The business and practice of psychiatric advanced practice nursing in long term care

Abstract

Given the state of health care in the U.S. and the growing health care needs addressed by the Affordable Care Act of 2010, the Institute of Medicine (IOM) released The Future of Nursing: Leading Change, Advancing Health which identified challenges faced by the U.S. health care system and the significant role of nursing as a part of the solution ( Institute of Medicine, 2011 Institute of Medicine The future of nursing: Leading change, advancing health. The National Academies Press, Washington, DC2011 Google Scholar ). Among the top challenges to health care include an aging population and rising chronic diseases ( Institute of Medicine, 2011 Institute of Medicine The future of nursing: Leading change, advancing health. The National Academies Press, Washington, DC2011 Google Scholar ). While nurses, particularly advanced practice registered nurses (APRNs), are poised to fill provider shortages and to address health care needs across the health care system, there is a substantial need to deliver services in the community, especially long-term care (LTC) and assisted living facilities where, as of 2010, only 2.4% of APRNs work ( Dodaro, 2008 Dodaro G.L. Long-term fiscal outlook: Long-term federal fiscal challenge driven primarily by health care. https://www.gao.gov/products/GAO-08-912TDate: 2008 Google Scholar ; Institute of Medicine, 2011 Institute of Medicine The future of nursing: Leading change, advancing health. The National Academies Press, Washington, DC2011 Google Scholar ; Steinwald, 2008 Steinwald A.B. Primary care professionals: Recent supply trends, projections, and valuation of services. https://www.gao.gov/new.items/d08472t.pdfDate: 2008 Google Scholar ). In response to this demographic forecast, the Institute of Medicine, 2011 Institute of Medicine The future of nursing: Leading change, advancing health. The National Academies Press, Washington, DC2011 Google Scholar recommended that the Medicare program remove restrictions governing APRN practice. Other federal agencies, such as the Department of Veterans Affairs and the Indian Health Service allow most APRNs full practice authority regardless of state practice laws ( Indian Health Services, n.d Indian Health Services. (n.d.). Part 3 - Professional services, chapter 4 - Nursing: Advanced practice nurses: Scope of practice. Retrieved July 24, 2019 from https://www.ihs.gov/ihm/pc/part-3/p3c4/. Google Scholar ; Department of Veterans Affairs, 2016 Department of Veterans Affairs Advanced practice registered nurses. https://www.federalregister.gov/documents/2016/12/14/2016-29950/advanced-practice-registered-nursesDate: 2016 Google Scholar ; Sofer, 2017 Sofer D. VA grants most APRNs full practice authority. American Journal of Nursing. 2017; 117: 14https://doi.org/10.1097/01.NAJ.0000513271.43979.37 Crossref Scopus (4) Google Scholar ); yet, the Centers for Medicare and Medicaid Services (CMS) continue to defer to the state practice laws regarding APRNs' practice ( Centers for Medicare and Medicaid Services, 2012 Centers for Medicare and Medicaid Services Nursing facility services (codes 99304-99318). https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm4246.pdfDate: 2012 Google Scholar ), which greatly affects LTC residents' access to health care in states with more restrictive practice laws. The Federal Trade Commission, 2014 Federal Trade Commission Policy perspectives: Competition and the regulation of advanced practice nurses. https://www.ftc.gov/reports/policy-perspectives-competition-regulation-advanced-practice-nursesDate: 2014 Google Scholar concurs with the IOM that APRNs offer a unique solution to the provider shortage and lack of healthcare access, and that removing unnecessary APRN practice barriers can promote competition in the healthcare market and reduce healthcare costs.