Princeton, N.J.—A new policy brief from the Robert Wood Johnson Foundation (RWJF) highlights ways to clear barriers blocking Advanced Practice Registered Nurses (APRNs) from doing more to help meet the rising demand for health care services resulting from an aging population and the increased access to care called for by health care reform.
The brief, Improving Patient Access to High Quality Care: How to Fully Utilize the Skills, Knowledge, and Experience of Advanced Practice Registered Nurses, identifies a series of barriers to APRNs' practice, including:
- Legal hurdles, including state laws and regulations that prohibit APRNs from practicing to the full extent of their training and education, and Medicare and Medicaid reimbursement restrictions that effectively do the same;
- Institutional barriers, including hospital policies that are more restrictive than state laws and regulations, barring APRNs from admitting patients or performing certain procedures; and
- Cultural barriers, including resistance by some hospitals and other health care institutions to team-based, interprofessional care.
“The majority of states place significant and unnecessary restrictions on APRNs, causing delays in treatment, and making it difficult for APRNs to provide care in rural areas, where physicians are often scarce. Between health care reform and the aging patient population, we need all hands on deck,” said Maryjoan Ladden, PhD, RN, FAAN, RWJF senior program officer and the executive editor of Charting Nursing’s Future.
The brief highlights three models for better leveraging the skills, knowledge, and experience of APRNs, including:
- The U.S. Department of Veterans Affairs (VA) employs more than 5,000 APRNs, providing primary, specialty, acute, ambulatory, tele-health, and home health care services. Relying on the constitutional doctrine of federal supremacy, the VA plans to allow APRNs who meet certain criteria to practice to the full extent of their education and training without direct supervision from physicians, even in jurisdictions with more restrictive regulations.
- The University of Pennsylvania Health System has pioneered the Transitional Care Model, an approach that relies on APRN specialists to design and implement comprehensive plans for follow-up care for discharged hospital patients. An initial clinical trial of the approach produced strong results, providing improved health outcomes at significantly lower cost.
- The Duke University Health System's Department of Cardiovascular Medicine has adopted an interprofessional team-based approach to increase access to care and improve patient satisfaction. Under the new model, doctors, nurses, and Physician Assistants are all able to work to the top of their competency and licensure.
The brief is the 20th in RWJF's Charting Nursing's Future series. It is free and available online here. The next brief in the series, due later this summer, will focus on nurses' academic progression, gauging progress toward achieving the Institute of Medicine's recommendation that 80 percent of the nursing workforce have a baccalaureate or higher degree by 2020.
About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For more than 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter at www.rwjf.org/twitter or Facebook at www.rwjf.org/facebook.