This research paper is aimed to address the restrictions of nurse practitioners autonomy, which directly impacts nurse performance in the primary care settings and why the Floridian law that interdict them from having full authority to practice should be amended. The increase in the population of Americans who are getting health insurance due to the Affordable Care Act and the aging American population is worsening the already existing shortage of primary care providers. Currently, one physician serves at least 1537 people, which is higher than the national ratio of one physician per 1463 people. Nurses play a crucial role in the provision of primary medical care, but the State of Florida refused to give them the autonomy to work alone. Nurse practitioners outperform primary care physicians if to talk about patient satisfaction and the availability in both rural and urban places. Additionally, they can provide standard care and their educational preparation in primary care settings makes them suitable to practice autonomously. Unfortunately, the Floridian Nurse Practice Act only allows them to practice under the supervision of a physician, and if they are found carrying out acts prohibited by law, they are liable for severe punishment. This law should be amended because these professionals are capable of working independently that may also help to reduce the costs of medical care and improve the economy.
The healthcare system is comprised of many healthcare professionals including nurses who account for a majority of the workforce. The Institute of Medicine (IOM) (2010) explains that the profession of the nurse is the largest segment of the workforce in the United States (US) healthcare system whose members are committed to providing high quality patient care. This profession plays a vital role in helping the whole country realize the importance of the main objectives of the Affordable Care Act. Naylor and Kurtzman (2010) reiterate that nurses are the largest group of the healthcare workforce in every state of the US and they are the initial point of contact for patients in many healthcare institutions. In the previous decades, the number of the registered nurses who also had a license to practice has grown steadily to more than three million (Naylor & Kurtzman, 2010). This growth has come together with the increase in the number of qualified nurses as well as with the growing capacity of highly trained advanced-practice registered nurses, also called ARPNs. ARPNs are the registered nurses with at least a masters degree and who are certified by a professional organization of nursing. Furthermore, they have a license to deliver quality medical care consistent with their areas of expertise and the legislations and laws governing the nursing scope of practice within each state of the country.
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Many states in the US pose a great challenge to these nurses because they lack the freedom of carrying out their activities without limitations of the regulations. American Association of Nurse Practitioners (AANP) (2016) explains that most American nurses only blend their clinical expertise in assessing, diagnosing, and treating serious health conditions in addition to promoting disease prevention measures and management functions of health care institutions. This shows that despite nurses can offer quality healthcare services they still face enormous challenges in fully executing their abilities because they need to operate under physicians that sometimes can interfere with their autonomy to practice. In some states like California, laws have been passed to allow nurses to work autonomously. However, the state of Florida is yet to embrace such changes through the amendment of nursing laws, which hinder their freedom to practice to the full extent of their knowledge. This research paper asserts that those legislations that obstruct the autonomy of nurses in the State of Florida to carry out their professional roles to the whole extent of their knowledge need to be changed through a law amendment.
The primary function of any nurse including nurse practitioner is to provide quality nursing care to patients, their family, and friends, or the community as a whole when it requires their services. AANP (2014) assert that nurse practitioners are not only licensed to work independently but also competent to primary care services in acute, ambulatory, and long-term care settings. They have specialized advanced education that translates to improved clinical skills so as to provide standard health care for diverse populations in the country. More than 70-80% of the advanced practice registered nurses work in primary care settings including areas of pediatrics, gerontology, nurse midwifery, and adult health (Naylor & Kurtzman, 2010). Moreover, the services that these nurses destine to the state of Florida and to the US at large are of a very high quality because of their advanced level of education and expertise.
Unfortunately, only a few states in the country permit full practice for these professionals that something has negative impact on their practice and, what is the most important, on the health of the local people. Strict standards of licensing in some states of the US, especially in Florida, are a significant barrier to nurses in many fields of practice (Pike & Glans, 2016). Hain and Fleck (2014) reiterate that state licensure not only regulates the nursing profession and its practice but also creates huge obstacles for the nursing practice. The state laws define the role of the nurse, articulate their oversight requirements, and govern prescriptive and practice authorities. Most of the times, the professional roles of nurses are unnecessarily restricted since these regulations keep nurses from providing primary health care services permitted by both their educational preparation and professional licenses comprehensively (Naylor & Kurtzman, 2010). Therefore, the barriers posed by these state licenses and laws are detrimental to the practice of these valuable professionals.
