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NU623 : Create a response to the Post below by Erin: Using APA style and a minimum of 2 references.

Post by Erin :  The article I chose to summarize is titled, "Federal, state, and organizational barriers affecting nurse practitioner workforce and practice." Poghosyan (2018) claims that NPs are the fastest growing workforce between 2013 and 2025 because expected growth is 93%. It is essential that NPs have the ability to deliver primary care to the millions of Americans who desperately need it. However, barriers at the state, federal and organizational levels impede NPs from delivering primary care to those who need it most.

Some examples of barriers to care include Medicare reimbursement rates, federal regulation requires physicians to sign NP homecare orders for validity, certain states restrict NPs from practicing independently, and organizationally NPs are not given the same support from medical assistants that physicians have, which underutilizes an NP's skill set (Poghosyan, 2018).

I do agree with the author's claims in this article. NPs are needed in a primary care setting. With barriers at the federal, state and organizational levels, ultimately those barriers are limiting access to quality care and improving patient outcomes. I believe it is up to the individual provider to know their scope of practice, limitations, and refer patients when necessary. With primary care providers being in high demand in rural areas, it is frustrating to see states restrict an NP's scope of practice (Xue, Ye, Brewer & Spetz, 2016). Many primary care physicians do not want to practice in rural areas for personal and/or financial reasons. I know many NPs that are willing to work in rural areas across the U.S., however, they are limited based on individual state laws that restrict them from opening an NP-run clinic or a private practice to serve those vulnerable populations.

Unfortunately, I live in one of the five worst states to practice as an APN (MidlevelU.com, 2013). Florida has some of the strictest laws in the nation. A collaborating physician is required for an NP to practice, in addition, the method of supervision between a physician and the NP must be in written form. NPs can prescribe Schedules II-V controlled substances under physician supervision and in written protocol as well. NPs can prescribe controlled substances in outpatient and hospital settings when prescribing authorized substances only. A 3-day supply is allowed for schedule II drugs, and children under 18 years of age may not be prescribed psychotropic medications unless the NP is a certified Psychiatric Mental Health Nurse Practitioner. NPs are not allowed to prescribe controlled substances in pain management/relief clinics. However, the collaborating physician may limit these restrictions further if they see fit to do so (Scopeofpracticepolicy.org, 2019).

MidlevelU.com. (2013, October 9). Nurse Practitioner Scope of Practice: Florida. Retrieved from https://midlevelu.com/blog/nurse-practitioner-scope-practice-florida

Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioner workforce and practice. Nursing Economics, 36(1), 43-46.

Scopeofpracticepolicy.org. (2019). Florida Scope of Practice Policy: State Profile. Retrieved from http://scopeofpracticepolicy.org/states/fl/#tab-nurse-practitioners

Xue, Y., Ye, Z., Brewer, C., & Spetz, J. (2016). Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing outlook, 64(1), 71-85.