Practice Authority Research Articles

Nurse practitioners’ perception of temporary full practice authority during a COVID-19 surge: A qualitative study

BackgroundAt the beginning of the COVID-19 pandemic in the United States, 22 state governors temporarily waived physician supervision of nurse practitioners to expand access to health care during the state of emergency. ObjectiveWe examined the nurse practitioner perception of the simultaneous scope of practice changes and the exigent pandemic demands during the initial COVID-19 surge in Massachusetts. MethodsQualitative descriptive design using content analysis of open-ended responses to a web-based survey of Massachusetts nurse practitioners conducted in May & June 2020. ResultsSurvey response rate was 40.6 percent (N = 389). Content analysis identified four themes including: 1) State waivers enabled more control over practice and more expedited care, 2) State waiver did not change practice either because of pre-established independence or employers not changing policy, 3) Perception of nurse practitioner role as both versatile and disposable and 4) Telehealth increased access to care and created an autonomous setting. ConclusionsAlthough findings suggest fewer barriers in some areas, the temporary removal of state-level restrictions alone is not sufficient to achieve immediate full scope of practice for nurse practitioners. There is a need for regulatory frameworks that optimize the capacity of the advanced practice nursing workforce to respond to global health emergencies. US-based policymakers and healthcare organizations should revise outdated scope of practice policies and capitalize on telehealth technology to utilize the full extent of nurse practitioners. Likewise, nursing leaders should be a voice for nurse practitioners to more effectively and safely maximize the nurse practitioner contribution during emergency responses. In countries where the role is under development, regulators can leverage these findings to establish modernized nurse practitioner scope of practice policies from the outset.

Reducing Nurse Practitioner Turnover in Home Based Primary Care: A Department of Veterans Affairs Quality Improvement Project.

Access to healthcare is challenging for both Veterans and the nation's general population. To keep up with national primary healthcare needs, the Department of Veteran Affairs (VA) implemented Home Based Primary Care (HBPC). After a structure remodel at a Texas VA medical center, 40% of nurse practitioners (NPs) left the HBPC department in one year. The Anticipated Turnover Scale and the Misener NP Job Satisfaction Scale were administered online (n = 7), and results were used to complete a program evaluation. Forty-three percent of participants indicated intent to leave, and 56% of answers indicated job dissatisfaction. Seven categories were identified to mitigate voluntary turnover: Recognition; Shared governance; Orientation; Full practice authority; Collaboration; Organizational workflow maps; and Mentoring. Implementation of recommendations resulting from this project may help retain NPs in both VA and non-VA organizations, reduce organizational costs, support optimal patient outcomes, and increase access to healthcare.

Socio-economic determinants of smallholder mixed crop-livestock farmers’ choice of climate change adaptation in the drylands of Northern Ethiopia

Purpose This paper aims to understand the perception of smallholder farmers on climate change, identify major livestock related climate change adaptation (CCA) strategies and their determinants in selected neighboring districts of Tigray and Amhara regions of Ethiopia. Design/methodology/approach A total of 416 household heads were involved in a questionnaire survey using a multistage sampling approach. To understand the socio-economic factors that influence farmers’ perception on climate change (CC) and/or variability, a binary logit model was used. Multinomial logit model was used to identify the determinants of smallholder farmers’ choices of adaptation strategies. Findings Milk reduction, weight loss, feed shortage and frequent animal disease outbreak were indicated as major impacts of CC on livestock production. About 86.2% of the farmers’ exercise CCA measures where livestock health care and management (25%), followed by livelihood diversification (21.5%) and shifting and diversification of livestock species (20.9%) were the top three adaptation measures implemented. Education, knowledge on CCA strategies, access to veterinary service and extension, market access, annual income, non-farm income, total livestock unit, sex of household head and household size were the major determinant factors to farmers’ choice of CCA. Research limitations/implications Concerned authorities working in CC related sectors should give due attention to improve smallholder farmers’ access to extension and veterinary services, market access and climate information to enhance their adaptive capacity to CC impacts. In addition, incorporating climate change awareness trainings into the existing extension packages is crucial to enhance the awareness of farmers on climate change and implement appropriate adaptation strategies. Moreover, it is very essential to provide appropriate herd management and marketing strategy based on the production system to avoid the significant price reduction during drought periods. Practical implications Concerned authorities working in CC related sectors should give due attention to improve smallholder farmers’ access to extension and veterinary services, market access and climate information to enhance their adaptive capacity to CC impacts. In addition, incorporating climate change awareness trainings into the existing extension packages is crucial to implement appropriate adaptation strategies. Moreover, it is very essential to provide appropriate herd management and marketing strategy based on the production system to avoid the significant price reduction during drought periods. Originality/value This research is focused on smallholder crop-livestock farmers, livestock-based CCASs and presents the determinant factors to their choice of adaptation.

