Posted: February 26th, 2023
READ- My intent is to practice as an FNP in the state of Florida and in the state of Florida it is required by those applying to be nurse practitioners to hold valid registered nurse licenses, have earned a master's degree or earned a certification from a post master's degree program in a nurse specialty, have finished a minimum of five hundred hours of clinical, and be nationally certified in advanced practice by a recognized board of specialty nursing (Florida Board of Nursing, 2019). Nurse practitioners can practice at three different levels; restricted, reduced, and full practice (American Association of Nurse Practitioners, 2019). In Florida, nurse practitioners' practice at a restricted level (Florida Board of Nursing, 2019). This means that nurse practitioners in Florida are restricted in a minimum of one part of their practice and need to be delegated, supervised, or managed by a physician prior to being able to practice as a nurse practitioner (American Association of Nurse Practitioners, 2019). According to Rule 64B9- 4.010(1) in the administrative code for Florida, a nurse practitioner "shall only perform medical acts of diagnosis, treatment, and operation pursuant to a protocol between the nurse practitioner and a Florida-licensed medical doctor, osteopathic physician, or dentist" (Florida Board of Nursing, 2019). The protocol has to contain specific information, such as, the nurse practitioner's information, the doctor's information, information about the practice, an explanation of the nurse practitioner's responsibilities including procedures that may be performed, disorders manageable and treatable by the nurse practitioner, medicines that may be prescribed by the nurse practitioner, and circumstances where the doctor has to be contacted (Florida Board of Nursing, 2019). Presently, in the state of Florida, nurse practitioners are unable to sign death certificates or Baker Acts, unable to certify Do Not Resuscitate Orders, and neither Medicare nor Medicaid recognizes a Florida nurse practitioner as a primary care provider (Florida Association of Nurse Practitioners, n.d.).
Unlike most states, Florida has several laws that restrict full utilization of these highly qualified health care professionals (Florida Association of Nurse Practitioners, n.d.). These barriers include the need to have a supervisory agreement with a Florida Licensed physician, inability to involuntarily commit a suicidal patient under the Baker Act, inability to sign death certificates, lack of recognition as primary care providers on Medicaid and Medicare and private insurance company provider panels and other restrictions (Florida Association of Nurse Practitioners, n.d.). According to Florida Association of Nurse Practitioners (n.d.), as a result, NPs cannot deliver health care to Floridians and often must send patients to the emergency room for care they otherwise could treat which in turn causes an unnecessary delay in care. These restrictions also place heavy burdens on certain populations of patients, especially those who receive Medicaid, and live in rural areas and these restrictions drive up the costs of care (Florida Association of Nurse Practitioners, n.d.).
There is a strong and recurrent pattern of statistical significance that emerges when comparing full practice of NPs and preventable hospitalization rates in the dually enrolled Medicare-Medicaid population, there admission rate in those recently having post-acute hospital care for rehabilitation, hospitalization rates from the nursing home setting, and overall health outcomes as noted by Oliver et al. (2019). This research shows that the utilization of full practice of NPs is associated with decreased hospitalization rates in multiple populations and, thus, can effectively impact quality and cost of health care (Oliver et al., 2019). According to Oliver et al., (2019). As recommended by both the IOM and Federal Trade Commission, investigation and action need to be taken to remove barriers to APRN practice. With the results of this research and others already in the literature, it seems logical to expect that barriers to APRN practice be removed without further delay in order to facilitate another method of providing quality, cost-effective health care nationwide (Oliver et al., 2019).
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