COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority
Corresponding Author
Christopher H. Stucky PhD, RN, CNOR, CSSM, NEA-BC
Department of Nursing, Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, North Carolina, USA
Correspondence Christopher H. Stucky, PhD, RN, CNOR, CSSM, NEA-BC, Department of Nursing, Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, 2817 Reilly Rd, Ft Bragg, NC 28310-7301.
Email: [email protected]
Search for more papers by this authorWilliam J. Brown PhD, RN, FNP-BC, FAANP
Department of Nursing, Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl, Germany
Search for more papers by this authorMichelle G. Stucky DNP, RN, WHNP-BC, IBCLC
Cumberland County Public Health Department, Women's Health Nurse Practitioner, Fayetteville, North Carolina, USA
Search for more papers by this authorCorresponding Author
Christopher H. Stucky PhD, RN, CNOR, CSSM, NEA-BC
Department of Nursing, Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, Fort Bragg, North Carolina, USA
Correspondence Christopher H. Stucky, PhD, RN, CNOR, CSSM, NEA-BC, Department of Nursing, Center for Nursing Science and Clinical Inquiry, Womack Army Medical Center, 2817 Reilly Rd, Ft Bragg, NC 28310-7301.
Email: [email protected]
Search for more papers by this authorWilliam J. Brown PhD, RN, FNP-BC, FAANP
Department of Nursing, Center for Nursing Science and Clinical Inquiry, Landstuhl Regional Medical Center, Landstuhl, Germany
Search for more papers by this authorMichelle G. Stucky DNP, RN, WHNP-BC, IBCLC
Cumberland County Public Health Department, Women's Health Nurse Practitioner, Fayetteville, North Carolina, USA
Search for more papers by this authorAbstract
The coronavirus disease 2019 (COVID-19) pandemic ushered in a new era for advanced practice registered nurses, as emergency regulatory and policy changes expanded the nurse practitioner (NP) scope of practice. The legislative changes enabled NPs to bolster the national pandemic response by working to the full extent of their education and training. The changes are only temporary, and many have contemplated the permanent impact of COVID-19 when healthcare transitions to a postpandemic normal. NPs now have a unique opportunity to educate others about the merit of their role and advocate for permanent legislative changes. In this creative controversy manuscript, we build a case that national NP full practice authority increases access to care and is vital for a sustainable and resilient healthcare system that can react to future pandemic crises.
REFERENCES
- 1 American Association of Nuse Practitioners. Coronavirus disease 2019 (COVID-19) policy and practice updates. https://www.aanp.org/advocacy/advocacy-resource/coronavirus-disease-2019-covid-19-policy-updates. Accessed September 16, 2020.
- 2Renke C, Callow L, Egnor T, et al. Utilization of pediatric nurse practitioners as adult critical care providers during the COVID-19 pandemic: a novel approach. J Pediatr Health Care. 2020; 34: 490-494.
- 3Lai AY, Skillman SM, Frogner BA Is it fair? How to approach professional scope-of-practice policy after the COVID-19 pandemic. https://www.healthaffairs.org/do/10.1377/hblog20200624.983306/full. Accessed August 1, 2020.
- 4 American Medical Association. AMA successfully fights scope of practice expansions that threaten patient safety. https://www.ama-assn.org/practice-management/payment-delivery-models/ama-successfully-fights-scope-practice-expansions. Accessed September 16, 2020.
- 5 American Association of Nuse Practitioners. More than 290,000 nurse practitioners licensed in the United States. https://www.aanp.org/news-feed/290-000-nps-licensed-in-us. Accessed September 16, 2020.
- 6Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press; 2011.
- 7 American Association of Nuse Practitioners. What's a nurse practitioner (NP)? https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner. Accessed September 16, 2020.
- 8 American Association of Nuse Practitioners. Nurse practitioners in primary care. https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioners-in-primary-care. Accessed September 16, 2020.
- 9Graves JA, Mishra P, Dittus RS, Parikh R, Perloff J, Buerhaus PI. Role of geography and nurse practitioner scope-of-practice in efforts to expand primary care system capacity: health reform and the primary care workforce. Med Care. 2016; 54(1): 81-89.
