DN733 Unit 6 Assignment: Policy Issue Analysis Worksheet

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

Social

Economic

Ethical

Political

Legal

Environmental

Cultural

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 49^th 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)

What is their ‘stake”?

What is their value orientation?

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).

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).

(Barton et al., 2021.

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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.

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.