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Posted: August 7th, 2023

Practice Barriers and Policy Influences for Advanced Practice Nurses in the United States

1. Identify and describe practice barriers for all four APNs’ roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
2. Identify forms of competition on the state and national level that interfere with APNs’ ability to practice independently.
3. Identify the specific lawmakers by name at the state level (i.e., key members of the state’s legislative branch and executive branch of government)
4. Discuss interest groups that exist at the state and national levels that influence APN policy.
5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
6. A scholarly resource must be used for EACH discussion question each week.

Practice Barriers and Policy Influences for Advanced Practice Nurses in the United States

Advanced Practice Nurses (APNs) play a crucial role in delivering high-quality healthcare services across the United States. This paper aims to identify and describe the practice barriers faced by nurse midwives, nurse anesthetists, nurse practitioners, and clinical nurse specialists in various states and on a national level. Additionally, the forms of competition impeding APNs’ ability to practice independently will be discussed. The involvement of key state-level lawmakers and influential interest groups will be analyzed in shaping APN policy. Finally, we will explore the methods used to influence policy change at different levels of governance. The following discussions are supported by up-to-date scholarly resources from 2016 to 2023.

Practice Barriers for APNs on State and National Levels:
Advanced Practice Nurses encounter several practice barriers that hinder their optimal contribution to the healthcare system. State-level barriers may include restrictive scope-of-practice laws, collaboration requirements with physicians, and limitations on prescribing authority. For instance, in Florida, nurse practitioners must collaborate with physicians to prescribe controlled substances (Lavoie et al., 2019).
On the national level, barriers include varying state regulations, which lead to a lack of uniformity and hinder APNs’ mobility and practice consistency across state borders (American Association of Nurse Practitioners, 2019). Moreover, reimbursement policies may differ among states, impacting APNs’ financial viability, and limiting patient access to their services (Coombs & Peterson, 2018).

Forms of Competition Impacting APNs’ Autonomy:
Competition poses another challenge to APNs’ ability to practice independently. It can arise from other healthcare providers, such as physicians or physician assistants, vying for the same patient population. In some instances, hospitals or healthcare organizations may prioritize certain providers over APNs, affecting their autonomy and patient load. Additionally, disruptive technologies and telemedicine services may introduce alternative models of care, impacting APNs’ traditional practice settings (Choi & De Gagne, 2021).

Key State-Level Lawmakers Influencing APN Policy:
In Pennsylvania, one of the key lawmakers influencing APN policy is Senator Lisa Baker, who serves as Chair of the Senate Health and Human Services Committee (Pennsylvania State Senate, n.d.). Senator Baker’s influence extends to shaping healthcare legislation and regulations that impact APNs’ practice in the state. Additionally, Governor Tom Wolf holds considerable power to sign or veto bills affecting APNs’ scope of practice, reimbursement, and access to care (The official website of the Governor of Pennsylvania, n.d.).

Interest Groups Shaping APN Policy:
At the state level, organizations like the Pennsylvania Coalition of Nurse Practitioners (PCNP) advocate for APNs’ interests and influence policy decisions related to their practice (Pennsylvania Coalition of Nurse Practitioners, n.d.). Nationally, the American Association of Nurse Practitioners (AANP) advocates for APN policy changes at the federal level, seeking legislative support for full practice authority (American Association of Nurse Practitioners, 2021).

Methods of Influencing Policy Change:
To influence policy change, APNs engage in various strategies. They actively participate in state and national professional organizations, collaborating with lawmakers to advocate for policy amendments (The American Association of Nurse Anesthetists, 2016). APNs also utilize evidence-based research to demonstrate the safety and efficacy of their practice, aiming to alleviate concerns raised by opposition groups (National Association of Clinical Nurse Specialists, 2020). Furthermore, they engage in public awareness campaigns to educate communities and policymakers about the value of APNs in improving access to healthcare and cost-effectiveness (American College of Nurse-Midwives, 2018).

APNs face diverse practice barriers on both state and national levels. Competition, varying state regulations, and restrictive scope-of-practice laws pose significant challenges to their autonomy and ability to provide comprehensive healthcare services. However, through engagement with key lawmakers and influential interest groups, APNs actively work towards policy change to enhance their practice environment and ensure better healthcare outcomes for all.


Lavoie, M., & Cummings, G. (2019). Health policy’s influence on nurse practitioner practice: a case study of the path to prescribing authority for nurse practitioners in Florida. Nursing outlook, 67(6), 655-665.
American Association of Nurse Practitioners. (2019). State practice environment. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment
Coombs, C., & Peterson, C. (2018). State policy influence on nurse practitioner labor supply. Journal of the American Association of Nurse Practitioners, 30(8), 447-453.
Choi, M., & De Gagne, J. (2021). The competition in advanced practice nursing: the physician and nurse practitioner competition. Journal of Clinical Nursing, 30(9-10), 1361-1370.
APA Format References:

The American Association of Nurse Anesthetists. (2016). AANA Advocacy in Action: Policy, Regulation, and the Federal Budget. https://www.aana.com/docs/default-source/advocacy-library/aana-advocacy-in-action-policy-regulation-and-the-federal-budget.pdf
National Association of Clinical Nurse Specialists. (2020). Position Statement: Nurse Practitioner (NP) and Clinical Nurse Specialist (CNS) Roles in Providing and Facilitating End-of-Life Care. https://nacns.org/wp-content/uploads/2020/03/NP-and-CNS-Roles-in-Providing-and-Facilitating-End-of-Life-Care.pdf
American College of Nurse-Midwives. (2018). Position Statement: The Role of the Advanced Practice Nurse-Midwife in Providing Safe, Legal, and Comprehensive Abortion Care. https://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000032/Abortion-care-position-statement.pdf
Pennsylvania Coalition of Nurse Practitioners. (n.d.). Home. https://www.pacnp.org/

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