DN733 Unit 6 Assignment: Policy Issue Analysis Worksheet

DN733 Unit 6 Assignment: Policy Issue Analysis Worksheet


Part I:

  1. This week, you will create and present a model of policy development and apply it to the policy or health care issue you analyzed in Unit 6. A minimum of five scholarly, peer-reviewed sources, external to assigned course readings, must be included. Include speaker notes for each slide.
  2. Prepare a PowerPoint presentation (20–25 slides) that includes:
    1. a description of the health care policy issue analyzed in Unit 6; I included my paper attached from Unit 6
    2. a brief summary of the policy and/or policy solutions for the issue;
    3. an explanation of the model you created and a graphic representation of the model;
    4. integration of the tenets of social justice, equity, and cultural proficiency in the model;
    5. an illustration in the model of innovative solutions to achieve policy implementation;
    6. a description of the stakeholders; provide rationale related to why they are stakeholders in this policy development and implementation;
    7. a discussion of the support required for the policy or policy solutions to be effective; Identify the role of research in policy development;
    8. an appraisal of data that supports this policy implementation;
    9. a discussion of how nurse as leaders participate as a member of the interprofessional team; and
    10. a summary of what you and your peers can do to strengthen nursing’s influence in the policy process.
  1. Grading criteria—

— Describes the health care policy or issue analyzed in Unit 6 using scholarly support.

— Summarizes the policy and/or policy solutions analyzed in Unit 6 using scholarly support.

—Creates and explains a model of policy development selected for the policy or issue; includes a graphic representation of the model using scholarly support.

–Integrates the tenets of social justice, equity, and cultural proficiency in the model using scholarly support.

–Illustrates in the model innovative solutions to achieve policy implementation using scholarly support.

—  Identifies stakeholders using scholarly support.

— Discusses the support required for the policy to be effective; Identifies the role of research in policy development using scholarly support.

— Appraises data that supports this policy development using scholarly support.

— Summarizes what you and your peers can do to strengthen nursing’s influence in the policy process using scholarly support.


DN733 Unit 6 Assignment: Policy Issue Analysis Worksheet

Part I

Analysis Criteria Response
Name of person completing the analysis; sphere of government




The person completing this analysis is Kimberly Clark, DNP, APRN, FNP-c. She is employed by the Texas Health and Human Services Commission

Is their potential bias? Explain your response.




As a practicing Family Nurse Practitioner in a Rural community, I am biased due to my employment and personal knowledge of the healthcare disparities in rural communities. I believe that APRN’s can bridge the gap in the provider shortage and increase access to quality care in rural areas of Texas and all over the United States.
What is the issue that requires a policy solution?





If APRNs were given full practice authority, would it bridge the gap in healthcare disparities and increase access to care addressing provider shortages?
Context: Add evidence for the following perspectives:

















Social:Healthcare provider shortages have been worsening and are expected to continue to decline in the next decade. Revising federal and state regulations and updating policies that prevent Americans from comparing health plans would allow for competition that would reduce healthcare costs (HHS, Treasury, & Labor, 2018, p.1).May organizations such as the Federal Trade Commission, National Governors Association, AARP, Robert Wood Johnson Foundation, and the Heritage Foundation have shown support for allowing APNs to practice at the top of their licensure and training. The Department of Veterans Affairs responded by immediately to access to care issues by granting the right for full practice authority to all APRNs working in VA hospitals, clinics, and facilities. This action addressed the critical findings with the lack of access for medical for veterans, thus ensuring access to care while providing quality care for our veterans(Rugs et al., 2021).

Economic: Nurse Practitioners (NPs) are prepared at the master’s and doctorate level to practice at the top of their licensure and training in medicine. This includes assessing patients and prescribe medications without the need for collaborating agreements with a physician to practice independently (Chattopadhyay &Zangaro, 2019). These nurses are ready to step in at moment’s notice and fill the void and gap for access to care, and immediately address healthcare disparities (HHS, Treasury, & Labor, 2018, p.1).

