Please respond to discussion below using APA 7th edition and 2-3 references. Pr

Please respond to discussion below using APA 7th edition and 2-3 references.
Prescriptive Authority
One barrier that has slowed down the progress of advanced practice nursing is the prescriptive authority based on each state. There are three divisions that the
American Association of Nurse Practitioners have created to categorize each state. These include restricted, reduced, and complete or full. If a state allows full practice
authority, the advanced practice nurse may autonomously prescribe medications equivalent to a physician. There are twenty-two states that allow full practice authority.
In states that have reduced and restricted prescriptive authority, the advanced practice nurse requires supervision by a physician (Zhang & Patel 2022).
There are sixteen states who allow reduced practice authority. The last twelve states are fully restricted. The states that have reduced prescriptive authority have
different limitations for the medications that advanced practice nurses may prescribe. In the states that are restricted, the advanced practice nurse needs direct
supervision from a physician when prescribing controlled substances (Zhang & Patel 2022).
Over time, more strategies to overcome prescriptive authority are emerging. In the 1990’s, progress was made as the Controlled Substance Act allowed advanced
practice nurses to have prescriptive authority, but they also required authority by the DEA. The advanced practice nurses needed a DEA number tied to the physician
they were working with, which was found to be restricting. Later that year, they amended the Controlled Substance Act, and mid-level practitioners were able to obtain
their own DEA numbers in states where there was full prescriptive authority (Hamric et al., 2013). There is still progress that needs to be made but over time the
advanced practicing nurse’s ability to prescribe is expanding.
Identified Practice Environments
Another barrier that has slowed down the progress of advanced practice nursing is each state’s identified practice environments described as full, restricted, and
reduced. This is a barrier that interferes with an advanced practice nurse to provide care with their full educational training. When a state allows full practice authority,
the advanced practice nurse may evaluate, diagnose, interpret, and order diagnostic tests, initiate treatments, and prescribe controlled substances under their state’s board
of nursing license. In both reduced and restricted states, advanced practice nurses are not able to practice at least one domain that a full practice state allows. In some
states, a physician is required to delegate and continuously supervise advanced practice nurses for them to practice. This interferes with advanced practice nurses and
their full ability to provide care (Kleinpell et al., 2022).
Strategies that may help overcome these barriers include involving advanced practice nurses in the credentialing process within each organization and creating a
practice committee to support advanced practicing nurses. Another strategy is making sure we stay within our scope of practice when prescribing and assessing. These
strategies may assist in allowing advanced practice nurses to practice within their full extent of training and education. This leads to better patient care and outcomes
with a higher quality of care (Kleinpell et al., 2022).
Payor Policies
One last barrier that has slowed down the progress of advanced practice nursing is payor policies. Advanced practice nurses are reporting that payor policies have
a large, negative impact on practicing to the full extent of their education and training. Since advanced practice nurses may have a more restrictive scope of practice in
some states, this leads to payor policies being stricter and preventing advanced practice nurses from practicing independently. Many times, commercial health plans do
not recognize advanced practice nurses as primary care providers and must bill under a physician’s name, which leads to not paying the nurse practitioner directly or
reimbursing them at a lower rate (Hain & Fleck, 2014). A possible strategy for overcoming this barrier is to remove the barriers that are preventing advanced practice
nurses to practice independently. Advanced practice nurses have contributed to high quality primary care; therefore, they should be provided equitable pay (Hain &
Fleck, 2014).
References
Hamric, B. A., Hanson, M. C., & Tracy, F. M., & O’Grady, T. E. (2013). Advanced Practice
Nursing: An Integrative Approach (5th ed.). Saunders.
Hain, D., & Fleck, L. (2014). Barriers to NP Practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). https://doi.org/10.3912/ojin.vol19no02man02
Kleinpell, R., Myers, C. R., Likes, W., & Schorn, M. N. (2022). Breaking Down Institutional Barriers to Advanced Practice Registered Nurse Practice. Nursing Administration Quarterly, 46(2), 137–143. https://doi.org/10.1097/naq.0000000000000518
Zhang, P., & Patel, P. (2022). Practitioners and prescriptive authority. http://europepmc.org/books/NBK574557