially in urban and rural areas. Removing barriers can also provide an efficient delivery of care by removing delays such as requiring physician oversight and collaboration. It can even decrease costs by reducing office visits, care services and repetition of orders, which could prevent duplication of services and billing costs.

According to the US Agency for Healthcare Research and Quality’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, nurse practitioners outscored physicians on over 75 percent of the satisfaction questions.

Giving nurse practitioners full practice authority allows them to utilize all their abilities to help others. Take a look at this infographic to learn more about how nurses are a valuable asset to healthcare in the United States.