The level of quality care nurse practitioners provide compared with their physician colleagues in the primary care setting: A systematic review.

There is an increasing demand for high-quality primary care providers without adequate supply to meet the need. Nurse practitioners (NPs) are uniquely positioned to fill this demand but influence on regulatory practice authority from concerned groups regarding patient safety and quality of care has delayed this as an effective solution. The objective was to address concerns abovt NP-led care by examining evidence regarding patient safety, clinical outcomes, cost, and patient satisfaction that reflect on the ability of NPs to provide high-quality care within the primary care setting and to compare their ability with standard models of care led by physicians. A systematic review was completed using PubMed, CINHAL Complete, and Scopus. Using PRISMA guidelines to critique literature and the John's Hopkins Research Evidence Appraisal tool, articles were analyzed comparing the quality of care between NP and physician providers in the primary care setting. A total of 11 articles met the criteria and reveal that NPs provide equal or better quality of care for all outcomes outcomes when compared with their physician colleagues. Quality patient care provided by NPs in the primary care setting is equal to, and in several cases superior to, that of physicians. Concerns for patient safety and quality care outcomes seem unsupported by data, and state legislatures should continue to grant full practice authority. as an effective source of providing high-quality primary health care.

The interaction between Greek affiliation and religiosity on problem drinking in college students

Objective: Greek affiliation is associated with increased problem drinking in college, while religiosity typically offers protective benefits. The current study examined the interaction between Greek status and religiosity-both public (e.g., religious attendance) and private (e.g., prayer frequency)-on problem drinking. Participants and Methods: Undergraduates (N = 477) completed an online survey battery in late spring 2019, at the end of their freshman year. Results: Analyses focused on prayer frequency were not significant; however, the two-way interaction between Greek affiliation and religious attendance was significant. There was no difference in problem drinking across Greek and non-Greek students when religious attendance was low. As frequency of religious attendance increased, Greek students engaged in increased problem drinking compared to non-Greek students. Conclusions: Greek involvement may undermine the protective authority of religious practices on problem drinking, in part through moral licensing, whereby morally sound behaviors (i.e., religious attendance) may justify past or future problem drinking.

A policy analysis of nurse practitioner scope of practice in Massachusetts.

Nurse practitioner (NP) practice has evolved since inception of the role in 1965. Educational requirements have been standardized requiring a master's degree, yet variation in NPs scope of practice exists across the United States. As the population ages and more Americans have health insurance coverage, the demand for health care continues to increase. Shortages of clinical providers and changes in hospital models of care continue to burden the health care system. Nurse practitioners have been found to provide safe, high-quality patient care and are a potential solution to ease the burden on our health care system. Nurse practitioner scope of practice restrictions limit the ability for NPs to practice independently. The purpose of this article was to analyze the advanced practice registered nurse's (APRNs) scope of practice policy in Massachusetts (MA) where APRNs just recently obtained full practice authority. Legislation to remove NP scope of practice restrictions in MA had been presented several times but was met with resistance from physician advocacy groups stating that NPs lack the education requirements to practice independently. A recent report from the MA Health Policy Commission demonstrates the impact that NPs have on lowering health care costs and servicing individuals in underserved areas of the state. During the pandemic, restrictions on NP scope of practice in MA were temporarily removed. It was realized that if NPs can practice independently during a pandemic, then they certainly are competent to practice independently at other times. A reassessment of NP scope of practice to allow for full authority should be completed nationally.

The Stories They Tell: What INGO Mission Statements Reveal about their Authority

ABSTRACT International nongovernmental organizations (INGOs) play an increasingly important role in global governance. Without coercive capacities, INGOs must build their authority to be heard, and ideally, influential in global governance. However, we know little about how INGOs build and defend their authority in practice. We argue that mission statements characterise how INGOs make authority claims to their audiences. Drawing on existing research on INGOs and global governance, we identify five dimensions of authority: accountability, representativeness, effectiveness, legality, and universal morality. We analyse the mission statements of 11 leading INGOs (high status) and 46 other INGOs (low status) from 2003 and 2013. We find that leading INGOs are more likely to emphasise accountability and legality while other INGOs are more likely to highlight representativeness. Our findings open up an exciting research agenda to study how authority relationships are constructed in global civil society.

