Important Issue # 1

The nurse should be able to practice fully according to their education and training; however, there are a number of barriers impeding the process. In general, nursing is a profession that provide individuals healthcare by diagnosing and treating human responses to illness. As stated in Taber (1993), the nurse’s ability to function independently and make self-directed judgement depends on their professional background, motivation, and opportunity for professional development. Although this statement is a significant factor in the practice of nursing, limitations still exist that prohibit nurses ability to practice to the full extent. Healthcare is changing, therefore the nursing profession must continue to evolve. As stated by the Institute of Medicine of National Academies (IOM, 2011), nurses have great potential to become leaders of innovative strategies to improve the healthcare system, however historical, regulatory, and policy barriers present some limitations for generating wide spread transformation. Historically nurses were known to work, depending upon the supervision of the physician. Today the nursing profession is able make independent decisions, and be a colleague in a collaboration effort with other disciplines. The nursing profession has four categories of advanced practice registered nurses (APRNs) of different specialties: Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Nurse Midwives (CNMs), and Certified Registered Nurse Anesthetists (CRNAs). One of the most popular APRNs is the Nurse Practitioner. According to Huston (2010), nurse practitioners are registered nurses who are prepared through advanced education and clinical training to provide a wide range of preventive and acute health care services to individuals of all ages.  Nurse practitioners have a high degree of practice autonomy. Regulations that vary from state to state place limitations on the NP’s scope of practice according to Institute of Medicine of National Academies (2011); therefore regulatory barriers can restrict the scope of practice of an APRN by limiting or denying the authority to prescribe medication, admit patients, assess patient conditions and order and evaluate tests. Education, training, and safety is not a concern; rather political decisions is the known factor deciding the scope of practice for the NPs, (Institute of Medicine of National Academies, 2011). The state regulatory barriers have to be resolved to allow NPs to pratice fully. One resolution consist of the federal government issuing a policy for all states to follow. The IOM report (2011), suggests that the federal government can promote effective reforms by collection and disseminating best practices from across the country and incentivizing their adoption. Other recommendations listed in the IOM (2011), include the following: expand medicaid program to include coverage of APRN service within the scope of practice, just as physician services are covererd; and expand opportunities for nurses to lead with healthcare organizational support and help to take lead in developing/adopting innovative patient-centered care models. The nursing profession would succeed in the role as a leader in patient-centered care because nurses are patient advocates that care for each patient from a holistic approach. In order for the nursing profession to meet the requirements of practicing fully, nurses must first achieve higher levels of education.