The Future of Healthcare for the APN
Rosetta Vaughn
Grantham University
Foundation of Advance Practice Nursing
NUR506
Aimee Kirkendol RN, DNP, FNP-BC
May 21, 2014

The Future of Healthcare for the APN
According to the IOM report addresses nursing in all practice levels, with the greatest emphasis on advance practice. The report identifies barriers, describes new structures and opportunities, and provides overall specific vision regarding the vital contribution of advanced practice nurses to the health care system. The Department of Veteran’s Affairs (VA), the Geisinger Health system, and Kaiser Permanente are used as examples of care delivery organizations that maximize nursing scope of practice.
The transformation of the VA from a hospital-based system into a primary care focused organization is based on the maximization of nurse practitioners (NPs) as primary care providers. As a result, by 2007, VA patients experienced higher quality and significantly lower-cost care compared with similar Medicare populations.
Geisinger is noted in the report as an organization that that transitioned from a high-cost, specialty-focused medical facility to an organization of high value. Geisinger’s vision includes “having staff work up to the limit of their license” and to “redistribute caregiving work to increase quality and decrease cost.” Under this model, nurses in call centers shifted to primary care sites and established relationships with patients and families, resulting in the creation of more effective care plans thus reducing hospitalizations. Additionally, Geisinger created its own NP-staffed convenient care clinics.
Kaiser is noted for its experimentation with nurses’ roles to improve quality and patient satisfaction, and to lower costs. The organization established the discharge nurse role, which has full authority over the discharge process from acute care through home care, hospice, or palliative care. Positive outcomes including increasing the number of discharged patients who see a home health provider within 24 hours of discharge from 44% to 77% (Richard Ridge RN, MBA, PhD 2011).
In contrast, inconsistencies in the scope of practice are still prevalent depending on the state where an APN is employed. These discrepancies are contrived from strong efforts on the part of some physician groups that perpetuate the misconception that APN care is substandard and hazardous to the public’s wellbeing. The American Medical Association recently published a document entitled the Scope of Practice Data Series, which provocatively explicates that an APN degree does not warrant a change in a nurse’s scope of practice. Furthermore, the AMA has stated that any potential role expansion for APNs may endanger the health of patients and the public (American Medical Association 2009).
Although these deleterious beliefs do not necessarily encompass the voice of the entire physician profession, this negativity continues to drive a divisive breach amid health-care professionals. To counter these efforts, APNs must publicly and politically decree our excellent performance standards, and our ability to deliver high quality outcomes for our patients, their families and the community (American Academy of Nurse Practitioners 2012).
In conclusion, as America moves forward since the Supreme Court upheld the Affordable Care Act (ACA), communities and policy makers have questioned whether the primary care workforce can meet anticipated demand. The federal health care law will affect more than 32 million of the 50 million uninsured individuals in the United States. Many will be searching for health care providers. Primary-care providers are currently in short supply throughout the nation as physicians continue choosing to practice in higher paying specialties. As our nation continues to struggle with primary care physician shortage, primary care nurse practitioner programs have steadily increased to fill this deepening gap with quality health care providers. Lastly, it is time for our profession to stand in the forefront and have our voices resonate (Susman J. 2010).

Reference
American Academy of Nurse Practitioners, “Two national nurse practitioners Organizations announce plans to consolidate.” Web Published: July 3, 2012
American Medical Association. “Scope of practitioners’ data series: Nurse practitioners.” Published: October 2009
Richard Ridge RN, MBA, PhD, CENP, NEA-BC 2011. Nursing Management Volume 42 Number 6 Pages 32-37
Susman J “It’s time to collaborate-not compete with NPs.” Journal of Family Practice 2010: 59(12): 672.