Limited Scope of Practice for APRNs in Georgia and the movement toward Autonomy Ann Giedd
Catholic University of America
November 21, 2011
Independent practice is central to the APRNs professional role (Weiland, 2008). In Georgia, factors involving state rules and regulations such as the need for physician collaboration and supervision in order to diagnose and prescribe have created practice environments that are detrimental for full recognition of APRNs as autonomous providers, hence, keeping them from practicing to the full scope of their education (Weiland, 2008). In Georgia, the social and economic outcomes of supervision and lack of utilization of APRNs include a decrease in patient access to care, increased health care costs and a denial of the primary care provider status (Weiland, 2008). Additionally with the possibility of a physician shortage of almost 200,000 by 2020 and the influx of almost 23 million newly insured Americans needing primary care providers, the impact is that society is paying for the underutilization of a capable resource, not just financially but by a serious lack of access to care (Weiland, 2008). In Georgia, the role of APRNs can be carried out only with full professional recognition as independent providers (Weiland, 2008).
Twenty Four states and the District of Columbia allow independent practice for APRNs (Pearson, 2010). APRNs have independent offices and practices and work as hospitalists in various capacities in all of these regions (IOM, 2010). They provide competent, safe care and still collaborate with other medical professionals for the wellbeing of the patient they treat when needed (IOM, 2010). The collaboration of providers in these states are now working toward implementing a new model of patient care called the patient centered medical home model (PCMH) (IOM, 2010). This model stresses collaboration of all independent medical professionals.
Clearly, APRNs must articulate their independence as practitioners in order to attain fulfillment as professionals. Georgia state rules and regulations mandate that APRNs are regulated by not only the Board of nursing but also the Medical board. In order for APRNs to have autonomy to practice, they must have the trust and confidence of the Georgia medical board and community. Historically, physicians in Georgia have not wanted APRNs to practice independently, which has been a barrier to policy change. Collaboration though is the key to change. Physicians with early collaborative training with APRNs may have more positive attitudes toward APRNs, but even such exposure will not necessarily lead physicians to support APRNs’ independent practice (Street and Cossman, 2010). Scope and severity of the problem to be solved by the policy The Georgia Legislature should remove the barriers to practice for advanced practice registered nurses (APRN) allowing full autonomy to practice without the collaborative agreement or supervision of a medical physician. Removing barriers to practice reduces costs, increases consumer choice, and improves health care quality (IOM, 2010). Furthermore, reform of the scope of practice for APRNs should conform with the National Council of State Boards Nursing Model and Nursing Practice Act and Model Nursing Administration Rules. The Georgia legislature should amend Georgia statutes to clarify and increase the scope of practice for APRNs for full autonomy and independent practice. In many states, including Georgia, despite the urgent need to expand access to primary care and preventive services, a number of barriers prevent the full deployment for independent practice of APRNs (Pohl et al, 2010). Twenty four states including the District of Columbia permit independent practice for APRNs (Pearson, 2010). Seven other states require physician collaboration to prescribe; the rest require physician collaboration to diagnose, treat and prescribe (Pearson, 2010). But these...
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