Introduction
The signing of the New York state budget law in 2022 by Governor Kathy Hochul marked the end of restrictions placed on advanced practice registered nurses (APRN). New York joined a list of states that have expanded the scope of work for Nurse Practitioners (NP) (Rodriguez, 2022). The law removed restrictions that require NP to have a contract with a supervising physician to be allowed to practice. Removing restrictions on NP has been cited by nurse organizations as a major policy shift that helps lower medical costs, increase healthcare access, and improve the quality offered.
APRNs/NP
Nurse practitioners are highly qualified professionals with at least a master’s degree on top of the usual nursing education. They are particularly essential as they provide services that are normally reserved for full-fledged physicians (Zwilling, 2018). In particular, the three categories of Nurse practitioners, including clinical nurse specialists, nurse anesthetists, and nurse midwives, have additional qualifications that allow them to offer similar services as those offered by physicians (Zwilling, 2018). Thus, nursing practitioners provide primary, acute, and specialty care with or without restrictions.
APRN/NP Regulation
APRN practice is defined by the Nurse Practice Act, together with other regulations, rules, and statutes at the state level. Traditionally, APRN practice has been the purview of state legislation which has led to the enactment of completely different rules guiding the education, certification, and accreditation of APRNs (Poghosyan et al., 2022). This situation means that certified APRNs in one state cannot practice in other states without certification from that state’s nursing board. In addition, some states limit the scope of practice for APRNs by requiring a physician supervisor before an NP is allowed to practice.
APRN Consensus Model
Due to contradictions in the regulation of APRN roles, licensure, accreditation, certification, and education, an APRN Consensus Model was adopted (Sabo et al., 2017). This model aimed at unifying the regulation of APRN practice in all states to ensure that an APRN from one state could practice in another state without being required to go through that state’s certification process. Despite the model being passed in 2008, most states are yet to adopt most of its recommendations. In New York, the coming into effect of the law removing restrictions on NPs is a step in the full implementation of the model.
The Need for Unrestricted APRNs
Primary healthcare personnel forms the backbone of any healthcare sector around the world. Most patient interactions occur at the primary healthcare level making it an essential element of healthcare. However, despite its importance, America is expected to experience a sharp shortage of up to 48,000 primary healthcare personnel by 2034 (Derosa, 2022). This shortage will be catastrophic to minorities and other vulnerable groups because it will lead to negative health outcomes, reduced access, and increases in costs.
Arguments for Removing APRN Restrictions in New York
The COVID-19 strain on the healthcare sector in the state of New York gave a new life to a proposal to remove restrictions on APRN practice. The proponents argued that primary care physicians had similarly qualified as nurse practitioners, and thus it made no sense for physicians to continue supervising nurse practitioners in the state. In addition, they argued that a free reign by APRNs would lead to improved access in underserved and rural areas and lower the cost of healthcare as NPs would no longer be required to pay for their supervision by a physician (Rodriguez, 2022).
Arguments for Maintaining Restrictions on Nursing Practice in New York
New York is a predominantly Democratic state where a majority of representatives come from the Democratic party. This dynamic means that the governor’s agenda almost always sails through despite intense debate offered by minority Republicans. This was the case with the removal of restrictions, as the opposition argued that their removal would not have an immediate impact and that the state needed a clear policy on increasing access (Rodriguez, 2022). In addition, they argued that removing restrictions would endanger patients’ lives and lead to an increase in lawsuits involving nurse practitioners and patients for negligence.
Key Stakeholders in the Policy
The stakeholders in this policy change by the state of New York include the state legislators, the state government (executive branch), the state registered nurse practitioners, and primary healthcare providers in the state. The legislators and the executive have a stake in the policy because it is their job to ensure healthcare is accessible, quality, and affordable for all (Rodriguez, 2022). Registered nurse practitioners have a stake in the policy because it is they who were mandated to be paying physician supervisors before. Finally, primary healthcare professionals have a stake in the policy because the burden of providing primary healthcare in an environment of shortages of physicians falls on them.
