Advanced Practice Registered Nurses Practice Research Articles

36th Annual APRN Legislative Update: Improving practice scope and authority, one state at a time.

Advanced practice registered nurses (APRNs) across the US continue to remove statutory and regulatory barriers to patients' full access to APRN care. The status of APRN practice in each US state and Washington, D.C. is examined, with any updates to practice authority and reimbursement reported.

Evaluating the Impact of Executive Orders Lifting Restrictions on Advanced Practice Registered Nurses During the COVID-19 Pandemic

In the early stages of the COVID-19 pandemic, strains on the healthcare system forced many U.S. states to revisit long-standing statutory limitations on the care coordinated by advanced practice registered nurses (APRNs). This was done by issuing waivers via executive, legislative, or board of nursing orders. To identify the impact of temporary practice waivers on APRNs' direct patient care during the COVID-19 pandemic. This cross-sectional study utilized a two-phased approach. First, a confidential online survey was conducted of APRNs practicing across 27 U.S. states. Second, comprehensive APRN discipline data from 2019 to 2021 were retrieved from the National Council of State Boards of Nursing's Nursys database and reviewed. Univariable and multivariable binary logistic regression models were used to determine the significance of observed trends. A total of 16,699 APRNs responded to the survey for a response rate of 14.2%. APRNs practicing in private outpatient clinics, in rural areas, and in health provider shortage areas were more likely to report a positive effect of the practice waiver (all p < .05). Providers noted that the waivers allowed them more time with their current patients and expanded the geographic boundaries of their direct patient care to take on new patients. Furthermore, despite the changing profile of APRN care during the early stages of the pandemic, including a pronounced increase in telehealth usage, the current review found no evidence of an uptick in discipline cases brought against APRNs in 2021. Full practice authority for APRNs benefits patients by promoting expanded access to care and increasing the resiliency of our healthcare system without compromising patient safety. It is time for states and organizations that employ APRNs to recognize that permanently removing barriers to APRN practice is essential to the health of our nation.

Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19

Advanced practice registered nurses (APRNs) play a pivotal role in providing healthcare, including preventive care services, to the public. However, barriers to APRN practice exist that impact the provision of vital healthcare services that APRNs are authorized to provide based on their education, training, licensure, and certification. This article provides an overview of APRN barriers to practice, including in the face of the COVID-19 pandemic, and discusses key policy and regulatory implications.

The State of Advanced Practice Registered Nursing in Alabama

Scope of practice for advanced practice registered nurses (APRNs) varies according to U.S. jurisdiction licensure requirements. Nineteen U.S. jurisdictions currently allow independent practice in all four APRN roles: certified nurse midwife (CNM), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS). Twenty-six U.S. jurisdictions allow full practice authority for CNPs. APRNs practicing in the remaining U.S. jurisdictions have varying practice restrictions, which are dictated by their state licensure laws. Alabama's scope and standards of practice restrict all APRN roles. During the initial months of the COVID-19 pandemic, Alabama was one of many U.S. jurisdictions that implemented emergency waivers, thereby expanding the scope of APRN practice and granting increased autonomy to APRNs while caring for more complex patients. Once the pandemic threat lessened, many U.S. jurisdictions, including Alabama, returned to pre-pandemic restrictive scope of practice regulations. Through empirical evidence, we conducted a review of APRN practice before, during, and after the pandemic. The literature included anecdotal reports of safe delivery of healthcare provided by APRNs working under the emergency waivers. The literature revealed that APRNs are prepared to practice to the full extent of their scope of practice and provide high-quality healthcare services to improve access to care. Alabama and other U.S. jurisdictions where APRN practice is restricted should advocate for legislative changes supporting APRN full practice authority commensurate with their educational training and certification.

35th Annual APRN Legislative Update: Updates to APRN practice authority in the United States.

Advanced practice registered nurses (APRNs) continue to make history by being at the forefront of legislative victories that have culminated in increased patient access to care. Modernization of APRN practice in various states, some influenced by the COVID-19 pandemic, has resulted in easing of regulations, including those relating to supervision, collaboration, license renewal, and portability, in reduced and restricted practice settings.