Increasing Access to Medications and Devices for the Care of Low-Risk Childbearing Families: An Analysis of Existing Law and Strategies for Advocacy.

Limited access to medications and devices relevant to the care of low-risk childbearing families acts as a barrier to the successful integration of high-quality midwifery care into health care systems. Families who live in clinically underserved areas, whether urban or rural, are particularly in need of perinatal professionals who can provide comprehensive care. This article reviews existing US laws that impact whether families who choose community-based care with direct entry midwives have access, through their chosen provider, to the medications and devices relevant to their normal perinatal and postpartum care. Scope of practice and practice authority are considered as they relate to access to medications and devices primarily for certified professional midwives and state-licensed midwives. These professionals are the primary health care providers offering community-based care and birth at home and in freestanding birth centers. Washington state laws are compared and contrasted with laws from other states and jurisdictions, with the aim of identifying ways to improve service delivery for families who choose community-based midwifery care. Recent and historical efforts to expand Washington state's midwifery drugs and devices formulary are described. This discussion outlines the Washington context for direct entry community midwifery practice, highlights relevant legal examples, and describes current and future efforts around quality improvement.Information from a midwifery clinic serving some of Washington's most vulnerable pregnant and postpartum families allows for an exploration of the role that access to essential medications and devices might play in supporting midwives to address health inequities. Ideal statutory and regulatory language, lessons learned from an analysis of Washington's experience, and strategies to overcome barriers are described to aid and inspire midwifery advocates in other jurisdictions who want to increase access and enhance their ability to offer current evidence-based care. Policy makers can improve health, health equity, consumer choice, and access to evidence-based care by using ideal legal language for midwifery practice authority.

“What's the Brief?”

“What's the Brief?”

State responses to COVID-19: Potential benefits of continuing full practice authority for primary care nurse practitioners

BackgroundDuring the COVID-19 pandemic, federal and state governments removed the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions. PurposeTo support policy makers' efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline recommendations for policy, practice, and research. MethodsWe have conducted a thorough review of the existing literature. FindingsNP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost. DiscussionThe changes to support full practice authority enacted to address COVID-19 are temporary. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure.

Visual Anthropology

Visual anthropology encompasses two parallel aims: the production of anthropological media (including ethnographic film, video, photography, drawing, interactive media, etc.) as well as the anthropological analyses of media (including films, videos, photography, drawings, etc.). Conceptually, visual anthropology draws on theoretical and methodological connections between human perception and imagination, the use and production of audiovisual media, and ethnography. This entry explores how the work of visual anthropologists has contested, expanded, and transformed the discipline of anthropology. It also illustrates how the methods and debates in visual anthropology raise critically important questions about authorship, power, and the representation of culture that bear on the work of artists, filmmakers, photographers, curators, and journalists, among many others. The production of audiovisual materials in anthropological research is often overlooked. Yet technological advances in film and audio recording in the mid-twentieth century afforded anthropologists and filmmakers increasing opportunities to incorporate filmmaking into ethnographic and cross-cultural research. Since the 1980s, the establishment of visual anthropology programs within some academic departments, combined with the increased accessibility of video and digital media technologies globally, prompted important critiques of anthropological image-making and image use. It also helped develop new approaches to understanding visual experiences as a cultural practice. Four central concerns of visual anthropology at present are ethnographic filmmaking and theory, Indigenous and activist media, the study of visual culture, and multimodal anthropology. Taken together, this entry shows how visual anthropology has contested, expanded, and transformed understandings of power, authority, and meaning in media-making practices.

Implications of State Scope-of-Practice Regulations for Pediatric Intensive Care Unit Nurse Practitioner Roles.

