Advanced Practice Nurses comprising nurse midwives, nurse anesthetics, and clinical nurse specialists play a crucial role in the health sector. APNs experience many barriers internally and from medicine as they try to acquire independence within nursing's dominion. The nurses may be willing to provide cost-effective and quality care, which is essential to the patients, but the barriers continue to affect them negatively. The difference in education preparation between the physicians and APNs poses an excellent challenge for APNs while carrying on their duties. Physician organizations believe that APNs are incapable of providing the same quality of patient care as physicians who have more rigorous and more extended training than APNs(Peterson, 2017). The doubt that if APNs may be able to prescribe narcotics and controlled substances is another major challenge. There is a policy of reducing licensure and practice regulated by a collaborative agreement with an outside health discipline before an APN provides patient care and prescriptions. The regulation states that for an APN to provide patient care, there must be team management., delegation, or supervision from an outside health discipline. APNs do not get the chance to follow their patients when they get admitted to acute care facilities. Continuity care to patients is a necessity that ensures the best care to patients until they fully recover. The reason for denying APNs admitting privilege is not yet apparent.
The federal trade commission critically creates competition at the national level through advocacy, study, and enforcement(Daniel & Tara, 2014). Competition in the health sector helps create expansion plans to provide better care to patients in remote areas, provide better service delivery models, better services, better-developed products, better methods for future and cost-effective quality medical care. Maryland state independently provides the extent of practice guidelines, which determines the scope of health care services ad procedures that numerous health care executives are permitted to give. These rules dictated to which extend the APNs are supposed to operate independently without supervision. The fact that APNs and other health practitioners may be licensed to provide the same services brings competition. The FTC rules have given a particular group of professionals the capacity to restrict entry to the market by an alternative, competing category of health practitioners, therefore refusing healthcare consumers the advantages of more considerable competition. The rules also address the role of doctors and physicians in supervising the APNs.Due to the APNs' outstanding performance in providing effective and safe health care, several institutions conclude that APNs can operate independently without supervision and remain within their range of certification, licensure, and training.
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The state legislative branch of Maryland consists of a 141-member house of delegates (42 republicans and 99 democrats) and a 47-member senate (15 republicans and 32democrats) ("Maryland government, state, local & federal," 2020). The house speaker steers the house of delegates while the senate president heads the senate. The state's executive branch comprises the governor, lieutenant governor, attorney general, comptroller, treasurer, and public works board. Interest groups play a crucial role in health care reform and other issues in the state of Maryland. The groups are of great value and need though they sometimes distract and annoy the APNs.
At the state and national level, the interest groups that influence the APN policy comprise members of the legislature, bureaucratic agencies, the patients, nurses, and physicians. The interest groups participate in lobbying for a specific stance associated with healthcare, which guides(Themes, 2017) the shaping of policies. The approach of government officials in the legislature to be able to influence policymaking. Members of the legislature extensively participate in the shaping of the APN policies.
Various methods are used to influence policy change, including generating public protest demonstrations and pressure, building alliances, rating government officials, and lobbying techniques(Themes, 2017). Interest groups try to influence the general public in pressuring the government to change individual policies. The interest groups also form coalitions with other groups interested in the same legislation. By combining efforts, they can multiply the influence of the independent groups and share expenses. By publicizing the legislators' voting records, the interest groups seek to influence the legislators to be on their side. The interest groups act as lobbyists and directly interact with government officials in an attempt to control them.
In conclusion, APNs experience a variety of barriers that hinder their healthcare service delivery. These barriers are mainly caused by the underestimation of the APNs' capability to work correctly without supervision. Competition brought about by organizations involved in APNs' policymaking hinders APNs having the freedom to work independently. Lawmakers, especially in the legislature, are directly engaged in APNs' policymaking. Interest groups mainly focus on influencing the legislature to make policies that favor them through various methods such as lobbying.
References
Daniel, G. J., & Tara, K. I. (2014, March). Competition and the Regulation of Advanced Practice Nurses . Federal Trade Commission | Protecting America's Consumers. https://www.ftc.gov/system/files/documents/reports/policy-perspectives-competition-regulation-advanced-practice-nurses/140307aprnpolicypaper.pdf
Peterson, M. E. (2017, January). Barriers to practice and the impact on health care: A nurse practitioner focus . PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/
Themes, U. (2017, March 18). Interest groups in health care policy and politics . Nurse Key. https://nursekey.com/interest-groups-in-health-care-policy-and-politics/
Maryland government, state, local & federal . (2020, November). Maryland State Archives. https://msa.maryland.gov/msa/mdmanual/01glance/html/govern.html