Psychiatric Nursing Workforce Survey: Results and Implications.

The last national survey of psychiatric-mental health (PMH) nurses was conducted in 2016 and was limited to advanced practice registered nurses (APRNs). Data on the demographic and employment characteristics of the PMH workforce could inform how to optimize the PMH nursing workforce to address increasing demands for mental health services. The objective was to conduct a national survey of PMH registered nurses (RNs) and PMH-APRNs to gather data on their demographic, educational, and practice characteristics. An email survey was administered between October 2020 and February 2021 to all members of the American Psychiatric Nurses Association and to all PMH-APRNs certified by the American Nurses Credentialing Center. Separate surveys included 51 questions (RN) and 52 questions (APRN). Survey questions were informed by several sources including the Minimum Data Set for the Behavioral Health Workforce. Surveys were completed by 4,088 PMH-RNs and 5,158 PMH-APRNs, with a combined response rate of 12.1%. Findings suggest that the workforce is aging but has increased slightly in diversity. In all, 62.4% of RNs reported a hospital as their primary employment setting, while the majority of APRNs (70.4%) practice in outpatient settings. Forty-four percent of the PMH-APRN respondents indicated that most of their patients receive federal insurance. Nursing must plan for significant retirements in the PMH workforce in next 5 years. Hospital-based practice continues to dominate PMH-RN roles but might be expanded to community-based settings teaming with PMH-APRNs in outpatient sites. Increasing the diversity of the workforce should be prioritized.

Breaking Down Institutional Barriers to Advanced Practice Registered Nurse Practice.

Advanced practice registered nurses (APRNs) significantly contribute to health promotion, disease prevention, and disease management. Yet, barriers to APRN practice exist, including regulatory, state, and institutional barriers, that hinder their ability to practice to the full extent of their education, licensure, and certification. Nurse leaders can play an important role in helping reduce unnecessary institutional barriers to APRN practice.

COVID-19 effects on practice: Perspectives of Tennessee APRNs.

BackgroundIn response to the COVID‐19 pandemic, Tennessee's Governor issued executive orders temporarily suspending certain practice restrictions on advanced practice registered nurses (APRN), which expired after 2 months as the pandemic worsened.PurposeThis purpose of this qualitative study was to analyze APRN interview data to evaluate how prepandemic APRN practice barriers, executive orders, and the pandemic affected APRN practice in Tennessee.MethodsFifteen Tennessee APRNs who completed the National APRN Practice and Pandemic study also completed follow‐up interviews via a HIPAA‐compliant Zoom platform. Given the unprecedented circumstances associated with the COVID‐19 pandemic, we conducted a qualitative descriptive study seeking descriptions and unique perspectives of Tennessee APRNs. Consistent with qualitative study design, we conducted an atheoretical study that featured interviews, purposeful sampling with maximum variation sampling, and content analysis.ResultsThe major themes were practice changes, impact of executive orders, and ongoing care barriers. The data revealed that patients, APRNs, and other health care providers were strained in new and profound ways during the pandemic. An underlying theme was Tennessee APRNs' frustration with continued regulatory and other practice barriers despite their state's health and health care disparities and under resourced health care system.ConclusionThese findings indicate the need to improve care access and health outcomes, advocate for full practice authority for APRNs, support telehealth expansion, address transportation deficiencies, and respond to the pandemic‐precipitated mental health crisis.

Results of a National Survey: Ongoing Barriers to APRN Practice in the United States

Limited information is available on the barriers to practice for advanced practice registered nurses (APRNs) among states with full, restricted, and reduced practice. The purpose of this study is to identify practice barriers in relationship to United States (U.S.) state practice authority, APRN type, area of practice (rural, suburban, urban), and nature of practice (outpatient, inpatient, and both). An electronic survey of a convenience sample of APRNs was conducted to assess barriers to practice. Identified barriers were examined based on state practice environment, APRN role, practice setting, and location. Data were analyzed using thematic analysis for qualitative data and descriptive analysis for quantitative data. Over 7,000 APRNs representing all 50 states participated. Themes that were identified and reported by respondents, included licensure and administrative barriers, therapy restrictions, physician signature requirements, a lack of collegiality, prescribing barriers, uneven reimbursement, physician only procedures, and telehealth issues. Barriers were identified in all states, regardless of the type of practice authority. All four APRN role types identified practice barriers, some of which were more frequent for some roles than others. Restrictions for home health approval and the requirement for a physician signature for durable medical supply orders were identified by over 40% of respondents practicing in rural areas. Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with full practice authority. Continued efforts to reduce barriers to APRN practice are needed to ensure patient access to care, especially in rural areas.

