Global Health Workforce Shortage Essay Assignment

I am­­­­­­——.  I am representing the Centers for Disease Control and Prevention (CDC) as a policy analyst.  The CDC is the United States’ national health agency.  The CDC’s mission is to protect the health of the American population by saving lives and protecting them from health threats (CDC, 2019).

Eligibility for care at the Veteran’s Administration (VA) greatly expanded after the wars in Iraq and Afghanistan creating a need for the VA to transform itself from a hospital based system to a health care system (Institute of Medicine, 2011).  The transition brought with it a greater focus on primary care.  Veteran’s access to care was under tremendous scrutiny as a result.  Veteran’s were waiting over thirty days for a primary care appointment (Hussey et al., 2015).  The VA had to improve access for primary care and mental health.

Social

Economic

Ethical

Political

Legal

Environmental

Cultural

The veteran population requiring health care increased over the last two decades.  Accompanying this, the ageing population in the U.S. has also been growing.  These two issues have increased the workload in primary care (Lovink et al., 2018).  With the increased workload, access to care was reduced.  Nurse practitioners with full practice authority could address this workload issue.

Economically, the average salary of a nurse practitioner compared to a physician is $88, 330 less per year (U.S. Bureau of Labor Statistics, 2020).  Additionally, inpatients of nurse practitioners incurred 9% less costly stays than physician patients and 3% less costs were associated with outpatient nurse practitioner care than that of physicians (Morgan et al., 2019).  Overall, it is more cost effective to employ a nurse practitioner amounting to reduced wages and accrued patient care costs.  Nurse practitioners report that creating collaborative agreements with physicians is time consuming and expensive ranging from a few dollars to thousands of dollars (CDC, n.d.).

The two potential ethical issues at stake involve justice and nonmaleficence.  Fairness and equality in treatment exists when care is administered by a physician or nurse practitioner.  Research has demonstrated that the quality of care provided by the nurse practitioner is the same.  Nonmaleficence is the equivalent of doing no harm to the patient.  Again, nurse practitioner’s care has been validated again and again in the research as being as competent or greater than the physician (Liu et al., 2020).  Global Health Workforce Shortage Essay Assignment

Politics definitely have shaped responses to the policy situation.  The American Medical Association (AMA) opposes full practice authority for nurse practitioners while the American Association of Nurse Practitioners fight for full practice authority (Sofer, 2018).  The AMA is a powerful organization that has successfully advocated against full practice authority at the state and national level (Brom, Salsberry, & Graham, 2018).

Legally, each state’s nurse practice acts outline regulations nurse practitioners’ practice from.  Overall, regulations are inconsistent across the nation (Moore, Kabbe, & Gibson, 2020).  Required supervision of a nurse practitioner from a physician remains in many state’s nurse practice acts.  Twenty-three states and the District of Columbia grant nurse practitioners full practice authority (Smith, 2020).  The practice environment is divided into three groups:  full practice; reduced practice and restricted practice.  Many of the states with significant rural areas ascribe to the full practice authority.  The south is largely comprised of restricted practice states.

Minorities have varying access to care and are often faced with health disparities.  Restrictive state scope of practice regulations further impact health disparities for minorities (Poghosyan, & Carthon, 2017).

What is their ‘stake”?

What is their value orientation?

The benefit of full practice authority for nurse practitioners for health care beneficiaries is increased access to care, and reduced health care expenses.  Physicians are arguing that their greater level of education makes them better suited to manage patient care needs (Dillon, & Gary, 2017).  They are concerned about forced realignment and reductions in the job market.  Nurse practitioners want to work at the fullest extent of their education.  They want to be able to practice without the requirement of supervision.  They want equal reimbursement for the same care administered.  The AMA believes the health care of the population is at risk under the supervision of a nurse practitioner.  The AMA reasons that nurse practitioners will increase health care costs and put the safety of patients at risk (Robeznieks, 2020).  The problem becomes an “us against them” as opposed to joining efforts for the patients’ benefit (Peterson, 2017). Schools of education have an interest in full practice authority for nurse practitioners as this regulation could impact the content of the material utilized to educate the students.  It could also increase the number of applicants thus improving earning potential of a program.  Global Health Workforce Shortage Essay Assignment

Full practice authority addresses issues with access to care to include underserved areas.  It decreases costs by eliminating duplication of services and streamlines care by providing direct access to the providers (Dillon, & Gary, 2017).

Unintended outcomes of this policy include a decline in the number of bedside nurses, decreased quality in the education of nurse practitioner students, an

increase in adverse medical outcomes and an increase in liability (Auerbach, Buerhaus, & Staiger, 2020).  This leads to increases in malpractice insurance (Lambert-Kerzner et al., 2016).  Another consequence is a further reduction in primary care physicians.

1.  Do nothing.

2.  Grant full practice authority for nurse practitioners.

3.  Create clinical care teams that match patient care with the most qualified team member (Doherty, & Crowley, 2013). Global Health Workforce Shortage Essay Assignment

Granting full practice authority to nurse practitioners has reduced appointment wait times to less than 30 days thus increasing access to care (Rugs et al., 2021).  Nurse practitioners are cost effective and cost the health care system less than physicians.  Nurse practitioners are not expanding their role, but working within their education and experience levels.  Nurse practitioners refer patients to physicians when patient care needs exceed their expertise.

Clinical care teams offer varied education and clinical experience across their members.  The goal for this collaboration is to optimize the unique skills of each individual provider while meeting the needs of the patient (Doherty, & Crowley, 2013).  This option would allow for nurse practitioners to practice to the full extent for their training, but within the framework of a team.  A downside to this concept is that access to care would remain unchanged.  The team approach provides a ready resource for collaboration with complex patient care.   Global Health Workforce Shortage Essay Assignment

Do Nothing

Full Practice Authority Global Health Workforce Shortage Essay Assignment

Clinical Care Teams

The VA health system like every health care system has been negatively impacted by the shortages of primary care providers.  Veteran’s seek medical care in every state, territory and even country where they reside.  The care they are provided lacks uniformity given the varying regulations on scope of practice that exist through state boards of nursing.  Veteran’s that reside in rural areas face even greater challenges when attempting to access medical care.  The VA needs to improve access to care without increasing costs.

Grant full practice authority to nurse practitioners employed by the VA health care system to address access to care, maximize care delivery and optimize cost effectiveness.  Nurse practitioners increase access to care (Bischof, & Greenberg, 2021).  The evidence has demonstrated that nurse practitioners deliver quality care, in addition to cost effective care (Kippenbrock et al., 2019).  As demonstrated previously with the Indian Health Services and the U.S. Department of Defense, nurse practitioners fill the gap and provide care to the indigent, uninsured and the elderly (Lambert-Kerzner et al., 2016).  Unlike primary care physicians, the number of nurse practitioners continues to climb (AANP, 2018).  Nurse practitioners exist in numbers, they provide the same quality of care, and they are cost effective.  They successfully address multiple components of this policy debate.