Overarching Perspective of Stakeholders
The various stakeholders in the policy change held different perspectives on the idea of removing restrictions on Nursing Practice in New York. In particular, the state executive arm of government was adamant that the removal would eliminate shortages in primary healthcare physicians, and the NPs saw restrictions as unfair because they held the same qualifications as their physician supervisors (Zwilling, 2018). The legislators held similar views with the executive except for some who saw it as an exercise in futility due to potential lawsuits due to negligence. Finally, primary healthcare physicians viewed the policy change as important because it would eliminate primary healthcare professionals shortages in the long run.
Classification of Stakeholders as Advocacy Groups and Business Interests
Advocacy groups are involved in activism and may support or recommend certain changes in government, public policy, society, and/or law. An advocacy group comes together around a common issue. In this regard, primary healthcare physicians and nursing practitioners in the state of New York can be classified as advocacy groups because of their activism to get the state to remove restrictions on Nursing Practice permanently (Poghosyan et al., 2022).
Differentiating Business Interests and Advocacy Groups
Advocacy groups and business interests interest are fundamentally different on several levels. First, while business interests pursue a policy change with the intention of benefiting financially when the policy is ultimately passed, advocacy groups are more concerned with the impact the policy change will have on the public rather than its financial potential. In addition, advocacy groups pursue policy change in the interest of their members rather than in the interest of their businesses (Zwilling, 2018). Primary healthcare physicians and nurse practitioners were classified as advocacy groups because their support for the policy change was motivated by public and social good rather than the pursuit of profits. Differentiating between advocacy and interest groups matters because while they both work to change public policy, they have different objectives and intentions for doing so.
Impact of the Policy on Consumers
The removal of the policy restrictions will have a positive impact on consumers. These benefits include increased access to healthcare services, especially primary healthcare. Other benefits include reduced costs and reduced costs of healthcare (Poghosyan et al., 2022). The increase in primary healthcare services will also lead to greater patient satisfaction and increased positive patient outcomes.
Role of Government Agencies and Law and Regulation
The state government of New York and the legislature were instrumental in drafting the changes to the laws to increase APRN practice scope (Rodriguez, 2022). In addition, states are enacting similar legislation to expand the scope of APRNs. However, the implementation of the law will be the responsibility of the state nursing board.
Conclusion
The removal of the restriction on nursing practice by the state government of New York will lead to an increase in access to healthcare, improved quality of care, and reduced costs. The stakeholders involved in the drafting and enactment of the policy change include the executive and legislative arms of the state government of New York, primary healthcare personnel, and nurse practitioners in the state. In addition, the removal of restrictions is poised to lead to a deeper commitment to the full implementation of the APRN Consensus Model.
References
Derosa, T. (2022). Addressing The Physician Shortage As A Health Care Provider: Recruitment Changes. Forbes.
Mensik, H. (2022). New York grants nurse practitioners full practice authority. Healthcare Dive.
Rodriguez, S. (2022).New York Legislation Expands Nurse Practitioner Scope of Practice. Patient Engagement Hit.
Poghosyan, L., Pulcini, J., Chan, G. K., Dunphy, L., Martsolf, G. R., Greco, K., Todd, B. A., Brown, S. C., Fitzgerald, M., McMenamin, A. L., & Solari-Twadell, P. A. (2022). State responses to covid-19: Potential benefits of continuing full practice authority for Primary Care Nurse Practitioners. Nursing Outlook, 70(1), 28–35.
Sabo, J. A., Chesney, M., Tracy, M. F., & Sendelbach, S. (2017). APRN Consensus Model Implementation: The Minnesota Experience. Journal of Nursing Regulation, 8 (2), 10–16.
Zwilling, J. G. (2018). Multifaceted roles of the APRN. Advanced Practice Nursing Roles.