1. Hader, Richard PhD, NE-BC, RN, CHE, CPHQ, FAAN

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The Affordable Care Act, better known as healthcare reform, promises to provide Americans with improved access to healthcare through the elimination of requirements that precluded many from obtaining it. This means more Americans will be seeking preventive and primary care services, which may burden already taxed primary care providers. One of the reasons that there's a lack of access to primary care is that most states limit the scope of practice of advanced practice nurses (APNs).

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Politics is the major barrier that forbids APNs to practice to the fullest extent of their education and training. Political opposition has prevented state governments from allowing APNs to practice without the supervision or collaboration of a physician.


There are currently only 12 states in the country that allow nurses to fully practice as APNs without arbitrarily assigned limitations. These practice restraints cause an undo financial burden on patients who are seeking preventive and primary care and severely limit access to those unable to gain care from a primary care physician.


APNs are highly skilled practitioners who have been trained at a minimum with a master's degree in nursing and have passed a national certification exam. Why is it that their practice is controversial and their scope of practice is limited by the state in which they want to provide care?


The concerns over the practice of APNs are emotionally charged and not based within the framework of scientific evidence. Those promoting the restriction of practice of APNs are misinformed and need to reconsider their position in an effort to provide greater access and more affordable care within this country.


Many physicians are advocates of APNs because they realize the benefits gleaned from partnering with their practice colleagues to enhance the care provided to patients. A fully developed collegial relationship between physicians and APNs allows each partner to practice to the fullest extent of education and training and facilitate the coordination of care. In both medicine and nursing there are limits to practice from both an educational and a practical level. APNs have clearly demonstrated their ability to provide a continuum of care and services to patients, allowing their physician colleagues to better utilize their skills and expertise to address highly complex medical issues.


APNs aren't requesting to practice medicine; they're seeking the opportunity to practice the profession for which they've been educated. APNs need to be active care providers and be given the right to practice their profession in every state in this country, working to repeal laws and regulations that limit their practice.


Professional nursing organizations must collaborate and collectively seek federal legislation to ensure that highly qualified APNs have the ability to practice without restriction. A concerted effort demonstrating, through scientific evidence, that APNs deliver appropriate and timely care to their patients must be well articulated and presented to those imposing these restrictions. Our local communities need to be made aware that care provided by APNs is safe, efficient, and can be delivered at a reasonable cost.


Richard Hader

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