Ethical:Full practice authority is the authorization for NPs to assess, diagnosis, interpret tests, and initiate and manage treatment plans using medications prescribed by the NP.Policy restrictions prohibit NPs from caring for patients, even though they are masters and doctorally prepared nurses. Buerhaus (2018) explained that NPs in primary care can significantly impact access to care. He reported in his work titled, Nurse Practitioners: A Solution to America’s Primary Care Crisis, that APNsare most likely to see the vulnerable populations. The report also emphasizes the fact that the cost for Medicare patients is lower therefore creating cost savings at the source of the care. APNs have shown that they provide care that was of equal or more outstanding compared to that provided by other practitioners. Another key issue in the report supports the fact that there is no evidence that the lmitsplaced on NPs practice decreased the resources used by APRNs. In fact, the study shows that states with more restrictions used more resources than those without restrictions (Buerhaus, 2018).

Political: State licensure is the regulatory body for NP practice and is one of the barriers to NP’s full practice authority (FPA). Organized medicine is the most significant opposing stakeholder for full practice authority for nurse practitioners in Texasand every state in the United States. The American Medical Association (AMA) has adopted the stance that because physicians have more extended, more rigorous training, including residency, and they are superior in providing quality, safe care. They believe that NPs are not at the same level of standards (Hain & Fleck, 2018). The varying degree of physician supervision has the most significant impact on the NPs ability to have FPA. NP’s ability to fully practice at the top of their education and training. Even with the physician-led organizations opposing FPA, some consumer groups such as the AARP, have supportedFPA for NPs. The call to action is heard but, nursing cannot move because of the policy and legislative initiatives that stand in the way (Bridges, 2018). Texas is listed as 49th in the nation on access to and affordability of healthcare (AANP, 2021). The Institute of Medicine, the National Governor’s Association, the Federal Trade Commission, Brookings, the American Enterprise institute, and a dozen other organizations have all endorsed the policy. Within Texas, removing delegation barriers for NPs is supported by over 30 business, consumer, and healthcare organizations, including the Texas Association of Business, Texas Association of Health Plans, Texas Conservative Coalition Research Institute, AARP-Texas, Every Texan (Center for Public Policy Priorities), Texas Organization of Rural and Community Hospitals, University Health System, and others(TNP Texas Nurse Practitioners, 2022).

Legal:In 2021, Rep. Stephanie Klick, sponsor of HB 2029.The House Public Health Committee — chaired by Klick — held a hearing for the bill in March 2021, after which it was left pending. After this, the bill didn’t budge. Rep Klick explained that with the current pandemic and the snowstorms that Texas faced, it was just a hard session to get any bills passed, much less once so opposed by the legislative defense of the physician colleges who worked overtime to kill the bill (Kirshbaum, 2021).

Environmental:The Kaiser Family Foundation (KFF) 2021, reported research that there is a more significant proportion of NPs in areas such as Health Professional Shortage Areas and rural healththan physicians. The same study showed this is exaggerated in states withFPA for NPs (KFF, 2021). For example, one study found that NPs with FPA are 1.5 times more likely to practice in rural areas. The 2019 study for the KFF found that NPs serving rural communities increased from 25.2 to 41.3 for every 100,000 people, while the average number of physicians decreased from 59.5 to 47.8 for every 100,000 people KFF, 2019).

Cultural:NPs have been shown more comprehensive with their cultural competency approacheswithin the healthcare teams. NPs are trained in culturally sensitive subjects and situations. APRNs are encouraged to support advocacy, address contextual considerations, and are encouraged to adjusttheir treatments to meet the patient needs. They also developed multidisciplinary teams that emphasized holistic care to establish trust and to care for cultural differences while being able to cross boundaries, both with other health professionals and patients of diverse backgrounds(Karczewski, C. (2019)




CMS used data from all 3,143 counties in the US for 2016 and 2019 cost of Medicare, reported on the services provided during healthcare, other factors on the county level that are affecting access to health care and cost. Variations of regression models with cost functions were then used to show the numbers (CMS, 2020). The estimated cost functions enable (a) services to be  assessedfor the total national benefits (cost avoidance) that would provide significant cost savings if states were to lift restrictions on NP practices nationwide (b) the estimate for cost savings associated with counties in Texas that are lagging in lifting the restrictive policies; and (c) analysis of the role of NPs in cost-efficient delivery of overall care (CMS, 2020), (Markowitz et al., 2017).