- 10Poghosyan L, Carthon JMB. The untapped potential of the nurse practitioner workforce in reducing health disparities. Policy Polit Nurs Pract. 2017; 18(2): 84-94.
- 11Buerhaus P, Perloff J, Clarke S, O'Reilly-Jacob M, Zolotusky G, DesRoches CM. Quality of primary care provided to Medicare beneficiaries by nurse practitioners and physicians. Med Care. 2018; 56(6): 484-490.
- 12Woo BFY, Lee JXY, Tam WWS. The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Hum Resour Health. 2017; 15(1): 63.
- 13Kurtzman ET, Barnow BS. A comparison of nurse practitioners, physician assistants, and primary care physicians' patterns of practice and quality of care in health centers. Med Care. 2017; 55(6): 615-622.
- 14Perloff J, DesRoches CM, Buerhaus P. Comparing the cost of care provided to medicare beneficiaries assigned to primary care nurse practitioners and physicians. Health Serv Res. 2016; 51(4): 1407-1423.
- 15Phillips SJ. 32nd annual APRN legislative update: improving access to high-quality, safe, and effective healthcare. Nurse Pract. 2020; 45(1): 28-55.
- 16 American Association of Nuse Practitioners. Issues at a glance: full practice authority. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief. Accessed September 16, 2020.
- 17Miller IF, Becker AD, Grenfell BT, Metcalf CJE. Disease and healthcare burden of COVID-19 in the United States. Nat Med. 2020; 26: 1212-1217.
- 18Bloom JA, Foroutanjazi S, Chatterjee A. The impact of hospital bed density on the COVID-19 case fatality rate in the United States. Am Surg. 2020; 86: 746-747.
- 19Ranney ML, Griffeth V, Jha AK. Critical supply shortages—the need for ventilators and personal protective equipment during the Covid-19 pandemic. N Engl J Med. 2020; 382(18):e41.
- 20Hu Z, Chen B. The status of psychological issues among frontline health workers confronting the coronavirus disease 2019 pandemic. Front Public Health. 2020; 8: 265.
- 21CDC COVID-19 Response Team. Characteristics of health care personnel with COVID-19—United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(15): 477-481.
- 22Alharbi J, Jackson D, Usher K. The potential for COVID-19 to contribute to compassion fatigue in critical care nurses. J Clin Nurs. 2020; 29(15–16): 2762-2764.
- 23Gray DM, 2nd, Anyane-Yeboa A, Balzora S, Issaka RB, May FP. COVID-19 and the other pandemic: populations made vulnerable by systemic inequity. Nat Rev Gastroenterol Hepatol. 2020; 17: 520-522.
- 24Grimm CA Hospital experiences responding to the COVID-19 pandemic: results of a national pulse survey March 23–27, 2020. 2020. https://www.oig.hhs.gov/oei/reports/oei-06-20-00300.pdf. Accessed September 16, 2020.
- 25 The Guardian. Covid-19 healthcare worker death toll: 821 deaths under investigation. https://www.theguardian.com/us-news/2020/jun/17/covid-19-coronavirus-healthcare-workers-deaths. Accessed September 16, 2020.
- 26 Centers for Disease Control and Prevention. Strategies to mitigate healthcare personnel staffing shortages. Healthcare Workers.https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html. Accessed September 16, 2020.
- 27Glenza J Retired health workers urged to return as US coronavirus cases set to spike. https://www.theguardian.com/world/2020/mar/25/retired-health-workers-return-us-coronavirus. Accessed September 16, 2020.
- 28Sellers FS, Hauslohner A Houston, Miami, other cities face mounting health care worker shortages as infections climb. https://www.washingtonpost.com/national/houston-miami-and-other-cities-face-mounting-health-care-worker-shortages-as-infections-climb/2020/07/25/45fd720c-ccf8-11ea-b0e3-d55bda07d66a_story.html. Accessed September 16, 2020.
