Michele Pedulla, DNP, ARNP, CPNP-PC
A conversation with Dr. Michele N. Pedulla, ARNP, CPNP-PC Graduate Faculty Member, Purdue Global School of Nursing
Q. Why is APRN scope of practice important to me?
A. For all nurses, the importance of practicing to the full extent of education and training is at the heart of professional success and satisfaction. In fact, it is a core concept stated in a 2010 report from the Institute of Medicine (IOM), The Future of Nursing: Leading Change, Advancing Health. This report empowers every level of nurses to strive to reach higher goals academically and clinically.
Nurses are an integral part of the health care team, working not as part of a hierarchy, but rather collaborating with all health care professionals, including physicians, to improve the health of the nation one person at a time.
There is a trend nationally to move from illness-based services to health-based services and nurses are in a perfect position to take control and make a difference. Nursing is not a subset of medicine but rather a separate entity, with science and theories that apply uniquely to nursing and preserve the field's individuality. Working collaboratively with physicians and other health care providers, nurses are in a perfect position to set the table of change.
Q. Has there been progress toward the goal of expanded scope of practice?
A. Looking over the past year, there have been several areas of improvement. Three areas in particular were pivotal last year. These include the Nurse Practitioner State Practice Environment, the Campaign for Consensus, and the Federal Trade Commission's policy paper on the advanced practice registered nurse (APRN).
According to the American Association of Nurse Practitioners' Nurse Practitioner State Practice Environment, which indicates the positivity of the practice environment in each state, we are gaining ground. There are three levels:
- The green (Full Practice) states allow nurse practitioners to practice to the full extent of their education, including prescribing medications, and follow the recommendations for the practice model of the IOM and the National Council of State Boards of Nursing (NCSBN).
- The yellow (Reduced Practice) states decrease the ability of nurse practitioners to practice to the full extent in one or more areas and are regulated by outside sources other than the state board of nursing.
- The red (Restricted Practice) states again decrease the ability of nurse practitioners to practice to the full extent in one or more areas and require supervision, delegation, or team-management of the nurse practitioner by an outside health entity, thus blocking independent practice.
When comparing the figures for 2013 and 2014, two states moved from yellow to green, bringing the balance to 19 states plus the District of Columbia that are "green," 19 states that are "yellow," and 12 states are "red."
The movement toward expanded scope of practice for APRNs is gaining momentum, largely due to the Campaign for Consensus from the NCSBN. The goal of the campaign is to move toward uniformity in state laws for nurse practitioners through the Consensus Model for APRN Regulation, which will benefit health care professionals, regulators, and consumers.
The third area of change in 2014 was a policy paper from the Federal Trade Commission in which state legislators were strongly cautioned of the harm in limiting APRNs and scope of practice. This paper voiced strong support for the APRN as a primary health care provider, citing issues such as the shortage of providers and the need for improved competition for the benefit of the consumer. The paper also urged regulations that allow for a flexible system of collaboration between APRNs and other health care providers, including physicians.
Q. What will expanded scope of practice mean for APRNs?
A. APRNs will be able to practice to the full extent of their education and training, which will encourage a national shift from illness-focused to health-focused care. As the Consensus Model becomes a reality, a higher level of education and training may be in store for future APRNs. This may include doctorally prepared APRNs, the increased availability of residency programs for the new APRNs, and stringent certification examinations for APRNs. These goals are attainable with a collective effort, remembering that one does not DO nursing, one IS nursing.
Q. What can I do to support the effort of expanded scope of practice?
A. Nurses are encouraged to contact legislators and discuss in general how they perceive health care as the bedside provider and strive to make changes to improve health care for all. At all levels, nurses are expected to speak out and be heard.