Issue Analysis Part II

Who are the Stakeholders in this policy issue?

What is their ‘stake”?

What is their value orientation?








The main stakeholders for the FPA for Texas NPs are the NP policy activist, nursing advocacy experts, NPs in the communities, state legislators, nursing regulatory experts, nursing advocacy experts, nursing educators, physicians, and large employers of NPs, and leading health, policy, and consumer advocacy organizations (AANP, 2021; Buerhaus, 2018).

1.     The American Enterprise Institute – In 2018, the American Enterprise Institute submitted their support for FPA for NPs in Texas. They feel thatresearchersand organizations that influence health policy are increasinglyexpecting NPs can fill the void created by the lack of primary care physicians in Texas. The FPA would improve the uneven location of practice for primary care providers (Buerhaus, 2018). NPs can expand the role to fill the void in primary care with the support of stakeholders. (Buerhaus, 2018).

2.     AARP – In an AARP Public Policy from 2011-2012) The CEO of AARP Jo Ann Jenkins,endorsed the FPA for NPs in Texas. In the article, she wrote that States should allow all professionals to fully provide their training, knowledge, experience, and skills (Jenkins, 2018). She noted that Texas is wasting resources as more than 60 million American lives are waiting for physician services. Advanced Practice Registered Nurses (APRNs) could fill the gap if allowed (Jenkins, 2018).

3.     Texas Medical Association (TMA)- In March of 2021, Dr. Troy Fiesinger, Dr. Debra Patt, Dr. Cynthia Peacock, and Dr. Tina Philips all testified on behalf of the TMA regardingthe objections of TMA physicians to the passing of HB 2029(Berlin, 2021).They reported that the protests are because physicians are trained to provide complex differential diagnoses, develop treatment plans, order, and interpret test for 11 to 12 years.NPs are specifically trained to treat patients after a diagnosis and implement chronic disease management protocols (Berlin, 2021). Thedoctors also stated that the TMA believes that healthcare team members are not interchangeable; APRNs have their place on the team.TMA believes that APRNs are not trained to prepare them for independent practice. The TMA strongly supports improving access to care and lowering healthcare cost but will not support HB 2029 to do that (Berlin, 2021).



What are the health risk(s) addressed by the policy issue?








In a dissertation report by Nichole Alegria (2020), she reviews the literature to discuss how FPA for NPs can increase access to care and improve health for patient. Specifically,hypertension and diabetesare two of the costliest and most prevalent chronic disease that Americans face today (Alegria, 2020). The goal of FPA for NPs is to prevent these diseases and others from occurring by creating primary care available in every area of Texas, including the most rural of locations (Jenkins,2018).
How would the policy impact these risks? Use evidence.










Evidence suggests that policies that allow APRN to practice at the full extent of their licenses and training will decrease healthcare costs, improve access to care while maintaining a high quality of care, improve outcomes, and reduce preventable diseases (Ortiz et al., 2018; Holmes, 2016; Buerhaus, 2018).
Specify the policy consequences, both intended and unintended, to the best of your ability.











The opportunity for Texas to address the health care delivery crisis is imminent. The aging and growing population is needs care now. With the shortage of providers and increased enrollment into Medicaid, Texas must meet this need. If the policy is not changed,the supply of providers will not meet the demand.Patient wait times for acute and chronic care will continue to rise. Medicaid patients will have coverage, but unable to locate providers for healthcare within a timely,cost-effective way. Texas NPs will leave the state to practice in otherstates that have modernized licensure policies (H.R.J. Res. 387, 2019; CMS, 2020; Hain & Fleck, 2018).


Issue Analysis Part III

Specify 2-3 policy options (include ‘do nothing’ options – what happens if things continue as currently happening).













