NR506 Week 1 Discussion: Barriers to Practice

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NR506 Week 1 Discussion: Barriers to Practice – Step-by-Step Guide

The first step before starting to write the NR506 Week 1 Discussion: Barriers to Practice, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NR506 Week 1 Discussion: Barriers to Practice

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NR506 Week 1 Discussion: Barriers to Practice

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NR506 Week 1 Discussion: Barriers to Practice

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NR506 Week 1 Discussion: Barriers to Practice

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NR506 Week 1 Discussion: Barriers to Practice

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NR506 Week 1 Discussion: Barriers to Practice

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NR506 Week 1 Discussion: Barriers to Practice Instructions

Purpose

Discuss barriers to practice as an APN in one’s state from both a state and national perspective. Research methods to influence policy change from various forms of competition, state legislative and executive branches of government and interest groups. Have a look NR506 Week 2 Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study.

Activity Learning Outcomes 

Through this discussion, the student will demonstrate the ability to: 

  1. Discuss the history of policy development and policy-making in nursing (CO1) 
  2. Examine different types of policy and their relationships to healthcare policy (CO1) 
  3. Explain current barriers to practice for advanced practice nurses (CO2) 
  4. Discuss health policy and methods of lifting barriers to practice (CO2)

Due Date: Wednesday by 11:59 pm MT of Week 1 

Initial responses to the discussion topic must be posted by Wednesday 11:59 pm MT. Two additional posts to peers and/or faculty are due by Sunday at 11:59 pm MT.  Students are expected to submit assignments by the time they are due.

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday of week 1 by 11:59 pm MST, regardless of the number of days late. NOTHING will be accepted after 11:59 pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59 pm MT. 

Total Points Possible: 100

Preparing the Discussion

Using the readings from this week as well as reliable outside resources to: 

  1. Identify and describe practice barriers for all four APNs’ roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
  2. Identify forms of competition on the state and national level that interfere with APNs’ ability to practice independently.
  3. Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
  4. Discuss interest groups that exist at the state and national levels that influence APN policy.
  5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
  6. A scholarly resource must be used for EACH discussion question each week.

NR506 Week 1 Discussion: Barriers to Practice Example

Barriers to Practice

Georgia State laws regarding Advanced Practice Registered Nurses are significantly more restrictive compared to those of other states. APRNs in Georgia must have a protocol agreement with a supervising physician and adhere to additional supervision requirements. They are unable to prescribe Schedule II medications and their ability to order diagnostic tests is limited as well. Our healthcare laws in Georgia need to be modernized, allowing APRNs the authority to practice fully within the scope of their licensure and training. This will enable them to serve patients better and bridge the gaps caused by physician shortages.

Forms of Barriers

Georgia is currently categorized as a restricted practice environment, where advanced practice registered nurses are required to establish a Collaborative Practice Agreement, known as a nurse protocol agreement in Georgia, with physicians. According to existing legislation, a nurse protocol agreement is defined as a written document endorsed by an APRN and a physician, wherein the physician delegates certain medical tasks to the APRN, such as prescribing medications, medical devices, treatments, diagnostic procedures, or radiographic imaging tests in life-threatening situations. It is worth noting that Georgia stands alone among all states in imposing specific statutory restrictions on radiographic imaging tests (Kleinpell et al., 2023).

Physicians delegating authority through nurse protocol agreements are limited to engaging with no more than 8 APRNs simultaneously and supervising no more than 4 APRNs at any given time (Georgia Secretary of State, 2023). Furthermore, it is important to mention that APRNs are not authorized to prescribe Schedule I or Schedule II controlled substances according to current regulations in place. This discussion aims to explore the historical development and formulation of policies in nursing, evaluate various types of policies and their connections to healthcare policy, elucidate existing obstacles faced by advanced practice nurses in their professional field, and deliberate on health policy while considering strategies for eliminating these barriers.

At the national level, these obstacles reflect the broader discussion surrounding healthcare policy, shortages of healthcare providers, and limitations on accessing care. Advocates, including the American Association of Nurse Practitioners and other professional groups, stress the significance of eliminating these barriers for Advanced Practice Nurses (Denson & Timmons, 2022). By allowing APNs to utilize their education and training fully, it becomes feasible to tackle inequalities in healthcare and improve access to care in underserved areas.

Forms of Competition

In Georgia, “Advanced nursing practice” refers to the professional nursing practice undertaken by a registered nurse who satisfies the educational, practical, and certification criteria outlined by the Board. This category encompasses certified nurse-midwives, nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists in psychiatric/mental health care, as well as any other healthcare professionals mandated by the Board. Georgia was the final state to authorize prescriptive rights for APRNs and remains the sole state where APRNs are unable to order advanced imaging without limitations.

In this context, lawmakers and the Governor’s administration have consistently acquiesced to the sway of state medical associations (Bachtel et al., 2020). Attempts to eliminate barriers encountered by APRNs in terms of their scope of practice are consistently portrayed as contentious confrontations rather than collaborative endeavors aimed at enhancing healthcare accessibility. Hence, there may be opposition from physician organizations or lobbying groups at the state-level competition when it comes to expanding APRN practice autonomy. Their concerns often revolve around patient safety, scope of practice, and economic competition.