Nurse practitioner (NP) advocacy efforts often focus on attaining full practice authority. While the effects of full practice authority in primary care are well described, implications for hospital-based NPs are less clear and may differ because of hospitals' team-based care and administrative structure. This study examines associations between state scope-of-practice (SSOP) and clinical roles of hospital-based pediatric intensive care unit (PICU) NPs. We conducted a national survey to assess clinical roles of PICU NPs including daily patient care, procedural, and consultation responsibilities as well as hospital-level administrative oversight practices. We classified SSOP as full or limited (reduced or restricted SSOP) practice. We present descriptive statistics and evaluate differences in clinical roles and hospital-level administrative oversight based on SSOP. The final sample included 55 medical directors and 58 lead (senior or supervisory) NPs from 93 of the 140 (66.4%) PICUs with NPs. There were no significant differences in daily patient care, procedural, or consultation responsibilities based on SSOP (p > .05). However, NPs in full practice authority states were more likely to bill for care than those in limited practice states (66.7% vs. 31.8%, p = .003), while those in limited practice states were more likely to report to advanced practice managers (36.7% vs. 13%, p = .03). For PICU NPs, SSOP was not associated with variation in clinical responsibilities; conversely, there were differences in billing and reporting practices. Future work is needed to understand implications of variation in hospital-level administrative oversight.

Nurse practitioner scope of practice and the prevention of foot complications in rural diabetes patients.

Diabetic foot ulcers afflict a quarter of type-2 diabetes mellitus patients and are associated with higher mortality rates among people with diabetes. Routine primary and preventive care is essential to both prevent and treat foot ulcers before they can contribute to further adverse outcomes. One approach for expanding this care to people with diabetes in rural communities is increasing the practice authority of nurse practitioners. This study examines whether the presence of nurse practitioner practice authority is associated with fewer foot ulcer complications in rural populations as measured through the incidence of foot debridement-a common procedure for addressing severe diabetic foot ulcers. This study uses medical claims to estimate the incidence of foot debridement for US counties. A multivariable linear regression was performed to examine the association between nurse practitioner practice authority and the county incidence of foot debridement after adjusting for measures of local health care workforce and sociodemographics. Nurse practitioner practice authority was associated with 219.4 fewer foot debridements per 10,000 enrollees (P < .001) in rural counties. Rural health clinics (P < .03) and skilled nursing facilities (P < .03) were also associated with fewer rural debridements. The number of nurse practitioners (P < .69) and primary care physicians (P < .69) per enrollee were not significant. No measure of health care workforce was associated with the incidence of foot debridement in urban counties. Expanding nurse practitioner practice authority may be an effective solution for preventing complications from diabetic foot ulcers in rural communities.

Tinjauan Yuridis Lembaga Penahanan Terhadap Pelaksanaan Perintah Penahanan Hakim Yang Terdapat Dalam Putusan Pengadilan

The purpose of this study is to find out first, how the arrangements of detention institutions to ensure legal certainty on the implementation of the judge's detention order (Ordering the defendant to be detained immediately) contained in the Court's decision. Second, to find out the juridical implications for the defendant and the Public Prosecutor on the implementation of the judge's detention order contained in the Court's decision. The method used in this research is a normative juridical research method. The results of the study said that in the public interest detention can be done with strict conditions. Therefore, the detention made against the defendant is limited by the rights of the suspect/defendant and the legislation is carried out in a limitative manner in accordance with the provisions of the Criminal Code. The implementation of the judge's detention authority in judicial practice there is ambiguity of legal norms because it is not regulated in the Criminal Code on the rules of judge's detention authority after the verdict is pronounced by the judge so that it gives rise to different interpretations from the point of view of the Public Prosecutor and Defendant's Legal Adviser. The judge's detention order is in accordance with the Instructions from the Attorney General of the Republic of Indonesia in his letter Number: R-89/EP/Ejp/05/2002 dated 06 May 2002 states: if there is an order to detain the defendant contained in the decision, then the Public Prosecutor must immediately execute it , although the decision does not yet have permanent legal force, because the implementation of the detention of the defendant carried out by the Public Prosecutor does not execute the court's decision, but merely executes the Judge's order contained in the verdict, as referred to in article 197 paragraph (1) letter k KUHAP.

Post COVID-19 Reimbursement Parity for Nurse Practitioners

Reimbursement parity of nurse practitioners (NPs) and physicians is appropriate now more than ever. Studies have demonstrated that NPs provide the same quality of care as physicians, yet they do not receive the same reimbursement. The rise in full practice authority states, as well as nurse managed clinics and retail clinics, has led to more NPs practicing independently. The COVID-19 pandemic opened a need for NPs to provide a greater amount of care in more settings, and thus led to temporary removals of practice restrictions to increase access to care. This article offers a review of the issues, such as “incident to” billing; direct and indirect reimbursement; and quality of care. We consider MedPAC and reimbursement policy, post COVID-19 policy solutions, and action steps to move forward to seek reimbursement parity. The COVID-19 pandemic serendipitously led to the removal of many restrictions on NP practice, offering an opportunity for NPs to work with MedPAC to achieve full reimbursement for care provided.