Do Nothing option –If the policy is not changed the supply of providers will not meet the demand, wait times for healthcare acute and chronic will continue to rise, Medicaid patients will have coverage but no healthcare within timely cost-effective manners, Texas NPs will leave the state for states that have modernized licensure policies (H.R.J. Res. 387, 2019; CMS, 2020; Hain & Fleck, 2018)


Policy option #1

Policy for a transition period for supervision of NPs until a criterion is met then the NP would be granted full practice authority(Martsolf et al., 2018).


Policy option #2

Policies for direct supervision of APRNs, limiting prescription authority


Policy Option #3

Full practice authority for APRNs – FPA will likely increase access to care, as well as improving patient satisfaction and decreasing healthcare cost (Martsolf et al., 2018).



Rationale for policy recommendations














To garner the support of the state Medical Board of Texas and physicians NPs must representkey stakeholders other than the community of nursesand focus on stakeholders, such as AARP, hospital health systems, other organizations that where NPs are employed and organizations that care for the underserved Americans who were apprised and stand to benefit of APRNs having FPA​

(Barton et al., 2021.


Identify criteria to evaluate policy options – enter on scorecard.





Put each policy option in the Scorecard to rate your policy and its alternative




Policy Options Scorecard

Identify your policy and reasonable options including a “Do Nothing” option.

Use this scorecard to rate your policy and the policy options. You can add criteria that you think are appropriate to your particular issue. Code your responses by using pluses and minuses.


Code: ++ strongly positive, + positive, — strongly negative, – negative


Criteria: Evaluate your policy on each of these criteria Do nothing Policy Policy Option # 1 Policy Option # 2 Policy Option # 3


+ + ++
Protection of rights




Administrative feasibility




Evidence-based practice


Environmental effects


+ ++


+ ++
Cultural considerations


++ ++


Final Policy Problem Statement:


The policy aims at supporting full practice authority for nurse practitioners in the state of Texas. Evidenced-base studies show that APRNs are skilled, available, and ready to fill the gap in the healthcare crisis in Texas. Stakeholders have pledged their support for the policy supporting APRNs to work at the top of their licensures, training and education, experience, and skills. Allowing FPA would significantly reduce healthcare disparities and reduce healthcare cost in Texas.




Recommended Policy Solution–Identify which of the policy alternatives is the best solution–give rationale.

This paper recommends two policy options based on the analysis, that is the adoption of full practice authority. The adoption of full practice authority immediately or the full practice authority to be granted after a supervisory period by a physician. These options will equip APRNs with the ability to provide high quality, accessible care to every resident in Texas in a timely cost-effective manner. APRNs are ready to meet the challenge of healthcare disparities in Texas.









Alegria, N. M. (2020). Effects of Full Practice Authority on Chronic Disease Outcomes Disease Outcomes and Costs [Doctoral dissertation, Walden University]. ScholarWorks. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=9629&context=dissertations

American Association of Nurse Practitioners (AANP). (2021). AANP’s 2021 state policy priorities. Retrieved from https://www.aanp.org/advocacy/state/ 2021-state-policy-priorities

Barton, M., Hannum, B. C., Lindsey, M., & Towle, T. (2021). The Path Toward Full Practice Authority: One State’s Strategy. The Journal for Nurse Practitioners, 17(2), 147–152. https://doi.org/10.1016/j.nurpra.2020.09.011

Berlin, J. (2021). Legislative Hotline: Independent Prescribing for APRNs: A Bad Idea. Texas Medical Association. https://www.texmed.org/TexasMedicineDetail.aspx?id=56239

Buerhaus, P. (2018). Nurse practitioners: A solution to America’s primary care crisis (Poverty Studies) [Executive summary]. American Enterprise Institute. https://www.aei.org/research-products/report/nurse-practitioners-a-solution-to-americas-primary-care-crisis/

Bridges, G. (2018, July 1). Nurses seek to fill primary care gap. AARP. https://states.aarp.org/texas/nurses-seek-to-fill-primary-care-gap

Buerhaus, P. (2018). Nurse Practitioners: A Solution to America’s crisis. Washington DC: American Enterprise Institute

Centers for Medicare and Medicaid Services (CMS). (2020). NHE fact sheet. Retrieved from https://www.cms.gov/ research-statistics-data-andsystems/statistics-trends-andreports/nationalhealthexpenddata/nhefact-sheet.htm

Chattopadhyay, S., &Zangaro, G. (2019) The Economic Cost and Impacts of Scope of Practice Restrictions on Nurse Practitioners. Nursing Economic$, 37(6), 273-283.

