Nurse Practitioners’ Full Prescriptive Authority Results in Better Accessibility and Lower Costs by comparing Hawaii with California.
Introduction
Nursing is the most significant workforce in health care, and it will keep increasing in the years to come. With new technology, the healthcare model is evolving, and the demographical population changes; it will stimulate the need for nurses that get highly educated because their workforce and roles continue to expand. As the current workforce aging and a large number of them anticipated to retire by the year 2015. The two states Hawaii and California, both require nurses, hence, having Nurse Practitioners (NPs) who have registered with the Advanced Practice Registered Nurses (APRNs) to help around. They can administer without getting any limitation for controlled drugs and prescription (legend), adjunct medical/health services, durable therapeutic goods, devices, and other supplies and equipment. These nurses do not require a physician around to supervise or oversee as they are qualified. Their primary purpose of practicing for APRNs also being part of the Consensus Model of the APRN that fights to get uniformity of the State’s regulations. However, these do not apply in California as it has restrictions against independent prescribing. The existing laws have seen most of the states make or consider making amendments to allow the APRNs also including their privileges of independent prescription. However, some states have a disparity in significant ways that they opt to respect the authorities and stick to the State’s prescriptive authority. That’s where the physician oversees a nurse. The NPs are preferred as they are not costly and are reliable. Don't use plagiarised sources.Get your custom essay just from $11/page
Statistics show that Hawaii will probably have 3,311 nurses who will be practicing nursing have qualified professionally, while the United States get expected to face a shortage in the nursing industry. Nursing programs get encouraged through the partnering of private, public universities, and colleges for a secure future in the nursing industry. The institutes of medicine are trying to expand the nursing practice. Hawaii State Center for Nursing is partnering with different groups to look for optional pathways of getting advanced nursing education, while the nurses’ partner with others from the world to reshape the States’ healthcare. However, California is among the states that restrict NPs. They are required to prescribe medication with a physician around as oversight even after they go through and qualify to practice nursing. These restrictions lower the supply of NPs, reduce the use of primary care service, a lower amount of NPs, access to state residents are poor. Yet, the rates of visits by the emergency and hospitalization departments are excellent. Even with the restrictions, some argue that it is necessary to have the physician oversight to ensure the care given or provided is of quality. Physicians’ attention and that of the NP are comparable in quality as studies show that there is no difference even without the requirement of physician oversight. The NPs found in Hawaii enjoy their practice unlike their colleagues in California who have restrictions, and that’s the main reason for the paper to compare the two states.
Obamacare was formed to improve health-seeking morals with their focus aimed at the primary care sector. Preventive healthcare services get offered by the primary care providers to help reduce chronic conditions that seem to keep worsening, and they also assist in reducing the regular workforce that challenges in hospitals. Certified NPs play a vital part in primary care provisioning as chronic disease patients are increasing on a high level and the specialization of the physician. NPs, at times, render services of prescribing medicine under the physicians’ supervision, making them the providers of health primarily. Consequently, they get to obey the laws that stand as policy tools, which make states influence medical costs, accessing remote areas to offer medical services and preventive care. High healthcare utilization in places that have low healthcare accessibility and those with few physicians get noticed where the independence of NPs is allowed.
In Hawaii, NPs can provide services as States Board of Nursing license regulations allows them to also practice as professional physicians. This gives them the power to avail schedules, prescriptions, and offer advice on controlled substances. These are per Hawaii statues (Hawaii.gov, n.d). NPs get recognized as the first healthcare providers in Hawaii, or more specifically, the health insurance companies and organizations refer to them as the primary care providers when a client of theirs calls for the NPs caregiver option. Patients under primary care can get issued their drugs over the counter by the NPs as the nurses are allowed, and they can also hand out uncontrolled substances because the law gives them the right. Those NPs who have attained preservative authority can dispense controlled substances, over-the-counter medication, and legend drugs.
