Benefits of Less Restrictive Regulation of Advance Practice Registered Nurses in Florida

Implementing advanced practice nursing in France: A country-wide survey 2 years after its introduction

OBJECTIVES

To examine the characteristics of the first Advanced Practice Nurses in France and to compare the French model to international standards.

BACKGROUND

Common barriers and facilitators to their integration in healthcare provision have been identified internationally. In France, the legislative framework was introduced in 2016, and the first graduates entered the workforce in 2019.

METHODS

The French model was examined in comparison with Hamric's conceptual framework and to the International Council of Nurses' guidelines and definitions. A cross-sectional survey was also conducted, using three self-administered online questionnaires. Two were distributed to 2019 and 2020 graduates and a third to the accredited programme directors. The characteristics of advanced practice nursing graduates were described and compared based on employment status and field of practice (primary vs secondary/tertiary care).

RESULTS

Although the French model of advanced practice nursing meets Hamric's primary criteria and core competencies, it does not differentiate between Nurse Practitioner and Clinical Nurse Specialist roles. Of the 320 students enrolled in one of the 11 accredited training programmes 165 participated in the survey. Mean age was 40, and mean prior nursing experience was 15 years. By February 2021, 30% of respondents were still employed as Registered Nurses. Barriers to practice included insufficient income generation (primary care), the lack of position creation (secondary/tertiary care), the physician-dependent patient referral process and delays in prescription credentials approval.

CONCLUSIONS

The implementation of advanced practice nursing in France faces several barriers. Legislative adjustments and greater financial incentives to practice seem warranted.

RELEVANCE TO CLINICAL PRACTICE

as in other countries, France introduced advanced practice nursing to respond to the Public Health challenge of improving access to quality health care in the context of increasing chronic disease prevalence and limited resource allocation. Facilitating its integration in the healthcare provision landscape seems paramount.

Estimating the Effect of the New York State Nurse Practitioners Modernization Act on Care Received by Medicaid Patients

The demand for primary care services may surpass the supply of primary care providers, exacerbating challenges with access, quality, and cost in the U.S. health care system. Expanding the supply of, and access to, nurse practitioner (NP) care has been proposed as one method to alleviate these challenges. New York State (NYS) changed its regulatory environment for NPs in 2015. We estimate the impact of expanded NP scope of practice (SOP) regulations in NYS on total care days received by Medicaid beneficiaries from 2015 to 2018 using a model derived from national historical data from 1999 to 2011. We used a longitudinal data policy analysis framework and a generalized difference-in-differences model to identify the effect of changes in NP SOP regulations on total care days. The model included controls for state income and unemployment rates. Our results suggest that the policy change increased total care days provided to patients, but that this difference was not statistically significant and became negligible after computing the number of days per beneficiary. In addition, our results suggest that had NYS moved to a full practice environment, more care days could have been provided to Medicaid patients, and this difference was found to be statistically significant. Our results suggest that states should adopt full NP SOP practice environments to realize measurable benefits of expanded NP SOP.

The macroeconomic benefits of Tennessee APRNs having full practice authority

BACKGROUND

To-date, advocacy efforts to advance full practice authority for APRNs have primarily stressed arguments based on evidence on the cost effectiveness and quality of APRN-provided care, as well as the improved care access and patient satisfaction these providers offer.

PURPOSE

The economic impact analysis forecasts the additional job and economic output associated with granting Tennessee APRNs full practice authority.

METHODS

The IMPLAN software and a variety of data inputs were used to estimate the direct, indirect, and induced economic impact on jobs, labor income, value-added benefits, total output, and tax revenues.

FINDINGS

From a 2017 baseline, the cumulative impact of granting Tennessee APRNs full practice authority is a net gain of 25,536 jobs and $3.2 billion in economic impact.

DISCUSSION

Granting Tennessee APRNs full practice authority would confer substantial economic benefits and employment opportunities to the state.