State, Regulatory, and Institutional Barriers
Mississippi is a reduced state, which restricts a nurse practitioner’s ability to practice up to his or her full training, something termed as full practice authority. Specifically, those who intend to open their practice or a free-standing clinic have to enter into a collaborative agreement with a physician (Yang et al., 2021). Usual restrictions involve requirements for physician cosignatories for prescriptive as well as hospital admission capabilities.
Quality of Care
Physicians are required since APRNs cannot be listed as providers of record or carry their patient panel, and digital health records do not capture APRN care. Such practices disrupt the patients’ communication and the ability of the advanced practitioner registered nurse to offer appropriate follow-up care (Yang et al., 2021). This, in turn, has been discovered among the factors contributing to poor healthcare quality. Apart from interfering with the communication channel, they limit the patient’s choice of providers and declare the APRN’s care invisible.
Cost
In addition to the quality of care being affected, the cost is inflated due to state, regulatory, and institutional barriers. According to Yang et al. (2021), such hindrances include granting hospital admitting and other privileges, reimbursement, organizational bylaws, and provider credentialing policies and practices. Usually, the cost of state-mandated collaborative services is unregulated and can be too expensive. This can later be seen in the amount the patient is required to pay for specific services.
Access to Care
The barriers mentioned above contribute to many people being unable to access care. When the costs of state-mandated collaborative services are high, few people in the society can access the care. Most people in low-income households, especially in the last three years, have had to abscond from medical attention due to thehigh cost of healthcare services (Yang et al., 2021). This has meant that many have been denied access to care due to the barriers.
The Status of the APRN Consensus Model Implementation in Mississippi
An advanced practice registered nurse is the title used for any individual who holds certification and is presently licensed to practice in Mississippi. Additionally, it can be utilized to describe those licensed to practice under the Nurse Licensure Compact with a multistate licensure privilege to practice in the state (Litchman et al., 2018). The following include the APRN roles recognized in Mississippi: NP for Nurse Practitioner, CNM for Certified Nurse Midwife, and CRNA for Certified Registered Nurse Anesthetist. Registered nurses (RN) with a graduate degree in non-patient-facing roles cannot be acknowledged as APRNs (Litchman et al., 2018). As mentioned above, the term licensure is used for APRN roles in Mississippi.
In order to practice in an advanced role in Mississippi, an individual must earn a graduate degree at the Master’s level, majoring in nurse-midwifery, general nursing, or nurse anesthesia. Moreover, one is required to attend a recognized concentration as the Mississippi Board of Nursing has approved certain programs that meet their requirements. A recognized national accreditation agency must fully accredit the programs. National certification is needed in Mississippi to practice in an advanced practice role (Litchman et al., 2018). One must achieve this through an acknowledged national certification agency and has to relate to the selected specialization. Mississippi, a reduced state, only allows for independent practice if an agreement is reached. For instance, a nurse practitioner who intends to open their practice must enter into a collaborative agreement with a physician (Litchman et al., 2018). In independent prescribing, authorized certified APRNs may prescribe schedules II, III, IV, or V.
The potential of Telehealth to Mitigate Treatment Barriers and Ability to Improve Health Outcomes
One major barrier facing young people in accessing mental health services is stigma. Telepsychiatry has great potential to eliminate stigma as a service user can access services discretely (Naal et al., 2021). The COVID-19 pandemic added novel challenges to offering care for individuals with HIV. Nevertheless, challenges present opportunities, and the coronavirus disease catalyzed telehealth’s implementation, which may enhance care for HIV and co-occurring behavioral and medical issues. Employing it within HIV care has numerous benefits (Naal et al., 2021). Current research has shown that it reduces stigma-related delays in care (Naal et al., 2021). For example, several people with HIV report high levels of stigma as well as consequent self-isolation (Naal et al., 2021). However, a virtual platform can aid in mitigating some perceived intimidation related to face-to-face treatment. This is particularly as digital spaces protect clients from fear of meeting someone they know or being seen on their way to or from an appointment.