California, unlike Hawaii, NPs here have restrictions on prescriptive powers in the primary healthcare setting. These include pediatric, internal wellness, and family wellness. The NPs may autonomously offer a prescription of schedules and controlled substance drugs if the practitioner practices freely. In California, too, they recognize NPs as first-line healthcare providers; thus, they can offer health services without a referral or any supervision from other healthcare backgrounds. Hence, its good to note both states have NPs who practice prescriptive authority, even though restrictions of practicing authority hold the ones in California. But there have been pleading to the nursing board to permit them to exercise full prescriptive authority. A prescriptive authority bill dubbed HB 423 was made law in 2016, and it recommended NPs get issued with prescriptive authority. It allowed practitioners to offer a prescription of controlled substance drugs as long as there was enough supervision (FANA, 2016). NPs were required to have written procedures from dentists and doctors for diagnostic tests, the diagnoses, and even when it came to providing physical and occupational therapy. The procedures have the regulations of controlled substance drugs and their prescription. California’s productivity and the cost of care are not comparable as they have low production in-terms of supporting NPs while they want more from them. They pay high for medical coverage and insurance as they have few nurses in the State with those living in the rural and underserved areas suffering the most. The few NPs have started to link with the communities so that they can offer a little healthcare. However, the restrictions hinder them from potentially doing their best for these communities. If they eliminated the supervision by the physician, it could reduce the cost of healthcare in state governments. The restrictions tend to encourage malpractice payments by physicians; hence, this makes it difficult to get any healthcare if you don’t have money to buy a service that should get provided autonomously.
There are some implications of NPs in prescriptive authority that are critical in Hawaii, one being access to primary healthcare needs and increased provision to the public due to the influx of the NPs that practice prescriptive authority. Hawaii rated among the best in the quality of healthcare provided in the US, as it features in the top ten. California has poor quality healthcare, and it’s among the bottom ten, according to the Agency for Healthcare Research and Quality (AHRQ n.d). Nurses in Hawaii had their prescription powers of NPs get legitimized in 2019, allowing them to provide care, mostly to those in underserved regions of Hawaii. This law provided answers for the scarce primary healthcare workers that were there previously. The State of Hawaii had a particularly serious challenge documented seeking primary care in all tits islands among the persons residing in the rural areas. Keeping up with the rising number of human populations in Hawaii, the Health Resources and Services Administration (HRSA) shows that there is a need to hire over three thousand NPs by the year 2025.
California NPs abilities are limited when it derives to providing care for the State’s residents. This is brought by the need to secure partnerships with the medical doctors, and they are costly when it gets to the point where they want to offer a prescription to straightforward health needs. The State practices prescriptive authority on controlled substances. Becoming an NP in California, you need to acquire a master’s degree and get licensure from the nursing board. The number of NPs in California keeps dropping as the restrictions of the State towards independent authority get pushed, and the NPs feel underrated. These imply that the practice in Hawaii highly contrasts that of California as the NPs in Hawaii have the privileges to the full independence of prescriptive authority lacking the supervision of physicians. While in California, the limitations to NPs show that healthcare services access is limited to areas where physicians responsive and available to medical demands. They also are required to maintain safe practices because anything that’s beyond the State’s regulations they endanger the publics’ health. Unfortunately, those living in rural places may not get access to quality and responsive primary care. The State’s reluctance to give the NPs full independence authority has seen the medical insurance and other expenses get incurred in the medical provision, raising the cost.
Full independence and prescriptive are in-short the aspects of changing the delivery of healthcare in the United States. Hawaii is a perfect example of states where NPs are allowed to practice complete independence and prescriptive powers and also get recognized in the State as primary caregivers. However, NPs from California require to put more effort into pushing for the State to allow them to carry out their roles as primary caregivers. California has it’s NPs restricted to controlled substances while working under supervised practice. Full prescriptive powers and independence of NPs stand to benefit residents in the form of access to healthcare and cost incurred to get quality healthcare. Areas where the NPs practice full independence there is adequate healthcare. Hawaii has its residents in underserved and rural regions accessing quality healthcare as their physicians, and the NPs are permitted to exercise without the management by the medical doctor. It is essential for the State of California to push through and pass a law that allows the NPs to practice full independence so that they can be able to carry out prescriptive powers to the residents so that they can enjoy quality primary care by the easy access of healthcare and also deflated costs of healthcare.
