Advanced practice registered nurses (APRN) are a vital part of the health system of the United States. APRNS are Master and post Masters level nurses providing care in specific roles for the patient population. APRNS are prepared by education and certification to assess, diagnose, and manage patient problems, order test, and prescribe medications. (National Council of State Boards of Nursing, n.d). Lyder (2012) discussed the growing need for an increased number of primary healthcare providers due to the shortage of primary care providers. Lyder (2012) recognized that the APRN, through experience and education as being primed to step in and fill the gap as providers of primary care. However, full acceptance of the APRN as an equally qualified autonomous provider of care continues to exist despite this growing need. This paper will address the barriers that arise from the philosophy and goals, model of care delivery and systems model, that contribute to the continued lack of acceptance of the APRN as an autonomous primary care provider.
Philosophy and goals. Factors contributing to the acceptance of the autonomous primary care provision by the APRN remains the confusion surrounding the lack of a common definition of the APRN which results from as lack of standardized programs leading to APRN preparation, and most importantly the lack of common legal recognition across jurisdiction (National Council of State Boards of Nursing, 2008). …show more content…
However, the National Council of State Boards of Nursing continues work to reach a mutually agreed upon consensus model, which clarifies the role of the APRN, standardizes basic entry level education programs, and most importantly unifies legal recognition across jurisdiction.
Systems Model and Model of patient care delivery by the APRN. Poghosyan, Lucero, Rauch, and Berkowitz (2012) reported that for about five decades, APRNS have been utilized to deliver primary care, traditionally in underserved areas or to vulnerable populations. However, despite the APRN being recognized a valued member the primary health care team and experiencing a steady growth and expansion as primary care providers in diverse settings, road blocks still exist as autonomous primary care providers. Contributing to the APRN lack of recognition continues to present challenges in the form of practice, policy, and research recommendations for better utilization of the APRN education, experience and skills (Poghosyan, 2012). Sibbald, Wathen, Kothari, and Day (2013) noted that primary health-care teams (PHCTs) are inter-professional teams that include, but are not limited to, physicians, nurse practitioners, nurses, physical therapists, occupational therapists, and social workers, who work collaboratively to deliver coordinated patient care. Team-based models of PHCT delivery have been created to achieve (or work toward) several benefits to the health system, health care providers, and patients, including better coordination of care, increased focus on collaborative problem solving and decision making, and a commitment to patient-centered care (Sibbald et al, 2013). Furthermore, the desired outcomes for PHCTs are reduced mortality and improved quality of life for patients, a reduction in health-care costs, and a more rewarding professional experience for the health-care worker. Organization’s philosophy and goals, model of patient care delivery, and systems model as a contributing factor for lack of acceptance for autonomous APRN practice. Marquis (2014) acknowledged the challenges of implementing primary health care on the PHCT model, in that PHCT mirrors many of the challenges seen in more traditional primary care, including hurdles in their formation; overcoming the traditional physician-dominated hierarchy in determining who should lead the team; role confusion; and determination of structure and function of the team. In addition, because the inter-professional team brings together differing viewpoints, life experiences, and knowledge of evidence-based practices, determining what knowledge is most important in caring for the patient can be confusing. Without doubt the difficulties of the PHCT model contribute to the confusion regarding the role of the APRN. Moreover, given that a large number of APRNS work within the PHCT model of care delivery, the importance of reaching an APRN consensus model highlight the important need to reach an agreed upon consensus model for the APRN regulation. Resolving areas of uncertainty and knowledge gaps, regarding the systems model to improve APRN acceptance as a primary care provider. Rhodes