Scanning the Environment

How well APRNs use their "golden age" depends on the engagement of each individual (see Table 9.1). Developing leadership skills and increasing the understanding of the political process will support the effectiveness of APRNs as they seek to increase their engagement. Business theory has described the concept of "scanning the environment," the monitoring of the organization's internal and external environment. APRNs can use this concept in the monitoring of the local and national health policy environment. The individual APRN can extend his or her reach at the federal and state levels by participating in professional organizations whose staff scan the environment daily Scanning the local environment is just as important and provides an opportunity for direct involvement, especially for the fledgling political activist.

Locally, APRNs can scan for opportunities to educate others about their role and respond to barriers when identified. It may be as simple as having the language on the school health form changed from physician to provider. When institutional policies set up barriers to full practice authority, the well-informed APRN is positioned to respond. Institutional policies that are more restrictive than necessary may be a result of a knowledge gap. The administrators who created the policy may lack an understanding of changes in federal and state laws that govern APRN practice. When an informed APRN presents data with a request for a change in policy and emphasizes the effect on improved patient care and the benefit to the organization, that APRN will be presenting a strong argument in support of his or her agenda. The uninformed APRN is at the mercy of policies from others that may not represent the current regulations. For example, a portable x-ray company, unaware of the change that occurred in the regulation in the physician fee schedule, may refuse to accept an order from an APRN. This may negatively affect the patient of an informed APRN who acquiesces to the policy. However, an informed APRN could use the strategy of providing data, emphasizing the effect on the patient and the benefit to the organization, and may successfully accomplish the objective and benefit colleagues as well.

Working Collaboratively

Collaboration not only with other APRNs but also with other health care providers will be a growing requirement in new regulatory models. With the redesign of health care delivery systems, all health professionals find their traditional roles and responsibilities changing. New delivery models include accountable care organizations, medical/health homes, and retail clinics. These models are intended to be patient centered and to help contain costs. The Center for Medicare and Medicaid Innovation at the CMS was an agency created as a result of ACA. The center is charged with testing new health care delivery models. APRNs need to be aware of these initiatives and become active participants in the development of the models.

As the public became more aware of the value of the patient-centered care provided by APRNs, coalitions formed outside of health care to support expansion of advanced practice nursing. It is equally important for APRNs to articulate their expertise and the contribution that advanced practice nursing can make to the success of the new delivery models, working together with other professionals to meet the objectives of improved quality at a cost savings. With increased emphasis on interprofessional collaboration and new graduates who are prepared with interprofessional educational experiences, obstacles that have separated professionals in the past will hopefully be removed. Interprofessional models emphasize collaboration and increase the understanding of the expertise that each profession brings to the care of the patient.

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