HEALTH CARE POLICY: IMPLICATIONS FOR ADVANCED NURSING PRACTICE
Since the Patient Protection and Affordable Care Act (ACA) was passed in 2010, the opportunities for advanced practice nurses (APRNs) have increased tremendously. This has been referred to as the "golden age" for APRNs. The release of the Institute of Medicine (IOM) report that same year, The Future of Nursing: Leading Change, Advancing Health, has been another factor in adding opportunities for APRNs. These events were preceded by the publication in 2008 of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education, completed through the work of the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee. While state laws that govern APRN practice will need to be updated to fully realize all the changes proposed by the Consensus Model, changes have already occurred in educational programs, certification examinations, and the accreditation processes. The effect of these factors combined to advance the opportunities for APRNs and helped unify their voice and purpose.
As the public has become better informed of the full capacity of APRNs to provide health care, groups outside of health care have advocated for the removal of boundaries that prevent APRNs from practicing to the full extent of their education and training. The Center to Champion Nursing in America is a joint initiative of the Robert Wood Johnson Foundation (RWJF) and AARP. The Campaign for Action (accessible at campaignforaction. org), coordinated by the RWJF through the Center to Champion Nursing in America, is a national campaign that works to implement the recommendations of the IOM report on the Future of Nursing: Leading Change, Advancing Health (2010). The Center helps form coalitions of professionals, the public, and businesses to remove barriers to practice and care. Another key contribution to removing barriers came from the Federal Trade Commission (FTC) in 2014 as it addressed the threat to competition in the marketplace that results from the requirement for physician supervision of APRNs. Policy Perspectives: Competition and the Regulation of Advanced Practice Nurses added support for allowing APRNs to practice to the full extent of their preparation and licensure (FTC, 2014).
An important development for nurse practitioners (NPs) was consolidation in 2012 of the two largest NP organizations, the American College of Nurse Practitioners and the American Academy of Nurse Practitioners, into one organization: the American Association of Nurse Practitioners (AANP). NPs now have one voice addressing issues that affect practice and a coordinated front to address policy issues. The AANP has the potential to achieve results that neither organization had been able to accomplish alone. The consolidation of these two major NP organizations addresses the observation by O'Grady (2011) that APRN organizations were fragmented and that unification would be a key to increasing APRNs influence in health policy. In 2014, the new AANP celebrated reaching the 50,000-member milestone.
APRNs today more than ever before need to be informed health professionals who are aware of the current health policy issues, the process necessary to make change happen, and the advocacy groups for nursing and advanced practice nursing that are working to remove barriers and support policy that will allow them to provide the best care to their patients. Patient-centered care is the hallmark of nursing and has become the focus of health care nationally and the motivation for the formulation of coalitions to support the advancement of APRN practice.
No matter the scale of the health policy issue or the size of the community it affects, the process of creating health policy is basically the same on the local, state, and national levels. Knowing how that process works and ways to influence it empowers the APRN to stand up for health policies on any level. The purpose of this chapter is to help the APRN understand and engage in that process.