34th Annual APRN Legislative Update: Trends in APRN practice authority during the COVID-19 global pandemic.

Relaxation of existing regulations in supervision, collaboration, license renewal, and portability due to the continuing COVID-19 pandemic improved practice authority for advanced practice registered nurses (APRNs) in reduced- and restricted-practice states. This 34th Annual Legislative Update covers the scope of practice changes, and legislative and regulatory decisions that most impacted APRNs across the US in 2021.

Impact of COVID-19 pandemic on APRN practice: Results from a national survey

BackgroundThe impact of the COVID-19 pandemic on Advanced Practice Registered Nurse (APRN) practice is not well known. PurposeThis study aimed to describe state practice barriers and explore the effects of the COVID-19 pandemic on APRN practice. MethodsA descriptive study design used a 20-item web-based survey open from June 1 through September 23, 2020. FindingsA total of 7,467 APRNs responded from all 50 states, including nurse practitioners (n = 6,478, 86.8%), certified registered nurse anesthetists (n = 592, 7.9%), certified nurse-midwives (n = 278, 3.7%), and clinical nurse specialists (n = 242, 3.2%). A number of barriers to practice prior to the pandemic were identified. Most respondents (n = 6334, 84.8%) identified that practice barriers limited the ability of APRNs to provide care during the pandemic. DiscussionBarriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with Full Practice Authority (FPA), during the COVID-19 pandemic and with state executive orders waiving practice restrictions. The study findings can be used to advocate for policy changes to support APRN practice authority.

33rd Annual APRN Legislative Update: Unprecedented changes to APRN practice authority in unprecedented times.

In a year unlike any other in recent history, healthcare workers, including advanced practice registered nurses (APRNs), faced challenges and triumphs as the frontline in the battle against COVID-19. This 33rd Annual Legislative Update covers the scope of practice changes and legislative decisions that most impacted APRNs across the US in 2020.

Characteristics and practice patterns of advanced practice registered nurses caring for older adults: A survey of Gerontological Advanced Practice Nurses Association members

Advanced practice registered nurses (APRNs) play a pivotal role in meeting the increasing needs of elder care given the aging population. A good understanding of the characteristics of gerontological APRNs is important for future workforce planning. To understand the demographic, employment, and practice characteristics of APRNs who provide elder care. A 34-item survey was distributed to 2,500 current members of the Gerontological Advanced Practice Nurses Association. Three hundred and sixty-four members provided demographic information and employment and practice patterns. To examine the sample representativeness, the survey sample was compared with a sample drawn from the National Sample Survey of Nurse Practitioners 2012. Descriptive statistics were used for analysis. Most respondents were older than 55 years, held a master's degree, were certified as a Gerontology APRN, worked in a long-term/elder care setting as an APRN, earned a salary ranging from $105,001 to $125,000, and practiced in urban or suburban areas. Most respondents worked full time, provided care for people who were 55 to 75 years old, and prescribed under a collaborative agreement. The study results suggested that gerontological APRNs have the experience and competence to meet the increasing needs of elder care, practice in a variety of settings, including in rural areas, and spend much time with patients. Future efforts are needed to support APRN practice, such as improving their autonomy and independence.