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In the State of Florida, the situation with the nurses is rather complex, mainly because it is one of the US states that hinder nurses their autonomy to practice to the fullest potential of their education and training. Less than half of the states in the country permit nurse practitioners to practice fully and today, the practitioners in only 20 of the states have full authority to practice (Van Vleet & Paradise, 2015). This shows that a lot should be done to give nurses in the remaining states practice authority. In addition, Pike and Glans (2016) explain that states that have permitted full authority for nurse practitioners, including the District of Columbia, have also allowed these nurses to diagnose and provide appropriate treatment of certain illnesses. However, the AAPN (2014) requires state practices as well as the licensure laws to allow nurse practitioners to evaluate their patients, make necessary diagnoses, interpret diagnostic tests, make orders, initiate and manage treatments including the prescription of medical drugs only under exclusive licensure authority of the board of nursing. What is more, nineteen out of fifty states require the nurse practitioners to have a formal collaborative agreement with physicians in order to restrict nurse practitioners from practicing freely in at least one domain such as prescribing the treatment (Van Vleet & Paradise, 2015). In this case, nurses can only function under cover of their physician through which they have a collaborative agreement.
However, nurses in the state of Florida do not belong neither to the twenty not to the nineteen groups of states. It is among the remaining 12 states that have the strictest regulations that hinder nurses practice because it requires all nurse practitioners to have physician delegation or supervision while providing medical care (Van Vleet & Paradise, 2015). This means that in this state, nurses cannot work without the direction of their physicians, something that limits their ability to provide even primary care services despite the looming shortage of physicians. This is a huge challenge that requires the amendment of the law to allow the nurse professionals in Florida provide adequate care to the full extent of their abilities and knowledge.
The US experiences a massive shortage of primary care physicians that impact the provision of primary care services, and nurses can help address the shortage if given the full authority to practice. 56% of all visits to physicians are only for the primary care purposes while only 37% of doctors in the country are competent to practice primary care medicine (Bodenheimer & Pham, 2010). According to the American Academy of Family Physicians, the US will experience a shortage of more than 40,000 primary care physicians by 2020, which will lead to 51% deficit (Morris, Wong, Raines, & Karney, 2011). This means that many Americans may confront a shortage of vital primary care services because they will have no opportunity to identify a primary care provider.
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In the state of Florida, many locals who have health insurance may have to wait several months to get an appointment with a single primary care provider because of the severe and devastating shortages of doctors, especially in the remote and rural areas. The State Department of Health in Florida assert that 16 small rural counties have less than seven active physicians serving 10,000 residents compared to 22 active physicians who serve the same number of residents in the case of the other states of the country (Raedle, 2013). This figure still shows how serious is the problem of shortage for this state. It would take an additional minimum of 153 primary care physicians per 10,000 people to eliminate the current deficits. It might be even more difficult to do in the areas that are hit to the greater extend, such as Leon, Liberty, Alachua, Gadsen, and Dixie counties (Raedle, 2013). Solving this problem may take the effort of the nurses and physician assistants to provide primary care services autonomously.
The biggest part of the population affected by the enormous shortage is from the remote and rural areas. Van Vleet and Paradise (2015) explain that more than 58 million individuals in the US reside in geographic regions or belong to communities considered to be facing the wrath of the primary care physician shortage. This is because, in most of these areas, the supply of the primary care providers falls below the federally defined standards. The ratio of physicians to the population in urbanized regions of the country is100 for every 100,000 people while in the rural areas the situation is much worse since there are only 46 physicians for the needs of 100,000 people (Bodenheimer & Pham, 2010). The proportion of all the Americans living in areas underserved by primary care providers varies by state. In Florida, about 30% of the population lives in areas with small amount of primary care providers (Van Vleet & Paradise, 2015). This means that proper mechanisms and measures should be put in place to address the primary care needs of the locals possibly by providing nurse practitioners with full practice authority.
