Barriers to Practice for Advanced Practice Nurses (APNs) in Kentucky: A State and National Perspective

1. Practice Barriers for APNs in Kentucky and Nationally:

In Kentucky, Advanced Practice Nurses (APNs), specifically Family Nurse Practitioners (FNPs), encounter several practice barriers. Although Kentucky allows FNPs to practice fully, there are significant restrictions, particularly concerning prescriptive authority. FNPs must have a collaborative agreement with an overseeing physician to prescribe controlled substances, such as narcotics (Kentucky Board of Nursing, 2020). This requirement limits the autonomy of FNPs and can create barriers to patient care, especially in rural or underserved areas where physicians may not be readily available.

Nationally, practice barriers for APNs vary widely by state, with some states granting full practice authority while others impose restrictions that limit APNs’ ability to practice independently. Common barriers include limitations on prescriptive authority, scope of practice restrictions, and the need for physician supervision or collaboration agreements. These barriers not only hinder APNs from fully utilizing their training and expertise but also contribute to disparities in access to care across the country.

2. Forms of Competition on State and National Levels:

At both the state and national levels, APNs face competition from other healthcare providers, particularly physicians and physician assistants (PAs). There is a pervasive misconception that physicians provide superior care compared to APNs, which can lead to a preference for hiring physicians over APNs in healthcare settings. This competition is particularly evident in states like Kentucky, where some healthcare practices prefer to employ physicians or PAs over FNPs, despite the increasing demand for healthcare services.

Additionally, APNs face financial competition, as they are often reimbursed at lower rates than physicians for the same services. For example, nurse practitioners receive an average of 29% less reimbursement from Medicare than physicians for identical procedures (Perloff, DesRoches, & Buerhaus, 2016). This disparity in reimbursement rates can create financial challenges for APNs and may discourage some from pursuing or continuing in independent practice.

3. Key Lawmakers at the State Level:

In Kentucky, key lawmakers involved in shaping healthcare policy and influencing APN practice include members of the state’s legislative and executive branches. The Kentucky General Assembly, comprising the Senate and House of Representatives, plays a crucial role in passing legislation that affects APNs. Key figures include the Senate President, Speaker of the House, and members of the Health and Welfare Committees in both chambers.

The Governor of Kentucky also plays a significant role in healthcare policy. The Governor has the authority to sign bills into law, issue executive orders, and influence the direction of healthcare initiatives within the state. Collaboration between the legislative and executive branches is essential for advancing policies that support APN practice and address existing barriers.

4. Interest Groups Influencing APN Policy:

Several interest groups at both the state and national levels advocate for APNs and influence policy decisions. In Kentucky, organizations such as the Kentucky Coalition of Nurse Practitioners and Nurse-Midwives (KCNPNM) work to advance the interests of APNs by lobbying for legislative changes, providing education, and raising public awareness about the role of APNs in healthcare.

Nationally, organizations like the American Association of Nurse Practitioners (AANP) and the National Council of State Boards of Nursing (NCSBN) play a similar role in advocating for APNs. These groups work to standardize regulations across states, promote full practice authority, and address issues such as reimbursement disparities and scope of practice restrictions.

5. Methods to Influence Policy Change:

To influence policy change, APNs and their advocates can employ several strategies:

• Lobbying and Advocacy: Engaging in direct lobbying efforts with state legislators and executive branch officials can be effective in influencing policy. Advocacy efforts might include meeting with lawmakers, providing testimony at hearings, and collaborating with other healthcare professionals and organizations to support legislative initiatives.
• Public Awareness Campaigns: Raising public awareness about the role and value of APNs in healthcare is essential for shifting public perceptions and reducing competition from physicians. Public campaigns can highlight the quality of care provided by APNs, their ability to improve access to care, and the importance of removing practice barriers.
• Collaboration with Interest Groups: Partnering with interest groups, such as the KCNPNM and AANP, can amplify the impact of advocacy efforts. These organizations have established networks, resources, and expertise that can support APNs in their efforts to influence policy change.
• Research and Data Collection: Providing lawmakers with evidence-based research and data can be a powerful tool in advocating for policy change. Data demonstrating the effectiveness of APNs in improving patient outcomes, reducing healthcare costs, and expanding access to care can help counter opposition from physician groups and other competitors.
• Grassroots Mobilization: Engaging the broader APN community and the public in grassroots efforts, such as letter-writing campaigns, petitions, and public demonstrations, can create pressure on lawmakers to enact favorable policies. Grassroots efforts can also help build a broader base of support for APN practice authority.

By employing these methods, APNs can effectively influence policy change and work to remove the barriers that limit their practice at both the state and national levels.

Conclusion:

Advanced Practice Nurses in Kentucky, like in many other states, face significant barriers to practice, including limitations on prescriptive authority and financial competition with other healthcare providers. However, through strategic advocacy efforts, collaboration with interest groups, and raising public awareness, APNs can work to influence policy changes that expand their practice authority and improve healthcare access for all.