Key Lawmakers

The Georgia Board of Nursing ensures that the Nursing Practice Act and Board Rules and Regulations are upheld by establishing baseline criteria for nursing practice and education, investigating complaints lodged against nurses, and resolving said complaints (Georgia Board of Nursing, n.d.). The Board utilizes advisory committees to aid in its regulatory endeavors. Currently, the board is led by Tammy Bryant, who holds a Master’s degree in Nursing and a Bachelor’s degree in both Nursing and Registered Nursing Service Administration. She serves as the President of Practical Nursing Education on the board. Merry Fort, who holds a Bachelor’s degree in Nursing, serves as vice president for Registered Nursing Service Administration on the board. These influential individuals play key roles in enforcing laws through the state legislative authority – the Georgia State Assembly.

Interest Groups

In addition to presenting strong arguments regarding the challenges and facilitators of APRN care provision, multiple stakeholders play a role in shaping nursing practices in Georgia. During Crossover Day at the Georgia State Capitol, a small group consisting of two part-time lobbyists from the APRN coalition, two APRNs (out of approximately 15,000), and four dedicated high school volunteers worked tirelessly to pass HB 1092 (Bachtel et al., 2020). The bill aimed to eliminate radiology restrictions for Georgia APRNs.

Despite being outnumbered by a united front of medical lobbyists who engaged in private discussions with legislators throughout the chamber and hallways, the lobbyists remained steadfast in their efforts. The opposition argued that granting APRNs the authority to order advanced imaging would lead to increased costs and pose threats to patient safety. However, it is important to note that none of these claims have been supported by evidence from any of the other 49 states where APRNs are already permitted to order such tests. Nevertheless, organized medicine has consistently demonstrated its ability to come together when it perceives any potential challenge or threat facing its profession.

Methods Used to Influence Change in Policy

Nursing supporters in Georgia are intensifying their efforts to enhance participation from frontline nurses and their allies. The aforementioned interest groups have employed various lawful methods to influence policies, particularly those concerning APRNs. To effect change in healthcare policy, particularly regarding Advanced Practice Nurses, a comprehensive approach is necessary. This involves collaboration with diverse stakeholders, such as state government branches and interest groups, as well as addressing competition within the field.

In Georgia, APRNs have collaborated with their respective state and national nursing associations (such as the American Association of Nurse Practitioners and the American Association of Nurse Anesthetists) to advocate for favorable policy changes. Interest groups have also actively participated in lobbying efforts by engaging legislators through meetings, attending hearings, and emphasizing the importance of policy changes. Additionally, numerous research studies have been conducted and published, providing evidence that supports an expanded role for APNs and demonstrates their positive impact on healthcare access, quality, and cost-effectiveness.

Conclusion

Georgia has already experienced the consequences of inadequate access to primary healthcare, particularly in rural areas. An uneven distribution of physicians further compounds the issue. Advanced practice registered nurses possess the necessary training and expertise to bridge the gaps in our healthcare system, particularly when it comes to primary care. Over time, there have been advancements in healthcare education and practice that have resulted in various health professions sharing similar knowledge, skills, and expertise.

States that have adapted their licensure laws to reflect these educational developments are better equipped to address their residents’ primary care needs while also being flexible enough to embrace new models of delivering care efficiently using existing state resources. Regrettably, Georgia’s outdated licensure structure fails to recognize the professional capabilities of APRNs and only exacerbates the physician shortage within the state.

References

Bachtel, M. K., Hayes, R., & Nelson, M. A. (2020). The push to modernize nursing regulations during the pandemic. Nursing Outlook, 68(5), 545–547. https://doi.org/10.1016/j.outlook.2020.05.006

Denson, C., & Timmons, E. (2022, September 15). Addressing Georgia’s Healthcare Disparities: The Benefits of Full Practice Authority for Nurse Practitioners and Physician Assistants. Georgia Public Policy Foundation. https://www.georgiapolicy.org/publications/addressing-georgias-healthcare-disparities-the-benefits-of-full-practice-authority-for-nurse-practitioners-and-physician-assistants/

Georgia Board of Nursing. (n.d.). About the Georgia Board of Nursing. Sos.ga.gov. Retrieved October 28, 2023, from https://sos.ga.gov/page/about-georgia-board-nursing

Georgia Secretary of State (Ed.). (2023). Rules and Regulations of the State of Georgia: https://rules.sos.ga.gov/Download_pdf.aspx?st=GASOS&year=2023&depart=Departments&pdf=Department%20410%20RULES%20OF%20GEORGIA%20BOARD%20OF%20NURSING

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to APRN practice: Policy and regulatory implications during COVID-19. Journal of Nursing Regulation, 14(1), 13–20. https://doi.org/10.1016/S2155-8256(23)00064-9