AORN Position Statement on Advanced Practice Registered Nurses in the Perioperative Environment

AORN JournalVolume 112, Issue 4 p. 388-390 From AORNFree Access AORN Position Statement on Advanced Practice Registered Nurses in the Perioperative Environment First published: 29 September 2020 https://doi.org/10.1002/aorn.13182 Updated on February 16, 2022, after online publication: This position statement has been updated to include the following statement: AORN supports the American College of Nurse-Midwives position statement: The Certified Nurse-Midwife/Certified Midwife as First Assist During Surgery as the guidance for appropriate regulation, education, training, and credentialing for all midwives certified by the American Midwifery Certification Board, including those who are licensed in their states as APRNs. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat This AORN position statement delineates the definition and educational requirements for the advanced practice registered nurse (APRN) who works in the perioperative environment, including the preoperative, intraoperative, and postoperative patient care areas. Requirements for the APRN who practices in the role of first assistant at surgery are differentiated. The qualifications to be met and components of the clinical privileging process are described. POSITION STATEMENT AORN supports the role of the APRN in the perioperative setting who may or may not practice as a first assistant at surgery. AORN endorses the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education.1 AORN supports the American College of Nurse-Midwives position statement: The Certified Nurse-Midwife/Certified Midwife as First Assist During Surgery2 as the guidance for appropriate regulation, education, training, and credentialing for all midwives certified by the American Midwifery Certification Board, including those who are licensed in their states as APRNs. AORN believes that an APRN who practices in the perioperative environment must complete the education requirements as defined in the Consensus Model and be licensed or recognized as an APRN by the state in which he or she practices. AORN recommends that if a state regulatory agency elects to adopt this position statement as a requirement for eligibility to practice, the agency should develop a grandfather clause that allows the perioperative APRN and the APRN who is practicing as a first assistant at surgery at the time of adoption to continue to practice in that role within the state(s) of current licensure. Definition of a Perioperative APRN The perioperative APRN is a nurse who, as authorized by the applicable regulatory bodies, practices in the preoperative and postoperative areas; formulates clinical decisions in managing acute and chronic illnesses by assessing, diagnosing, and prescribing treatment modalities, including pharmacologic agents; promotes maximum patient functioning and wellness during performance of comprehensive health assessments; fosters patient advocacy and patient safety; uses the skills specific to the role of the APRN when diagnosing and treating the responses of the patient, family, and community to actual and potential health problems and the responses related to the prospect of having or of actually having an operative or other invasive procedure; uses the Standards of Perioperative Nursing Practice3 as a foundation for APRN practice; and incorporates specialized perioperative nursing knowledge and skills into the care of patients undergoing operative and other invasive procedures and care of the patient's family members. Definition of the APRN Practicing as a First Assistant in Surgery The APRN practicing in the perioperative environment as a first assistant at surgery functions in an expanded perioperative APRN role; must comply with all statutes, regulations, and institutional policies relevant to the APRN who first assists at surgery; is required, as of January 1, 2016, to acquire the knowledge and skills needed to provide safe, competent surgical first assistant services by completing a program that covers the content of the AORN Standards for RN First Assistant Education Programs,4 which may be a standalone program or may be a portion of a graduate or postgraduate program (eg, additional coursework included in an APRN graduate program); acts autonomously as part of the surgical health care team to achieve optimal patient outcomes in the preoperative and postoperative management of surgical patients and their complex responses to the surgical process; has responsibilities in the perioperative arena based on role-specific competency, patient populations, practice environments, accessibility of human and fiscal resources, and health care organization policy; works intraoperatively as a first assistant at surgery only and not concurrently as a scrub person or circulator; and works intraoperatively in a coordinated manner with the surgeon while using instruments and medical devices, providing surgical site exposure, handling