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Nursing

Identify and describe practice barriers for APNs in your state (ALABAMA) and discuss
these barriers on a state and national level.
The ability of APN s to work maximumly as per their training and education is an issue
in many states in the U.S. although allowing full practice for APNs is necessary for keeping
health costs down and ensuring effective delivery of healthcare services, some states such as
Alabama still restrict the practice of APNs. Alabama does not authorize APNs to prescribe
controlled substances, and it is one of the states that restrict APNs from providing such
prescriptions for their patient’s care. The restrictions to practice that are placed on APNs limit
their scope of practice, and this affects patients.
At the national level, APNs are allowed full practice authority, and there are no barriers
that may hinder their ability to transform primary care and practice maximumly. APNs are
expected to engage in full practice as pertains to their education level and training. By 2017, 44
percent of states, which equates to 22 states and the District of Columbia, had allowed APNs to
engage in the full practice (Peterson, 2017). Full practice authority is based on the mandate given
to APNs upon attaining the necessary qualifications. All APNs are given the mandate by state
practice and licensure laws to assess patients and take them through the necessary medical
processes until the stage where they are ready to start treatments (Peterson, 2017). Included in
this mandate is the authority to prescribe medications, and this is provided for under the licensure
authority of the state board of nursing. Further, at the national level, the ability of APNs to fully
practice is limited by outdated federal policies (Poghosyan, 2018). Such policies have the
potential to limit the provision of accountable and safe care.

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Identify forms of competition on the state and national levels that interfere with the APN’s
ability to practice independently.
APNs’ ability to practice fully is not only restricted by state and federal regulatory
policies, but there are also employment organizations that interfere with their ability to function
independently. A study conducted showed that physicians receive support from medical
assistants when providing primary care. However, APNs do not get support from such staff, and
this makes them perform tasks that would have been delegated to registered nurses or medical
assistants. This leads to the underutilization of APN’s advanced skills and competencies. APNs
face competition that could interfere with their ability to function effectively. Some physician
groups even suggest that APNs work in teams supervised by primary care physicians, who are
best suited to lead such teams. Also, since physicians receive substantially longer training
programs compared to APNs, they are best positioned to form and lead health care teams
(Poghosyan, 2018). Primary care physicians pose competition to APNs because their roles in
regard to the provision of primary care are similar.
Identify the lawmakers at the state level (i.e., key members of the state’s legislative branch
and the executive branch of government).
The Alabama legislative branch has a council that comprises of the majority and minority
leaders of each house, and key officials from the House of representatives such as The Speaker
and the Chairmen of Ways and Means, as well as key officials from the Senate such as the
Lieutenant Governor and six senators who are elected by the state.
Discuss interest groups that exist at the state and national levels that influence APN policy.
The Federal Trade Commission (FTC) recommended that APNs be allowed to engage in
full practice as restricting them affected the quality of care delivered to patients (Federal Trade

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Commission, 2014). Also, the National Governors Association (NGA) also advocated for
barriers to practice to be lifted for all APNs so as to guarantee optimum delivery of care to the
patients. Further, the National Academy of Medicine (NAM) also advocated for APNs full
practice as a way of achieving optimal utilization of these professionals (Federal Trade
Commission, 2014). Another group that has made contributions to the issue of the practice of
APNs is the Department of Veteran Affairs, which issued a rule to have APNs working in the
VA system engage in full practice.
Discuss methods used to influence change in policy in forms of competition, state
legislative, and executive branches of government and interest groups.
Public policy is designed by a political system. Interest groups aim to have an impact on
public policy. Some interest groups form political action committees that are used to rally
donors behind a certain cause. The funds can then be distributed to candidates in the campaign
process. The aim is to have certain candidates elected so that they can influence public policy
based on a certain ideology (Grossmann, 2012). Interest groups also organize meetings with
lawmakers. Lawmakers often lack time to address all issues raised. Lawmakers, in most cases,
rely on interest groups to highlight issues that may be facing citizens. Interest groups direct
lawmakers on the voting patterns that they should follow when making important decisions.
Interest groups also target members of certain committees. Interest groups understand the
importance of committees. Committees deliberate on important matters affecting the country.
Lawmakers lack expertise in every field. As a result, certain important matters are deliberated in
the committees. In influencing the decisions made by committees, interest groups influence
public policy. Interest groups also lobby the executive arm of government (Grossmann, 2012).

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Interest groups attempt to meet members of the executive and deliberate on important matters. In
doing so, the groups influence executive decisions made.

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References

Federal Trade Commission. (2014). Policy perspectives: Competition and the regulation of
advanced practice nurses. Washington, DC.
Grossmann, M. (2012). Interest group influence on US policy change: An assessment based on
policy history. Interest Groups & Advocacy, 1(2), 171-192.
Peterson, M. E. (2017). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner
Focus. Journal of the advanced practitioner in oncology, 8(1), 74.
Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioner
workforce and practice. Nursing Economics, 36(1), 43-46.