- 29Stucky CH, De Jong MJ, Lowe AW, Mathews B. COVID-19: initial perioperative and perianesthesia nursing response in a military medical center. J Perianesth Nurs. 2020; 35(4): 353-356.
- 30Diez-Sampedro A, Gonzalez A, Delgado V, Flowers M, Maltseva T, Olenick M. COVID-19 and advanced practice registered nurses: frontline update. J Nurse Pract. 2020; 16: 551-555.
- 31 Centers for Medicare & Medicaid Services. Trump administration makes sweeping regulatory changes to help U.S. healthcare system address COVID-19 patient surge. Press Release. https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19. Accessed September 16, 2020.
- 32 American Hospital Association. HHS asks governors to extend capacity of health care workforce to address pandemic. https://www.aha.org/news/headline/2020-03-26-hhs-asks-governors-extend-capacity-health-care-workforce-address-pandemic. Accessed September 16, 2020.
- 33 American Association of Nuse Practitioners. AANP applauds President Trump on signing of CARES Act. https://www.aanp.org/news-feed/aanp-applauds-president-trump-on-signing-of-cares-act. Accessed September 16, 2020.
- 34O'Reilly KB CMS shouldn't permanently relax rules on physician oversight. https://www.ama-assn.org/practice-management/payment-delivery-models/cms-shouldn-t-permanently-relax-rules-physician. Accessed September 16, 2020.
- 35Carthon JM, Barnes H, Sarik DA. Federal polices influence access to primary care and nurse practitioner workforce. J Nurse Pract. 2015; 11(5): 526-530.
- 36Brenan M Nurses continue to rate highest in honesty, ethics. https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx. Accessed September 16, 2020.
- 37Sundean LJ, Polifroni EC, Libal K, McGrath JM. Nurses on health care governing boards: an integrative review. Nurs Outlook. 2017; 65(4): 361-371.
- 38 National Governors Association. The role of nurse practitioners in meeting increasing demand for primary care. https://www.nga.org/center/issues/health-issues/the-role-of-nurse-practitioners-in-meeting-increasing-demand-for-primary-care/. Accessed September 16, 2020.
- 39 Federal Trade Commission. Policy perspectives: competition and the regulation of advanced practice nurses. https://www.ftc.gov/reports/policy-perspectives-competition-regulation-advanced-practice-nurses. Accessed September 16, 2020.
- 40 American Nurses Association. ANA's principles for advanced practice registered nurse (APRN) full practice authority. https://www.nursingworld.org/~49f695/globalassets/docs/ana/ethics/principles-aprnfullpracticeauthority.pdf. Accessed September 16, 2020.
- 41 Bipartisan Policy Center. Strengthening the health professional workforce. https://bipartisanpolicy.org/blog/strengthening-health-professional-workforce/. Accessed September 16, 2020.
- 42Rudner Lugo N, O'Grady ET, Hodnicki D, Hanson C. Are regulations more consumer-friendly when boards of nursing are the sole regulators of nurse practitioners? J Prof Nurs. 2010; 26(1): 29-34.
- 43Martsolf GR, Kandrack R The impact of establishing a full scope of practice for advanced practice registered nurses in the state of Indiana. https://www.rand.org/pubs/research_reports/RR1864.html. Accessed September 16, 2020.
- 44 CGFNS International. Americans need nurses and demand more access, not less, physician groups say no. https://www.cgfns.org/americans-need-nurses-and-demand-more-access-not-less-physician-groups-say-no/. Accessed September 16, 2020.
- 45 American Nurses Association. Practice & advocacy. https://www.nursingworld.org/practice-policy/. Accessed September 16, 2020.
- 46 American Association of Nuse Practitioners. Advocacy resources. https://www.aanp.org/advocacy/advocacy-resource. Accessed September 16, 2020.
- 47 NursesEverywhere. Nurses everywhere. https://www.nurseseverywhere.com/. Accessed September 16, 2020.
- 48Kostas-Polston EA, Thanavaro J, Arvidson C, Taub LF, FAANP Health Policy Work Group. Advanced practice nursing: shaping health through policy. J Am Assoc Nurse Pract. 2015; 27(1): 11-20.