or cutting tissue, providing hemostasis, suturing, and performing wound management. Clinical Privileging for the APRN Practicing as a First Assistant in Surgery The facility(ies) in which the APRN practices should establish a process to grant clinical privileges to the APRN as a first assistant at surgery. This process should include mechanisms to verify the APRN's professional education, licensure, certification, previous experience, professional references, qualifications to practice in the first assistant role, current and continued competency in the first assistant role, professional continuing education relevant to the first assistant role, health status, and malpractice and criminal history.5-10 RATIONALE Perioperative nursing is a specialized area of practice for the APRN. Specialty areas of practice require additional preparation. The perioperative APRN who works in the role of the first assistant at surgery is functioning in an expanded perioperative nursing role which requires additional specialized education. Glossary Advanced practice registered nurse: As stated in the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education (2008), an APRN is a nurse: who has completed an accredited graduate-level education program preparing him or her for one of the four recognized APRN roles; who has passed a national certification examination that measures APRN role- and population-focused competencies and who maintains continued competence as evidenced by recertification in the role and population through the national certification program; who has acquired advanced clinical knowledge and skills preparing him or her to provide direct care to patients, as well as a component of indirect care; however, the defining factor for all APRNs is that a significant component of the education and practice focuses on direct care of individuals; whose practice builds on the competencies of registered nurses (RNs) by demonstrating a greater depth and breadth of knowledge, a greater synthesis of data, increased complexity of skills and interventions, and greater role autonomy; who is educationally prepared to assume responsibility and accountability for health promotion and maintenance as well as the assessment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologic interventions; who has clinical experience of sufficient depth and breadth to reflect the intended license; and who has obtained a license to practice as an APRN in one of the four APRN roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP).1 REFERENCES 1 APRN Consensus Work Group, National Council of State Boards of Nursing APRN Advisory Committee. Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. https://www.aorn.org/guidelines/clinical-resources/position-statements. Accessed January 7, 2020. 2 American College of Nurse-Midwives. Position Statement: The Certified Nurse-Midwife/Certified Midwife as First Assistant During Surgery. https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000270/PS-First-Assist-Revisions-FINAL-Feb%202018.pdf. Revised December 2017. Accessed January 12, 2022. 3 AORN, Inc. Standards of perioperative nursing. https://www.aorn.org/guidelines/clinical-resources/aorn-standards. Accessed January 7,2020. 4 AORN, Inc. AORN Standards for RN First Assistant Education Programs. https://www.aorn.org/guidelines/clinical-resources/rn-first-assistant-resources. Accessed January 7, 2020. 5 Centers for Medicare & Medicaid Services. State Operations Manual Appendix A—Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. Rev 200. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Published February 21, 2020. Accessed June 22, 2020. 6 Centers for Medicare & Medicaid Services. State Operations Manual Appendix L—Guidance for Surveyors: Ambulatory Surgical Centers. Rev 200. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_l_ambulatory.pdf. Published February 21, 2020. Accessed June 22, 2020. 7 Human resources. In: Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission Resources; 2020: HR-1- HR-12. 8 Human resources. In: Comprehensive Accreditation Manual for Ambulatory Care. Oakbrook Terrace, IL: Joint Commission Resources; 2020: HR-1- HR-22. 9 Governance. In: Accreditation Handbook for Ambulatory Health Care. Skokie, IL: Accreditation Association for Ambulatory Health Care, Inc; 2018: 33- 40. 10 Administration. In: Accreditation Requirements for Ambulatory Surgical Centers. Chicago, IL: Healthcare Facilities Accreditation Program; 2017: 2-1– 2-17. PUBLICATION HISTORY Original approved by the House of Delegates, Atlanta: March 1995 Reaffirmed by the Board of Directors: December 2004 Revision approved by the House of Delegates: March 2006 Revision approved by the House of Delegates: April 2014 Revision approved by the Board of Directors: October 2014 Reaffirmed by the Board of Directors: February 2020 Editorial correction approved by the Board of Directors: January 2022 Sunset review: February 2025 Volume112, Issue4October 2020Pages 388-390 ReferencesRelatedInformation

