APRNs: Challenges and Opportunities

In light of the growing need for quality health care, advanced practice registered nurses (APRNs) are becoming increasingly valuable. Among other tasks, these professionals are trained to diagnose a range of conditions, prescribe medication/treatments, and refer clients to other care providers. Their education grants them a strong foundation of knowledge regarding their respective fields and prepares them to make appropriate, informed judgements. They practice direct patient care while meeting high quality standards and maintaining patient safety.

Unfortunately, this is not the full story. Though the need for APRNs in the care system is growing, several barriers stand in the way of these men and women performing to the full extent of their abilities.

One major issue is a general lack of recognition and understanding regarding the four APRN fields (clinical nurse specialist [CNS], certified nurse practitioner [CNP], certified registered nurse anesthetist [CRNA], and certified nurse-midwife [CNM]). The LACE model, which has reached its 2015 deadline for full implementation, lays out definitions and expectations for each title. Despite this, however, much of the public remains unaware of these options.

Intertwined with that problem is a lack of respect for APRN qualifications and legislation that denies them the opportunity to provide care outside of a physician’s supervision. Confining these nurses to only functioning under physician oversight ultimately impacts the total number of healthcare professionals available to provide care for an ever-growing patient population, as well as dramatically increasing cost.

Various organizations are fighting to change these conditions, including the American Nurses Association (ANA) and the American Association of Nurse Practitioners (AANP). They argue that APRNs should be given the authority to practice without a physician present. Studies such as this one by Health Affairs substantiate their arguments, suggesting that APRNs may be perfectly able to provide safe, quality care on their own. More statistics and research to support this opinion may be key to continuing to remove supervision regulations. Currently, only 21 states (plus DC) allow APRNs to work autonomously.

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Availability and sufficiency of education is another large problem. While APRNs benefit from the strong qualifications and training from their academic programs, there is an unfortunate side effect— most must commit to their studies fulltime in order to complete their coursework, and so cannot mediate tuition costs with part-time paid work. Compound that problem with the fact that most are required to take loans regardless, and it becomes very difficult to find any APRNs who are able to rejoin academia as faculty instead of continuing on to practice clinical work. This shortage in turn forces the few existing professors to be overworked in order to keep up with enrollment, causing burnout, exhaustion, and ineffective learning environments.

Economic issues also impede APRN residency and training. When coaching physicians, institutions receive Medicare compensation, but do not receive any for teaching APRNs. Anesthesiologists who train physician residents are compensated twice as much as when they train CRNAs. These differentials present serious hurdles in regards to APRN preparation.

It is essential that these obstacles hindering APRN performance and education are addressed as soon as possible. APRNs have the potential to provide cost-effective, high-value, quality care to a wide range of patients in a time when the need for such care is growing constantly.

How can I help?

• Join your field’s association
• Take any opportunity you can to train APRN students
• Add an informative APRN webpage to your hospital/institution’s site
• Volunteer/work to eliminate APRN restrictive legislation with the ANA or AANP

Are there any special opportunities for APRNs in the hospital workplace?

Yes! APRNs have the chance to work in highly collaborative, team environments. For example, the 2011 Institute of Medicine (IOM) report set into motion the move toward APRN opportunities to develop and implement their own improvement projects and take leadership roles in the workplace.

I want to document/communicate the contributions I make to my hospital/place of employment. Where do I begin?

Because APRNs provide a range of services, it can be difficult to organize and present their responsibilities and achievements in an orderly, sensible fashion. Here are a couple basic ideas to get you started.

• Create a professional portfolio— this will help you keep track of your accomplishments as you complete them. And when you need a list of past experience for a resume or interview, it will all be in one place!
• Develop performance goals— if you write these down and follow them through, you are not only more likely to excel in the workplace, but you can also maintain records of your achievements simply by checking them off the list.