Reference
Alexander, D., & Schnell, M. (2019). Just what the nurse practitioner ordered: Independent prescriptive authority and population mental health. Journal of Health Economics, 66, 145-162. https://www.sciencedirect.com/science/article/pii/S0167629618306143
Altman, S. H., Butler, A. S., Shern, L., & National Academies of Sciences, Engineering, and Medicine. (2016). Removing Barriers to Practice and Care. In Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK350160/
Altman, S. H., Butler, A. S., Shern, L., & National Academies of Sciences, Engineering, and Medicine. (2016). Removing Barriers to Practice and Care. In Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK350160/
Axman, L., Boren, D., Andera, S., & Baker, M. (2019). advanced nursing education family nurse practitioner students improve health outcomes for the medically underserved at nurse managed student run free clinics. International Journal of Nursing and Health Care Research. https://gavinpublishers.com/articles/research-article/International-Journal-of-Nursing-and-Health-Care-Research-ISSN-2688-9501/advanced-nursing-education-family-nurse-practitioner-students-improve-health-outcomes-for-the-medically-underserved-at-nurse-managed-student-run-free-clinics
Buppert, C. (2017). Nurse practitioner’s business practice and legal guide. Jones & Bartlett Learning. https://dl.uswr.ac.ir/bitstream/Hannan/32532/1/9781284117165.pdf
Coombs, L. A., Hunt, L., & Cataldo, J. (2016). A scoping review of the nurse practitioner workforce in oncology. Cancer medicine, 5(8), 1908-1916. https://onlinelibrary.wiley.com/doi/abs/10.1002/cam4.769
Dillon, D., & Gary, F. (2017). Full practice authority for nurse practitioners. Nursing administration quarterly, 41(1), 86-93. https://www.ingentaconnect.com/content/wk/naq/2017/00000041/00000001/art00014
Ferdows, N. B., & Kumar, A. (2019). NURSE PRACTITIONERS’PRESCRIPTIVE AUTHORITY AND THE RURAL URBAN DISPARITY IN MORTALITY RATES. Innovation in Aging, 3(Suppl 1), S564. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6846001/
LeVasseur, S. A., & Qureshi, K. (2015). Hawai ‘i’s Nursing Workforce: Keeping Pace with Healthcare. Hawai’i Journal of Medicine & Public Health, 74(2), 45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338566/
Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018, June). Impact of nurse practitioner practice regulations on rural population health outcomes. In Healthcare (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute.https://www.mdpi.com/2227-9032/6/2/65
Phillips, S. J. (2016). 28th annual APRN legislative update: advancements continue for APRN practice. The Nurse Practitioner, 41(1), 21-48. https://journals.lww.com/tnpj/Fulltext/2016/01000/28th_Annual_APRN_Legislative_Update__Advancements.5.aspx
Slutsky, J., Atkins, D., Chang, S., & Sharp, B. A. C. (2010). AHRQ series paper 1: comparing medical interventions: AHRQ and the effective healthcare program. Journal of clinical epidemiology, 63(5), 481-483. https://www.sciencedirect.com/science/article/pii/S0895435608001704
Spetz, J., & Muench, U. (2018). California nurse practitioners are positioned to fill the primary care gap, but they face barriers to practice. Health affairs, 37(9), 1466-1474. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.0435
Spetz, J., Toretsky, C., Chapman, S., Phoenix, B., & Tierney, M. (2019). Nurse practitioner and physician assistant waivers to prescribe buprenorphine and state scope of practice restrictions. Jama, 321(14), 1407-1408. https://jamanetwork.com/journals/jama/article-abstract/2730102
Traczynski, J., & Udalova, V. (2018). Nurse practitioner independence, health care utilization, and health outcomes. Journal of health economics, 58, 90-109. https://www.sciencedirect.com/science/article/pii/S0167629617301972