The push to modernize nursing regulations during the pandemic

Advanced Practice Registered Nurses (APRNs) stand ready and willing to improve access to care across the United States, both during the COVID-19 pandemic and beyond. Yet, their practice remains restricted in certain states due to long outdated regulations, even as many other healthcare regulatory changes have occurred via executive order (e.g., allowing for telehealth reimbursement and expediated licensing). For instance, the APRN Compact has been on standby since 2015. When the Federal HHS Secretary called upon all governors to lift restrictions on APRNs during the public health crisis, seven of the 28 restricted states took no action, and the Southeast remained the most restricted area of the country. Now-in the Year of the Nurse and Midwife, during the COVID-19 pandemic-is the time to push forward on permanently removing APRN practice barriers. Nationwide, this can be accomplished by increased engagement of nurses, who may, in turn, engage the public, physician champions, and other pro-nursing organizations.

Effect of state regulatory environments on advanced psychiatric nursing practice

The first key message in the landmark Future of Nursing report is that “Nurses should practice to the full extent of their education and training” (Institute of Medicine, 2011). Although there has been significant progress across states to remove or diminish barriers to the exercise of full scope of practice by advanced practice registered nurses (APRN), state regulations continue to unnecessarily restrict APRN practice in most of the United States. This article integrates data from studies that examine how state and local regulation affects psychiatric mental health APRN practice with the literature on how state scope of practice regulation affects the size and distribution of the broader APRN workforce, access to care, health care costs and prices, and innovation in health care service delivery. Common themes include confusion about regulatory requirements and mixed experiences of mandated physician supervision.

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

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.

Are Antibiotics Useful in Acute Chronic Obstructive Pulmonary Disease Exacerbations? Implications for APRN Practice.

The Research to Practice column aims to provide advanced practice registered nurses (APRNs) with an analysis of current research topics with implications for practice change within emergency care settings. The article, "Antibiotics for Exacerbations of Acute Chronic Obstructive Pulmonary Disease?" conducted by D. Vollenweider, A. Frei, C. Streurer-Stey, J. Garcia-Aymerich, and M.A. Puhan (2018), examines a Cochrane systematic review and meta-analysis of randomized controlled trials. The investigators evaluate the findings that compare clinical outcomes including adverse events, re-exacerbation, treatment failure, and mortality among intensive care unit patients, inpatient, and outpatient populations treated with antibiotics or placebo medications for acute chronic obstructive pulmonary disease (COPD) exacerbations. The findings are discussed in the context of narrowing the evidence gap to improve clinical recommendations. Their findings have implications for APRN practice, including the signs and symptoms associated with an underlying bacterial triggered COPD exacerbation and the patient populations most likely to benefit from antibiotic therapy.

How advanced practice registered nurse practice barriers impact health care access in Michigan.

Despite the Affordable Care Act increasing the number of insured individuals in Michigan, many individuals cannot access care as the state continues to have a provider shortage that is likely to get worse. It is well documented that when individuals lack primary care access, their health suffers. Advanced practice registered nurses (APRN) could help reduce the state's health care shortage, as the care they provide is safe, cost effective, and high quality. Unfortunately, Michigan's APRN practice restrictions limit these professionals from autonomously providing care to the underserved and rural populations that need them the most. Indeed, Michigan is behind other states that offer full practice authority to APRNs, and its health outcomes reflect this stance. Eliminating the restrictive practice environment in Michigan will give citizens better access to primary care.

Driving high-functioning clinical teams: An advanced practice registered nurse and physician assistant optimization initiative.

Rapid changes in the health care marketplace are driving health care systems to modify operations by which the advanced practice registered nurse (APRN) and physician assistant (PA) clinicians serve patients. By identifying more effective and efficient utilization workflows, organizations can meet these demands resulting in high-functioning clinical teams. With the growing number of APRNs and PAs within a large academic medical center, there was a recognized need to establish effective and efficient utilization practices for these health care providers. Directors of the Advanced Practice Provider Best Practice Center developed an internal nurse practitioner (NP)/certified nurse midwife (CNM)/clinical nurse specialist (CNS)/PA assessment service in which evaluations were conducted to optimize APRN and PA practice at the clinical/department level. This assessment excluded certified registered nurse anesthetists. Thirty-two clinical areas were evaluated between September 2016 and May 2019. This included an NP/CNM/CNS/PA survey and over 200 individual NP/CNM/CNS and PA provider interviews. Assessments addressed utilization, billing practices, professional development, and communication among team members. Qualitative and quantitative reports were compiled. Many common themes were identified. These were broken down into three major categories: productivity, clinical operations, and professional development/support. Several recommendations were presented to department leaders regarding NP/CNM/CNS/PA practice. Those departments who implemented several of the recommendations showed positive outcomes. This was evidenced by increased financial gain (increased relative value units, increase in revenue generated), increased patient access (increased clinic densities), and overall NP/CNM/CNS/PA satisfaction.