The state of Florida is not an exception because it is only one of the American regions that are suffering from the lack of primary care physicians. This state will require more than 4,671 primary care physicians by 2030, which is a 38% increase in comparison to the current levels of the available physicians and is also bigger than in which had only 12,228 primary care physicians (Robert Graham Center, 2015). Having such an increase in a state that is already facing an enormous shortage is not an easy task. Currently, the population of primary care physicians is 1537:1, which is higher than that of the national average of 1463:1 (Robert Graham Center, 2015). The proportion is a mere reflection that the state of Florida experiences more severe shortages than most of the states in the country.
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Many factors have contributed to the widespread shortage of primary care providers not only in the state of Florida but in the country as a whole. Cassidy (2013) explains that this dearth was even worsened by the Affordable Care Act that increases the health insurance coverage without increasing the supply of the care providers. The Act aims to improve the access to primary care services, yet it can do nothing to increase the number of providers in this field (Gadbois, Miller, Tyler, & Intrator, 2015). In addition, the increasing level of the aging population and the overall growth of both the population in the State of Florida and the US make current situation even worse. Van Vleet and Paradise (2015) reiterate that the rising demand for primary care services that has exacerbated the shortage of health care providers emanates from increased population growth and aging as well as the expansion of the insurance coverage under the Affordable Care Act. As a result of this, the best option to ensure Americans will be able to receive quality primary care services is through empowering nurses with full practice authority.
Nurses both in the state of Florida and in the US provide essential primary care services. In 2012, around 127,000 nurse practitioners were charged with the role of providing patient care in the country and about 60,400 of them were in primary care settings (Van Vleet & Paradise, 2015). These nurse practitioners are registered nurses possessing a master’s degree as their minimum educational achievement. Since more than 90% of them are prepared for primary care, they practice in both rural and urban settings (Van Vleet & Paradise, 2015). Unlike physicians, nurse practitioners enter mainly a primary care. Rural practices in the US rely mainly on nurse practitioners and physician assistants rather than on the doctors who are never elected to work in these underserved areas Gadbois, Miller, Tyler, & Intrator, 2015). The absence of physicians also occurs in community health centers, nursing homes, and other medical facilities. It makes sense to give competent nurse practitioners full practice authority because they are able to provide the necessary primary care that will also help to eliminate the shortage of the professionals in the places where they are most needed.
Although they provide quality primary care services, nurse practitioners in the State of Florida have to struggle for several years to move from the restrictive practice and licensure to the autonomously practice. Hain and Fleck (2014) explain that the main reasons why they are opposed to have the autonomy to practice are first of all the differences between their educational preparation and the one of the physicians. Next is a huge responsibility to prescribe controlled substances and narcotics safely, and the last is the inability to control the costs of health care. However, the quality of care provided by these nurses is high and patients who receive their services are more satisfied with the care than those served by physicians (Gadbois, Miller, Tyler, & Intrator, 2015). Additionally, the greater availability of nurses increases accessibility to receive medical care in time, which reduces unnecessary hospitalizations. Just like physicians, nurse practitioners provide high-quality care services that result in the improving of health outcomes.
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Advanced registered nurse practitioners in Florida are also impacted by the regulations of the Nurse Practice Act. The Board of Nursing provides the eligibility criteria to become a certified nurse practitioner in addition to administratively punishing the practitioners who commit actions prohibited by law (Van Vleet and Paradise (2015). The most unfortunate thing about this Act is that it authorizes to perform advanced or specialized nursing acts under the supervision of a physician. However, the law permits these nurses to autonomously practice some medical acts approved by a joint committee. Therefore, the state of Florida allows doctors who provide primary care services and to supervise the nurse practitioners, meaning that the physicians have the autonomy to practice while nurses are deprived of this privilege under the state law.