Hain, D., & Fleck, L. (2018). Barriers to np practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). https://doi.org/10.3912/ojin.vol19no02man02

Holmes, O. (2016). The case for full practice authority. Nursing, 46(3), 51-54. doi:10.1097/01.NURSE.0000480602.37640.a1

H.R.J. Res. 387, 86R Cong., 86R3025 (2019) (enacted). https://capitol.texas.gov/BillLookup/History.aspx?LegSess=86R&Bill=HB387

H.R. Res. HB 278, 86 (R) Cong., 86R 152 BEE-D Cong. Rec. 4065 (2020) (enacted). https://capitol.texas.gov/BillLookup/History.aspx?LegSess=86R&Bill=HB278

Jenkins, J., CEO, AARP. (2018, May 10). Advanced Practice Nurses Play an Essential Role in Health Care. AARP. https://www.aarp.org/health/health-insurance/info-2018/advanced-practice-nurses-healthcare.html

Karczewski, C. (2019). Enhancing cultural competence: Clinical settings, immersion experiences, service-learning, simulation, and nursing skills laboratory. In Teaching cultural competence in nursing and health care. Springer Publishing Company. https://doi.org/10.1891/9780826119971.0009

Kirshbaum, E. (2021, June 3). TNA outlines key to reviving bill to remove APRN restrictions. State of Reform. https://stateofreform.com/featured/2021/06/tna-outlines-key-to-reviving-bill-to-remove-aprn-restrictions/

Markowitz, S., Adams, E.K., Lewitt, M.J., & Dunlop, A.L. (2017). Competitive effects of scope of practice restrictions: Public health or public harm? Journal of Health Economics, 55(2), 201-218

Martsolf, G., Auerbach, D. I., &Arifkhanova, A. (2018). The impact of full practice authority for nurse practitioners and other advanced practice registered nurses in ohio.

Ortiz, J., Hofler, R., Bushy, A., Lin, Y., Khanijahani, A., &Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. Healthcare (2227-9032), 6(2), 65. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx? direct=true&db=edb&AN=131001514&site=eds-live&scope=site

Rugs, D., Toyinbo, P., Barrett, B., Melillo, C., Chavez, M., Cowan, L., Jensen, P., Engstrom, C., Battaglia, C., Thorne-Odem, S., Sullivan, S., & Powell-Cope, G. (2021). A preliminary evaluation of full practice authority of advance practice registered nurses in the veterans’ health administration. Nursing Outlook, 69(2), 147–158. https://doi.org/10.1016/j.outlook.2020.11.005

TNP Texas Nurse Practitioners. (2022). Texas Nurse Practitioners. https://www.texasnp.org/

The Kaiser Family Foundation (KFF) State Health Facts. Data Source: The Centers for Disease Control and Prevention (CDC). (2019) Percent of Adults Reporting Not Having a Personal Doctor. Retrieved from https://www.kff.org/state-category/ providers-service-use/access-to-care/

The Kaiser Family Foundation (KFF) State Health Facts. Data Source: The Centers for Disease Control and Prevention (CDC). (2021) Percent of Adults Reporting Not Having a Personal Doctor. Retrieved from https://www.kff.org/state-category/ providers-service-use/access-to-care/

U.S. Department of Health and Human Services, U.S. Department of the Treasury, & U.S. Department of Labor. (2018). Reforming America’s healthcare system through choice and competition. Retrieved from http://www.njccn.org/wp-content/ uploads/2018/12/Reforming-Americas-Healthcare-System-Through-Choice-and-Competition.pd