Barriers to NP Practice that Impact Healthcare Redesign

The barriers

State practice and licenses

NP practice is regulated by State licensing. Only about a third of the nation has acknowledged exercising full power license and rules of practice for NPS. State licensing regulates the exercise of the NP and constitutes an obstacle to nuclear power sources to maximize the practice of education and training. Vary the licence and practice the laws of nuclear power sources in the State, although the main objective of full exercise authority. What does this mean? Full exercise authority is "a group of State licensing laws and practices that allow for NPS to evaluate patients, diagnose, order and interpret diagnostic tests, start And management treatments, including medications under exclusive licence to the State Board of nursing "(American Association of nurse practitioner (AANP), 2014, P.1).

The problem is only about a third of the nation's license recognized authority and exercise full practice laws for NPS. The remains of nuclear power sources in the United States either have: 1) reduced practice and licensing, which means that the NP has the ability to engage in at least one component of practices established by And organized through a cooperative agreement with external health discipline in order to provide patient care; or 2) exercise restricted license which means that the national party has the ability to engage in at least one element NP practice and requires supervision, delegation, or management staff through external health discipline in order to provide health care to patients (AANP, 2013).

Has admitted the IOM report that overly restrictive regulations scope of practices in some States NPS as one of the most serious barriers to accessing care. Full exercise of authority referred also to exercise autonomy or independent practice. Under full power, nuclear power sources are required by State licensing of educational requirements and licensing practice, maintaining a national certificate, consult and refer to caregivers Other health according to patient/family needs, and be accountable to the public and the State Board of nursing to meet the standards of care in practice and professional conduct (AANP, 2014). Has admitted the IOM report (2011) overly restrictive regulations scope of practices in some States NPS as one of the most serious barriers to accessing care. Nuclear power sources with the same educational preparation and national certificate may encounter a compendium of restrictions when they move from one State to another, limiting their scope of practice (Safriet, 2011). Contrast range of practices across countries has an impact on patient care for the degree of doctor's supervision may affect policy and practice opportunities defended the NPS (Yi Boukus, cross and Samuel, 2013).

Physician related issues

Some professional organizations, including the American Medical Association, the doctors ' training is longer and tougher than the NPS, nurse practitioners are unable to Providing quality and safe care at the same level as physicians (American Medical Association (AMA), 2010; Fairman, ru, Hassmiller, Shalala, 2011). However, other doctors recognize that education and training is not the same as their own, however continue to assess nurse practitioners. In 2009, the American College of physicians published position paper identifying an important role to play in meeting the increasing demand for primary health care (American College of physicians, 2009). And might contribute to the many doctors confused about the role of nurse practitioners.

While health care reform is evolving rapidly, it is vital that the NPS and physicians collaborate to achieve best practices. In preparation for this article, he asked the local nurse practitioners about what they consider barriers relating to the doctor. One common denominator was the lack of doctors and other health care professionals knowledge "of nuclear power sources range of practices (Hain, personal communication, 15 February 2014). While health care reform is evolving rapidly, it is vital that the NPS and physicians collaborate to achieve best practices. Although doctors and NPS have a similar aim to improve patient outcomes, barriers to successful cooperation exist. Has been identified as not knowing the NPS range of practices as a barrier to successful collaboration (Clarín 2007, Phillips, Harper, Wakefield, green, wefrair, 2002). Hierarchical model of traditional medical practice contributes to collective action ineffective. This model reinforces the dominance of the health care team physician. The lack of primary health care providers struggle looms in the distance and health care providers to care for an aging population, this type of medical model is no longer sufficient. It is important to create collaborative models of care that embraces the gifts for all members of the health care team (IOM, 2011). This might be difficult to achieve if some doctors believed that nurse practitioners lacked competence to provide good care. That belief can be one of the main obstacles to exercise independent NP (Clarin, 2007).