The State of Florida limits the authority of nurses to practice to the full extent of their education and training. The Institute of Medicine (2010) recommends that nurses should be allowed to practice without supervision yet the law in the state of Florida limits this recommendation. For this to occur, the barriers that limit their practice should be removed by amending the Nurse Practice Act. The actions nurses do after they graduate from their respective institutions of learning vary widely for reasons related not to their education, training, safety concerns or abilities, but to the political decisions the state makes. The Institute of Medicine calls for the review and amendment of the state regulations so as to identify the limitations and correct them effectively to enhance the action of this profession. Allowing nurses to full work autonomously will benefit the community whose members nowadays find it hard to meet their primary care providers.
Furthermore, the shortage of primary care physicians is greater in Florida if compared to other states of the country, and amending the Nurse Practice Act will allow nurses to cover this shortage. Additionally, the primary care providers have little penetration into the remote rural areas of the state, and this means that the biggest part of the population in these regions rarely receive the services of primary care physicians. However, the nurses can serve in these areas very well because the number of nurses is bigger if compared to their physician colleagues. Although most physicians prefer working in urbanized places, there is still a huge shortage of the care providers. Only through the amendment of the law that will allow nurses to practice autonomously it is possible to address and eliminate the shortage.
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What is the most important, nurses deliver quality services, and granting them the autonomy to practice in primary care settings will improve the health of the Floridians. Patients who received care from nurses reported high levels of satisfaction. Nurse practitioners outperform physicians on measures concerning patient follow-up, provision of screening, counseling and assessment services, and time spent in consultations (Donelan et al., 2013). Nurses are taught to be patient-centered that includes care coordination to impact on the cultural and social factors such as family and environmental situation that also makes nurses well prepared for the provision of primary care. In fact, nurses provide holistic primary care.
Because of the increase in the aging population and open access to healthcare due to the Affordable Care Act, the challenge of high medical care costs is likely to be a big problem. In 2012, more than two million Americans were added to the health insurance program, and the number of people in the country is expected to rise beyond 30 million by the end of 2016 (National Governors Association, 2012). Through the use of nurse professionals in the delivery of autonomous primary care services, the state of Florida will register healthcare cost-savings and better health outcomes among the Floridian. The Perryman Group conducted a research study to determine whether Texas could realize an increase in cost savings upon the utilization of the nurse practitioners (Perryman Group, 2012). The study has found that greater use of these professionals would improve patient health conditions, increase health care access, and reduce the overall costs of medical services. The approximated savings were $8 billion in output and $16.1 billion in total expenditures. Some of the cost savings were because of the increased health conditions of the population that positively impact the economy through health workforce among others (Perryman Group, 2012). Work of a nurse practitioner together with the ability to prescribe medications without physician supervision would increase the quality of the health care services and reduce unnecessary hospital admission fees that will result in positive implementations of fund saving strategy. Nurses also reduce the costs of health care through their determination and commendable work in offering preventive services. Furthermore, their availability in remote non-urbanized areas reduces travelling costs of patients who want to find qualified primary care providers.
The state of Florida should amend legislations and laws that hinder the ability of nurse practitioners to work autonomously in primary health care facilities. These practitioners have a master’s degree in nursing and are licensed by the professional bodies to function to their fullest potential. However, Floridian law prevents them from serving the population and only gives physicians the independence to provide care without supervision. In this state, nurses are supposed to work under the superintendence of their physicians, and in case they perform duties the law prohibits, they are liable to punishment. Unfortunately, the state experiences the worst conditions connected to the shortage of primary care physicians both in urban and rural areas, although the rural areas are the most affected. This shortage can only be reduced when the nurse practitioners get the full authority to provide primary care mainly because they are capable of offering high-quality services just like the physicians. Moreover, their work not only improves the health of the population, but also has a very positive impact on the economy through the reduction of the health-care related spending, and through the increased level of health conditions of the workforce that helps to boost economic productivity.
