Practice & Access to Care

The Problem

All kinds of barriers can limit a nurse’s ability to provide high quality care. From the work environment to regulatory and reimbursement policies, the burden of these barriers is felt by Americans, especially those in underserved communities.

Barriers to Nursing Practice

In some states, despite the urgent need to expand access to primary care and preventive services, a number of barriers prevent the full deployment of nurses, in particular advanced practice registered nurses (APRNs). All states permit APRNs to prescribe medications, but many impose limits on this authority.

Like regulatory barriers, reimbursement policies also contribute to the unwillingness of some insurers to credential APRNs as primary care providers. This means these APRNs who are prepared as primary care providers, i.e. nurse practitioners and certified nurse midwives, cannot be reimbursed.

A color-coded map of the U.S. depicting physician-nurse practitioner restrictive collaboration by state.
To download a copy, visit:http://championnursing.org/aprnmap.

Supporting Evidence
APRNS are registered nurses with graduate education in preventing, diagnosing, and treating illness – including prescribing.

APRNs  include Nurse Practitioners who provide primary care; Clinical Nurse Specialists who provide advanced nursing care in specialty areas; Nurse Anesthetists who provide anesthesia services; and Certified Nurse Midwives who provide gynecological care to women of all ages, as well as obstetric care.

Nurses achieve APRN status through two nursing degrees (the undergraduate and the master's degree for the APRN license), supervised clinical training, and tested by national accredited testing bodies in nursing. Once certified by the state, continuing education and experience also add to their health care skills, just as is the case with other health care disciplines.

APRNs are licensed with prescriptive authority and educated and trained to do what health care consumers need them to do—care for those who need primary, preventive, and chronic care.

Nurse practice acts are laws that define the scope of practice of nurses, according to their level of education and certification.

The scope of practice for APRNs varies widely across the United States. For example, in some states, nurse practitioners need a written agreement with a physician to diagnose, treat, and prescribe. In other states, they can practice independently. And some states require physician collaboration only for nurse practitioners to prescribe.

Other Barriers

When health care work environments do not foster nursing leadership or create a culture of team work among various health care providers, nurses are not empowered to implement changes that could result in increased quality and lower medical errors.