In Florida, struggled for years, nurse practitioners to go exercise restricted license to fully exercise authority but constantly met opposition from some medical organizations. Recently, a "fact sheet" for members of the Florida Medical Association of independent opposition advanced practice registered nurse Bill. The reasons cited were: 1) significant differences in educational preparation between NPS and physicians. 2) concerns about nuclear power sources the ability to describe safely controlled substances and drugs. 3) shortage of doctors (must support initiatives to increase the number of doctors in the State). 4) shortage of nurses (NPS will affect the nursing workforce in the future); 5) inability to control health care costs (expanding role that could lead to the same doctors NP); 6) not (Control concern about risk of less qualified RNS practice without supervision (FMA Factsheet, 2014). Heated discussions about these topics had brought this issue to the fore practice range with some lawmakers support an expanded role for nuclear energy sources and other stands powerful with doctor organizations who oppose Expand the scope of practice for NPS.

A recent survey (donelan, DesRoches, Dittus, Buerhaus, 2013) that despite the lack of primary health care providers and primary care doctors and not likely to support the expansion of the roles and supply of nurse practitioners. The results of this study indicate that the majority of physicians in the sample (70% of respondents doctor 505) agreed that nurse practitioners must be exercised "maximum education and training."However, a lot of doctors don't agree with NPS play therapy or receive equal pay for similar services. On the other hand, the NPS saw was capable of leading role of therapy there must be equity in compensation for services. In addition, doctors believed it provided better quality care for patients after that nuclear power sources that were incompatible with the beliefs of the sources in this study and similar studies exploring this Concept.

Cochrane review indicated replacement doctors by nurses in primary care facilities that are similar to doctors, provided high-quality care nurse practitioners that lead to improved health outcomes (Laurent et al, 2004). Patient satisfaction was higher with the nurse-led care. However, this does not mean that patients prefer nuclear power sources for doctors. In fact, there have been mixed results with some patients prefer nurses and other doctors prefer. Results of this review should be considered carefully because there are several methodological limitations in the different studies. Regardless of whether care is delivered by NP or physician, the goal must be to meet the triple objective of health care. However, the policies of NP practice defended may pose challenges in achieving these goals.

Payer policies

Restrictive range exercise may lead to stricter defended policies limiting their independent nuclear power sources. According to many NPS policies championed a huge impact on their ability to exercise to maximize training and licensing (Yi Boukus, cross, and Samuel 2011). Payer policies often associated regulations of State practice and license. Restrictive range exercise may lead to stricter defended policies limiting their independent nuclear power sources. Forced to basically be in practice staff physician practice or hospitals or other entities (Yee et, 2013). May differ from commercial health plan payment policies often do not recognize NPS in primary care. In addition, these may be llalaatmadat resistant or payers pay those services directly. In some practices, the NPS ' incident ', which means doctor services billing for care under the doctor's name. Healthcare centres and medical services (CMS) state that bills to require that the doctor put an initial plan of care and nurse lead follow up care with a physician on site. Again, this kind of practice may limit only practice sites that are associated with the doctors. Even in States that have nuclear power sources full authority, and some public and private payers hinder NPS exercise independent of the doctor by not paying directly or pay a lower price (Yi et, 2013).

To ensure that important country for NP practice as it affects the ability of nurse practitioners practice independently and Bill services. To ensure that important country for NP practice as it affects the ability of nurse practitioners practice independently and Bill services. Health insurance mandate is ordered by the administrative authority, such as the State legislature, the insurance industry or health plans to cover a particular health-care providers, benefit and/or population The patient "(Pons, 2013, p 3). This state legislation varies from Bill to Bill, from State to State, and can significantly increase the cost of health insurance. The problem is that some States do not specify specific mandates to reimburse nurse practitioners in primary care.

Over the decades nurses was "invisible income". That may encourage the belief that nurses are not revenue generators ". "For the past decades nurses was" invisible income, "it means that nursing services are not separate from the other professional fees or institutional fees on billing data," which can enhance The belief that nurses are not revenue generators ". "This may contribute to the lack of representation or exclusion from decision making processes that define standards on costs and value, pricing, payment is based" (Safriet, 2011, pp. H-2). Nurse practitioners historically received low wages and fees payment as compared to their counterparts. These lower payments make it difficult for the financial burden of NP practice of primary health care (Chapman, Wides, and Spetz, 2010).

Alhawajiz barriers