Despite the intentions to create the best healthcare system in the country, many practice clinics continue facing a number of obstacles in providing services and collaborating. In addition, not all families are able to have high-quality care options because of low incomes or other social circumstances. The socioeconomic status of such underserved populations as migrants or Hispanics determines their possibility to receive care, and in Safriet’s report, several barriers and solutions were identified within advanced practice nursing (APN). In this paper, attention will be paid to such problems as restrictive state provisions and fragmented standards to prove the importance of removing mixed-regulator entities, eliminating statutory requirements, and promoting reimbursement reforms.
At this moment, many restrictions constrain the work of APNs and advanced practice registered nurses (APRNs). Safriet (1992) introduced several critical aspects in the healthcare system, including conflicting state provisions, fragmented state standards, and unclear prescriptive authority. Regarding the fact that many families are defined as underserved in American society due to their social or economic issues, not all of them have access to the necessary information. Many Hispanics and migrants should solve their administrative affairs, neglecting the need to prevent diseases, get primary care, or have a regular therapist. These populations expect healthcare providers to assist them in managing their well-being. However, according to Safriet (1992), nurses must satisfy its licensure requirements (the most restrictive type of regulation) to complete their functions properly. After legislative recognition, nurses also face the multiplicity of roles and titles that are defined by statutes (Safriet, 1992). Due to their cultural or social norms, not all migrants or Hispanics in South California could use the help of the same person (e.g., some communities do not allow female examination by a man or vice versa, and it is necessary to find another appropriate individual).
The potential impact of such barriers as legislative regulations and the lack of provisions cannot be ignored in APRN/APN practice. As soon as there are not enough nurses, who should perform their direct responsibilities and duties, nurse shortage and turnover may occur. Lowered job dissatisfaction, poor exchange of information, and no effective cooperation influence the quality of care. In underserved family practice clinics, migrants and Hispanics expect to find good care and supports. However, instead of staying competent in practice, APNs and APRNs do not have enough freedom and authority to act and make independent decisions. As a result, mistakes in assessment, diagnosis, and treatment are not always possible to avoid, and some changes are required.
There are many ways to improve the quality of nursing in local family practice clinics. However, the primary step has to be taken by the government to make sure other strategies could effectively work. As soon as legislatures remove requirements for formal collaboration and agreements, healthcare professionals could focus on their own skills and achievements. Safriet (1992) recommended to “eliminate all reference to mixed-regulator entities” (p. 478). To overcome the barrier of multiple nursing roles, there has to be an advisory committee that aims at developing specific positions and protecting the rights of nurses. This body is enough to follow a number of organizational rules but never prohibit the professionalism of nurses and their decision-making.
In conclusion, it is wrong to neglect the fact that some barriers still challenge the APN scope of practice. In addition to various roles and obligations, nurses have to follow certain regulations like licensure and certification. Instead of improving their skills and sharing knowledge, APNs have to check if there are legally appropriate for clinics and their services. Due to such unnecessary requirements, many Hispanics, migrants, and other underserved communities cannot get primary or preventive care.
Reference
Safriet, B. J. (1992). Health care dollars and regulatory sense: The role of advanced practice nursing. The Yale Journal of Regulation, 9, 417-488. Web.