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

Kleinpell, Ruth M.; Myers, Carole R; Schorn, Mavis N.

doi:10.1016/s2155-8256(23)00064-9

Cited by 12 publications

(4 citation statements)

References 25 publications

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“…In this approach, autonomy in the ethical limits of the multi-professional relationship consolidates knowledge as a fundamental value for the action of social agents. This knowledge is built gradually, and with strong historical and cultural adherence, and changes, from this perspective, need solid foundations to be transformed, covering other issues within the scope of the labor, economic and administrative market in each profession ( 19 ) , having a cultural implication that is defined by the health need in each country. It refers to the job market, financial interest and fair and equitable salary recognition, which must come together to valuing and enhancement of professional work ( 10 ) , in which the struggles in favor of this finding characterize the control of the profession in both countries.…”

Section: Discussionmentioning

confidence: 99%

“…In Portugal, the Ministry of Education, by Decree Law 1999, implements the training regulations for Higher Nursing Schools and brings legislation to ensure the essential elements for their development: autonomy and independence among health professions, non-functional dependence on nurses to other professions and respect for technical autonomy and their own skills ( 1 , 8 , 19 ) . These standards guarantee professional relations, organization and health work in both countries.…”

Section: Discussionmentioning

confidence: 99%

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Nurse autonomy expressed in Portuguese and Brazilian professional legislation: a documentary study (1986–2022)

Bellaguarda,

Queirós

2023

Rev. esc. enferm. USP

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Objective: To analyze the convergence of nurse’s autonomy expressed in Brazilian and Portuguese professional practice legislation. Method: Qualitative, social-historical documentary study on the normalization of Brazilian and Portuguese professional standards for nursing practice, materials socialized in the digital collection of the profession’s organizational and disciplinary entities. Qualitative analysis from the perspective of Eliot Freidson’s sociology of professions. Results: Ten standards were analyzed, five from each country, which establish legislation for the nurses’ professional practice. The following categories emerged: autonomy of knowledge and specific competence of the profession, in the ethical limits of the multi-professional relationship and in the disciplining of training for professional practice. Conclusion: The professional autonomy under analysis implies providing access to services and to multi-professionality for the availability of health to society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nurse autonomy expressed in Portuguese and Brazilian professional legislation: a documentary study (1986–2022)

Bellaguarda,

Queirós

2023

Rev. esc. enferm. USP

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“…In addition, electronic health records that fail to acknowledge APN care obscure the visibility and contributions of these professionals, affecting patient communication and follow‐up care. Inadequate professional recognition, poor relationships with physicians and administrators, and insufficient remuneration and reimbursement further constrain the practice environment for APNs (Kleinpell et al., 2023). These barriers limit the scope of practice for APNs and contribute to disparities in access to healthcare between rural and urban areas, underscoring the urgent need for reform.…”

Section: Overcoming Barriers and Embracing Potentialmentioning

confidence: 99%

Advancing health globally: Seizing the moment with advanced practice nursing

Catton,

Stewart,

Schober

2024

International Nursing Review

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This special edition of the International Nursing Review (INR) focuses on advanced practice nursing (APN) as a transformative force in the global healthcare landscape, championing an evidence-informed, people-centred approach aimed at enhancing health outcomes and healthcare experiences across the continuum. Simultaneously, APN is designed to reduce healthcare costs, increase collaboration among healthcare providers and create a working environment that promotes individual and the healthcare team's wellbeing.Standing as beacons of opportunity, progress and potential, APNs are recognized not merely as participants but as pivotal drivers in the shift towards the realization of Universal Health Coverage (UHC). Through their specialized skills and knowledge, which are based on an advanced level of education, the attributes of APNs exemplify the potential to redefine healthcare paradigms, making an indispensable contribution to the health sector and healthcare outcomes globally. APN is a rapidly emerging phenomenon that commonly encompasses the concepts of clinical nurse specialists, nurse anesthetists, nurse practitioners and nurse midwives.

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“…Other restrictive regulatory policies requiring physician oversite, like authorizing patient referrals to the APN, limit role efficiency and capacity to increase access to timely care (Kleinpell et al, 2023). These policies should be evaluated and revised as needed to ensure optimal utilization of APNs and achievement of patient and health system outcomes.…”

Section: Next Steps For Evolving and Optimizing The Implementation Of...mentioning

confidence: 99%

Evaluation of the implementation of advanced practice nursing roles in France: A multiple case study

Schwingrouber,

Bryant‐Lukosius,

Kilpatrick

et al. 2023

Journal of Advanced Nursing

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AimsThe aims of the study were to describe the processes used to introduce advanced practice nursing roles and factors that facilitated or hindered role implementation, examine the time advanced practice nurses (APNs) spend in role activities and how these activities relate to domains of advanced practice nursing and examine how implementation processes influenced APN integration within healthcare teams.DesignA multiple case study was conducted.MethodsFive cases were included, representing the four population areas approved for advanced practice nursing in France. Data were collected from January to March 2021 using observation, interview and document analysis methods. Data were examined using thematic analysis.ResultsParticipants included APNs (n = 5), nurses/allied health providers (n = 5), physicians (n = 5), managers (n = 4) and decision‐makers (n = 4). Stakeholder engagement and leadership provided by decision‐makers, managers, physicians and APNs facilitated role implementation. Poor stakeholder role understanding, uncertain role funding, and the COVID‐19 pandemic hindered role implementation. APNs spent the most time in clinical activities. Participants perceived the integration of APNs within the healthcare team and their impact on patient care to be positive.ConclusionStakeholder engagement and organizational and APN leadership facilitated the implementation of the roles, especially related to team‐based patient care. Further efforts are needed to strengthen APN involvement in non‐clinical activities and address role barriers.Implications for nursing and patient careSystematic and system‐wide approaches are needed to improve role clarity, role autonomy and health systems integration of APNs. Research should examine patient perspectives about APNs in France.ImpactThe results highlight how policies can create favourable conditions for advanced practice nursing role implementation in France. Internationally, this study serves as a reminder to APNs and nurse leaders about the strategies for and importance of implementation evaluation to support the optimal development of advanced practice nursing roles.Reporting MethodThe study reporting followed the Consolidated Criteria for Reporting Qualitative Research.Patient or Public ContributionNo Patient or Public Contribution.

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

Cited by 12 publications

References 25 publications

Nurse autonomy expressed in Portuguese and Brazilian professional legislation: a documentary study (1986–2022)

Nurse autonomy expressed in Portuguese and Brazilian professional legislation: a documentary study (1986–2022)

Advancing health globally: Seizing the moment with advanced practice nursing

Evaluation of the implementation of advanced practice nursing roles in France: A multiple case study

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