Apart from mitigating the treatment barriers, telehealth can improve outcomes in populations of HIV-positive, mental health, and behavioral health patients by enhancing access to care. Transportation problems are a common hindrance to care for these types of patients. Yet, the barrier may be eliminated when an individual has the option of an appointment from their home (Naal et al., 2021). Utilizing an online format may also aid in increasing the availability of convenient appointment times, broaden access to care for those in rural areas, and increase access to a wider range of experts.
Legislation Regarding APRN Role in Mississippi
Currently, a nurse practitioner is needed to enter into a collaborative agreement with a physician, which is presently successful. This would excuse nurse practitioners from the requirement after 3600 hours of practice (Phillips, 2020). The Board is legislatively established to regulate capable persons in the nursing practice. The Administrative Code highlights the qualifications and scope of practice. The Senate Bill 2007 (MO) is among the legislations in Mississippi that have succeeded. According to Section 1 of the Senate Bill 2007 (MO), an RN or APRN is needed to show qualifications for practice. Registered nurses and APRNs are required to be licensed, and all this is done to protect life and health.
One legislation that has been unsuccessful previously, particularly in the past four years, is a certificate of need program. According to the law, individuals must get approval from the state Health Department to build new facilities and add beds or diagnostic equipment to a facility (Phillips, 2020). Former state representative Mark Baker attempted thrice to fully eliminate the state’s CON regime in 2015, 2016, and 2017, and none of the bills reached the floor vote (Phillips, 2020). This is proof that all attempts at reform to enforce this have failed.
Nurses and APRNs Involvement in Legislative Policies
At the state and federal levels, nurses have gotten involved in policy and politics by joining professional nursing organizations, which usually bring nursing issues to Capitol Hill. The 2010 Institute of Medicine report recognized nurse involvement in healthcare decision-making as critical to creating long-term change through reform efforts (Tracy et al., 2020). The recommendation resulted in the formation of a group to increase the number of nurses serving on governing boards, intending to improve the health of communities and the nation through the nurses’ service on boards.
The nurses serving on governing boards of medical-related institutions have the opportunity and obligation to influence healthcare cost, access, and quality. The direction for an organization to offer cost-effective, quality care accessible to every stakeholder is improved by a governing body that is diverse in composition (Tracy et al., 2020). It has members who have adequate knowledge and insights into the healthcare field. The nurses are capable of leading through board governance and are equipped to direct organizations via transitions.
References
Litchman, M. L., Schlepko, T., Rowley, T., McFarland, M., & Fiander, M. (2018). A scoping review of Advanced Practice Registered Nurses consensus model outcomes: Part four of a four-part series on critical topics identified by the 2015 Nurse Practitioner research agenda. Journal of the American Association of Nurse Practitioners, 30(12), 710–723.
Naal, H., Mahmoud, H., & Whaibeh, E. (2021). The potential of telemental health in improving access to mental health services in Lebanon: Analysis of barriers, opportunities, and recommendations. International Journal of Mental Health, 50(3), 218-233. Web.
Phillips, S. J. (2020). 32nd annual APRN legislative update: Improving access to high-quality, safe, and effective healthcare. The Nurse Practitioner, 45(1), 28–55.
Senate Bill 2007 (MO) (U.S.).
Tracy, M. F., Oerther, S., Arslanian-Engoren, C., Girouard, S., Minarik, P., Patrician, P., & Talsma, A. (2020). Improving the care and health of populations through optimal use of clinical nurse specialists. Nursing Outlook, 68(4), 523-527. Web.
Yang, B. K., Johantgen, M. E., Trinkoff, A. M., Idzik, S. R., Wince, J., & Tomlinson, C. (2021). State nurse practitioner practice regulations and US health care delivery outcomes: A systematic review. Medical Care Research and Review, 78(3), 183-196. Web.