11212018Dear EditorAs a Registered Nurse currently pursuing a Nurse Practitioner license I

11/21/2018Dear Editor:As a Registered Nurse currently pursuing a Nurse Practitioner license, I would like to shed light on the incredible impact that giving NPs ability to work independently can make in healthcare. The purpose of this letter is to educate the public about the role of Nurse Practitioners and explain how providing NPs autonomy can benefit health of people nationwide. As a nation we are currently facing a shortage of both primary and specialist physicians by the year 2020 (Conover, 2015). Despite this issue, the US health care system is constantly seeking to improve patient outcomes, improve health of our population, and reducing costs (Judge- Ellis, 2017). Therefore, it is no surprise that when looking over the national objectives for improving health of all Americans, the first 10-year goal listed in Healthy People 2020 is the goal to “improve access to comprehensive, quality health care services” (“Access to Health Services”). Current barriers to health service include lack of primary care service providers, high cost of care, and delays in receiving care (“Access to Health Care”). Increasing the number of nurse practitioners that can practice independently solves these disparities. As of November 2018, only 21 states and District of Columbia allow NPs to practice independently: Washington, Oregon, Idaho, Montana, Wyoming, Nevada, Arizona, New Mexico, Colorado, North Dakota, South Dakota, Nebraska, Minnesota, Iowa, Alaska, Maryland, District of Columbia, Connecticut, Rhode Island, New Hampshire, Vermont, and Maine (“State Practice Environment”). Expanding the number of states that allow NPs to practice independently helps bridge the gap created by the shortage of primary care, the lower service rates charged by NPs helps lower the cost of care, and the overall ability to work without oversight helps improve the timeliness of care.The best health outcomes have been attributed to “finding a health care provider who the patient trusts and can communicate with” (“Access to Health Services”). The Nurse Practitioner role in primary care has been recognized to do just that. Studies show that NPs develop strong relationships with patients, help their patients achieve better health and lifestyle choices, and are able to achieve better patient satisfaction and patient outcomes with their methods (Judge-Ellis, 2017). As patients develop relationships with NPs, they are more inclined, based on NP support, to make better health and lifestyle choices (Judge-Ellis, 2017). Furthermore, studies examining safety and quality of care for APRNs have found that APRN practice outcomes are equivalent or better to those of physicians (Conover,2015). Nurse Practitioners’ ability to build trusting relationships helps build better patient-provider communication, that improves quality health care services, and improves overall patient outcomes and overall health of our population.The government’s goal to improve access to care is facing the imminent obstacle that the projected shortage of primary and specialist physicians by year 2020 will create (Conover, 2015). This shortage will create barriers to health service, delays in care, and preventable hospitalizations (“Access to Health Services”). Making the shortage even more critical to solve, is the increase demand in people seeking health care that the “expansion of coverage under the Affordable Care Act” has created (Conover, 2015). Meanwhile, we have well qualified NPs that are being held back from practicing to their full extent. The “use of Nurse Practitioners is one way to address the shortage of physician primary care providers” (Kuo, 2013). Removing regulatory barriers and increasing the number of states with full privileged NPs would increase access to primary care. The solution is staring us right in the face. Reducing the cost of care is another issue that expanding the autonomous practice of Nurse Practitioners can solve. High cost of care has been identified by Healthy People 2020 as a barrier to health care service (“Access to Health Services”). Studies providing cost analysis have shown that “APRN-provided care is less expensive to society than the equivalent physician-provided care” (Conover, 2015). The following contribute to lower costs: “a) training costs are much lower; b) compensation levels are much lower; and c) resource use often is lower (e.g., hospitalization, procedure rates)” (Conover,2015). For instance, in North Carolina, NPs make $140,000 on average, whereas residents could make as much as $259,000 (Conover, 2015). Using North Carolina as an example, if APRN use was expanded, annual health cost savings could range from $433 million to $4.3 billion (Conover,2015). The potential savings for other states could be just as high. In fact, projections for overall health system savings from removing restrictive regulations on NP practices “range from 0.63 percent to 6.2 percent” (Conover, 2015). Expansion of NP use can offer even more health savings based on established trend of Medicare patients seeking NP provided services. In fact, based on a 5 percent national sample of Medicare beneficiariesm between 1998-2010 “the number of Medicare patients receiving care from NPs increased fifteenfold” in the US (Kuo, 2013). Looking at Medicare reimbursements since January 1, 1998, we can already see the potential savings. Since then Medicare Part B has reimbursed NP provided services “at the rate of 80 percent of the lesser of the actual charge or 85 percent of the fee” (Conover, 2015). These projected savings ultimately remove barriers to access to care and offer more reason to expand use of independently practicing NPs. Overall, allowing Nurse Practitioners to practice independently increases access to health care, improves quality of care and patient outcomes, bridges the gap in the national primary care shortage, reduces health care costs, and improves overall health of our nation. Nurse Practitioners offer great patient-provider communication that nurtures healthy lifestyles. By expanding NP independent practice, we can offer primary care to meet the increasing demands for health care. The potential for savings also helps remove barriers to accessing health care. By bringing awareness to public regarding this issue, we can take steps to let NPs work to the full extent of their training, so they can provide accessible, timely, quality, affordable, comprehensive care that benefits people nationwide.Sincerely, Elina Golub RN BSN ReferencesAccess to Health Services. (n.d.). Retrieved December 9, 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-ServicesConover, C., & Richards, R. (2015, February). Economic Benefits of Less Restrictive Regulation of Advanced Practice Registered Nurses in North Carolina: An Analysis of Local and Statewide Effects on Business Activity. Retrieved November 20, 2018, from https://static1.squarespace.com/static/587a829ad2b8579268917db7/t/590f533003596e93eb6754b1/1494176565890/Report-Final-Version.pdf Judge-Ellis, T. (2017). Time and NP Practice: Naming, Claiming, and Explaining theRole of Nurse Practitioners. The Journal for Nurse Practitioners. Retrieved November 21, 2018, from https://www.npjournal.org/article/S1555-4155(17)30602-5/pdf.Kuo, Y., Loresto, F. L., Rounds, L. R., & Goodwin, J. S. (2013, July). States with The Least Restrictive Regulations Experienced the Largest Increase in Patients Seen by Nurse Practitioners. Retrieved November 24, 2018, from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.0072State Practice Environment. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment

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