REVIEW OF CURRENT HEALTHCARE ISSUES NURS 6053

How the Healthcare Issue Impacts Organizations

In one of the hospitals I work in, there has been a shortage in hospitalist physicians. At times, the organization was paying a huge sum to fill this shortage with locum physicians. In Washington State, Nurse Practitioners (NPs) are allowed to practice unrestricted, therefore, the organization hired 5 NPs to work as hospitalists. This not only was a cost-effective solution but was also an employee retention solution, as many physicians were leaving the organization due to burn out. However, there are 16 states and 3 U.S. Territories that have reduced practice regulations and 12 states that have restricted practice (State Practice Environment, n.d.). These restrictions limit access to care. When I worked in Texas, the clinic that I worked in had a waiting list for primary care appointments that went out 45-60 days due to a shortage in physicians and the limitations put upon NPs scope of practice. If Texas had full practice authority for their NPs, they could have done like my current organization did and hired more NPs to fill the void, therefore increasing the access to care.

Description of the National Healthcare Issue

Physician supply has been impacted due to the long training times, the capacity of medical schools, and the lack of residency positions (Auerback et. al., 2018). Due to the reduced number of physicians treating patients, we have seen an increase in the number of advanced practice registered nurses (APRN), especially NPs and physician assistants (PAs) that have overlapped with the care that physicians provide. Although this has helped address the shortage of primary care providers and specialists, the restrictions put on NPs in certain states has become a barrier for them to practice fully and fill the need for more care providers. For instance, in New York, there are written practice agreements between NPs and physicians (Poghosyan et. al., 2018). In 2015, New York adopted the Nurse Practitioner Modernization Act that would remove these practice agreements for NPs that had at least 3,600 practice hours, however sadly it has not been fully adopted and NPs are still limited in their scope of practice. Texas is another state that limits NPs practice by requiring that they practice under the supervision of a physician within a 75-mile radius (Wofford, 2019). These regulations affect patient’s access to care and do not assist in achieving the nation’s goal of efficient and cost-effective care for all when limiting the skill set of less costly providers (Poghosyan et. al,. 2018).

In order to provide better access to care and more cost-effective care, we must adopt the same full practice authority for NPs in all U.S. states and territories. Giving NPs the right to practice their skills fully would alleviate the shortage of not only primary care provides but also specialists, where the access to care is often long.

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References

Auerbach, D. I., PhD., Staiger, D. O., PhD., & Buerhaus, Peter I,PhD., R.N. (2018). Growing

ranks of advanced practice clinicians — implications for the physician workforce. The

New England Journal of Medicine, 378(25), 2358-2360.

doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1056/NEJMp1801869

Poghosyan, Lusine, PhD, RN, Norful, Allison, PhD, RN & Laugesen, Miriam. (2018). Removing

restrictions on nurse practitioners’ scope of practice in New York State: Physicians’ and

nurse practitioners’ perspectives. Journal of the American Association of Nurse

Practitioners, 30, 354-360. https://doi.org/10.1097/JXX.0000000000000040

Pohl JM, Hanson C, Newland JA, Cronenwett L. Analysis & commentary. Unleashing nurse

practitioners’ potential to deliver primary care and lead teams. Health Affairs.

2010;29(5):900-905. doi:10.1377/hlthaff.2010.0374

State practice environment. (n.d.). American Association of Nurse Practitioners.

https://www.aanp.org/advocacy/state/state-practice-environment

Wofford, P. (2019, July 8). Texas nurse practitioners fight for full practice authority. Nurse.org.

https://nurse.org/articles/texas-nurse-practitioners-fight-for-practice/

RE: Discussion – Week 1

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Hi Laura,

REVIEW OF CURRENT HEALTHCARE ISSUES NURS 6053

I agree with you that shortages in physicians impacts healthcare. The enactment of the Affordable Care Act and the growing population has contributed to physician shortages in the United States (Zhang et al., 2020). With more people having access to healthcare it has become a harder task to find enough physicians to provide care to patients. I agree with you that lack of physicians can negatively impact health organizations because it causes a barrier in access to healthcare.

In my work setting we have been impacted with physician shortages. We only have one child psychiatrist available to our patients. Though our organization utilizes many psychiatric nurse practitioners at times the care that they can provide is limited. For example, when a child needs to be committed to our unit, the child needs to be assessed by two psychiatrists. Since we only have one psychiatrist available in the hospital, to complete the commitment the patient is assessed via tele-psyche. At times the patient refuses to speak with provider via tele-psyche and we then must wait for another provider to come in from another hospital. This at times causes a delay in care.

Though my facility like your facility utilizes psychiatric nurse practitioners to provide better access to healthcare, in certain situations there are still barriers met due to the limitations on what the nurse practitioner can do in NJ. In Massachusetts nurse mental health clinical specialist can file to commit a patient (Johnson and Stern, 2014). I agree with you that giving nurse practitioners full practice authority across the state can help with the impact that physician shortages can have on access to healthcare. Great Post!

References

Johnson, J. M., & Stern, T. A. (2014). Involuntary hospitalization of primary care patients. The primary care companion for CNS disorders, 16(3), PCC.13f01613. https://doi.org/10.4088/PCC.13f01613

Zhang, X., Lin, D., Pforsich, H., & Lin, V. W. (2020). Physician workforce in the United States of America: forecasting nationwide shortages. Human resources for health, 18(1), 8. https://doi.org/10.1186/s12960-020-0448-3

REVIEW OF CURRENT HEALTHCARE ISSUES NURS 6053