Key Challenge in the Continued Development of APN Roles
Unfortunately, nurses face numerous barriers and challenges as they continue to develop their role and scope of practice. One such obstacle is their limited provision of Medicare home health services. According to Kleinpell et al. (2023) and Mason et al. (2021), this barrier in the Medicare setting significantly affects advanced practice registered nurses (APRNs), preventing them from providing services to certain patients. This concern not only narrows the scope of nursing practice but also affects patient outcomes. Moreover, the problem would likely not be as severe if not for the COVID-19 pandemic, which forced many people to stay at home, requiring medical support but unable to visit hospitals.
Nowadays, APRNs possess the necessary education, qualifications, and knowledge to perform independently of other specialists. As stated by the National Association for Home Care & Hospice (2020), not only physicians but also other highly skilled practitioners can care for their clients. However, APRNs are often required to hand them off to physicians due to outdated requirements, which potentially compromises program integrity and the quality of care (National Association for Home Care & Hospice, 2020).
Even now, when the COVID-19 pandemic is no longer an extremely severe threat, many patients still cannot wait for a physician to visit them and provide home healthcare (Famakinwa, 2020). If there are APRNs who can do that, and the quality of their services is not lower, why are they deprived of this opportunity? Heavy delays result in increased healthcare costs and reduced patient outcomes, while the limitation itself prevents nurses from developing and expanding their scope of practice.
Policy and Political Reforms Needed to Strengthen Quality and Care Provision by APNs
Due to the adverse effects of this barrier, policymakers have taken notice. Notably, they have achieved considerable success in addressing this limitation, and as a result, many APRNs can now certify Medicare home health services. Mason et al. (2021) note that the Home Health Planning and Improvement Bill, also known as S. 445/H.R. 1825, became the first significant intervention to allow APRNs to offer the mentioned services.
Previously, other attempts have failed to move forward (Mason et al., 2021). According to Famakinwa (2020), S. 445/H.R. 1825 was enacted in 2020 as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Undoubtedly, this is a significant step toward eliminating the key challenge for the continued development of the role and scope of advanced practice nursing.
Still, not all states are eager to implement this change in their local practices. Famakinwa (2020) mentions that the CARES Act faces various state-level barriers. To be more precise, in many states, nurses have a limited scope of practice that does not allow them to provide home health services without a physician’s supervision (Kleinpell et al., 2023). Next, states have more time to update their licensure standards to meet current federal requirements (Famakinwa, 2020). Eventually, the Medicaid payment rules also require reconsideration at the local level.
Essential Political Strategies for Advancing Advanced Practice Nursing
To ensure that the CARES Act receives more support in individual states and can be implemented successfully in the near future, it is essential to take some steps. Firstly, a practical political analysis should identify all barriers and issues that must be addressed before the act can have a significant positive impact. APRNs need to communicate the benefits of the act and similar legislation on social media and utilize media support and coalitions, such as the American Academy of Home Care Medicine, to spread awareness. Conflict management skills should be used when addressing physician opposition (Mason et al., 2021). Lastly, to demonstrate the act’s effectiveness, credible research and sufficient evidence highlighting its positive aspects, such as improved patient outcomes, reduced healthcare costs, and delays, should be provided.
References
Famakinwa, J. (2020). Non-physician certification in home health care blocked by state-level barriers. Home Health Care News.
Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing barriers to APRN practice: Policy and regulatory implications during COVID-19. Journal of Nursing Regulation, 14(1), 13–20.
Mason, D. J., Dickson, E., McLemore, M. R., & Perez, G. A. (2021). Policy & politics in nursing and health care. Elsevier.
National Association for Home Care & Hospice. (2020). Home health care planning improvement act (S. 445/H.R. 1825).