An exploration of perceived neonatal nurse practitioner authority in a restricted practice setting.

Perceptions of autonomy in practice affect Neonatal Nurse Practitioner (NNP) job satisfaction, retention, and motivation to pursue NNP roles. However, Novice to Expert theory describes the processes for transitioning to nurse practitioner roles are not in relationship with NNP practice autonomy. Relationships between Advanced Practice Registered Nurse (APRN) practice authority, state restrictions, APRN volume, and health care access exist. However, do APRN perceptions of autonomy relate to motivation to pursue practice authority? This study provides an exploration of perceptions of NNP practice autonomy in this context. Semistructured interviews conducted with NNPs and neonatologists practicing in a restricted setting explored perceptions of practice expertise and autonomy, based on Patricia Benner's Novice to Expert theoretical framework. Laddered methodology organized survey questions, and the Framework Method was used for analysis of results. The majority of eligible NNPs (n = 12, 67%) and neonatologists (n = 8, 67%) agreed to study participation. Identified themes were grouped into larger concepts, including "NNP practice authority," "NNP expertise," and "NNP autonomy." For example, "NNP expertise" included the theme "determining NNP expertise" and associated factors included "procedural skills," "years and acuity of practice level," and "confidence in management plan and emergent situations." Both neonatologists and NNPs perceived neonatologists as a practice authority with support for NNP autonomy. Factors indicating NNP expertise correlated with domains in Benner Novice to Expert theory. These findings support previous work concerning the evolution of expertise and transition to practice. More inquiry to understand perspectives of APRNs in restricted practice settings is indicated.

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.

Expertise within democracy: the case of New Zealand’s climate change commission

ABSTRACT The Climate Change Commission (CCC) has a mandate to provide independent, expert advice to the New Zealand Government to enhance the clarity and stability of climate change policies. This institutional innovation has occasionally been rationalised as a form of expert rule, especially by analogy with central banks. In reality, however, the CCC only has advisory powers, so lacks the practical authority to enforce rules or operate policy instruments. How then might the CCC exert greater influence on the low-emissions transition? One option is to double-down on the model of expert rule – that is, to create exceptions to parliamentary sovereignty and to empower the CCC as a technocratic (or epistocratic) institution that has independence over the means (and ends) of climate change policy. Subsequently, the CCC would have a right not only to be believed, but obeyed. But this is politically improbable and also increases the CCC’s susceptibility to trends in political culture and mass media that erode the epistemic privilege of experts. Accordingly, this paper offers reasons for the CCC to deepen its entanglement with democracy, such that its epistemic authority might achieve greater practical authority by informing the ends of popular sovereignty.

Students' experience of online learning during the COVID-19 pandemic: A province-wide survey study.

Online learning is currently adopted by educational institutions worldwide to provide students with ongoing education during the COVID‐19 pandemic. Even though online learning research has been advancing in uncovering student experiences in various settings (i.e., tertiary, adult, and professional education), very little progress has been achieved in understanding the experience of the K‐12 student population, especially when narrowed down to different school‐year segments (i.e., primary and secondary school students). This study explores how students at different stages of their K‐12 education reacted to the mandatory full‐time online learning during the COVID‐19 pandemic. For this purpose, we conducted a province‐wide survey study in which the online learning experience of 1,170,769 Chinese students was collected from the Guangdong Province of China. We performed cross‐tabulation and Chi‐square analysis to compare students’ online learning conditions, experiences, and expectations. Results from this survey study provide evidence that students’ online learning experiences are significantly different across school years. Foremost, policy implications were made to advise government authorises and schools on improving the delivery of online learning, and potential directions were identified for future research into K‐12 online learning. Practitioner notesWhat is already known about this topic Online learning has been widely adopted during the COVID‐19 pandemic to ensure the continuation of K‐12 education.Student success in K‐12 online education is substantially lower than in conventional schools.Students experienced various difficulties related to the delivery of online learning. What this paper adds Provide empirical evidence for the online learning experience of students in different school years.Identify the different needs of students in primary, middle, and high school.Identify the challenges of delivering online learning to students of different age. Implications for practice and/or policy Authority and schools need to provide sufficient technical support to students in online learning.The delivery of online learning needs to be customised for students in different school years.

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS