Survey Finds Barriers to APRN Practice Continued During COVID-19
In 2020, many states temporarily lifted selected practice barriers for advanced practice registered nurses (APRNs) to improve access to care during the pandemic. Tennessee was one of those states, and the Tennessee Nurses Association’s executive director asked researchers at the University of Tennessee College of Nursing if they could assess the impact of their Governor’s executive orders.
According to one of those researchers, Carole R. Myers PhD, RN, FAAN, the idea quickly grew into a two-phased study including a national survey and targeted interviews with Tennessee APRNs. Myers, a former co-leader of the Tennessee Action Coalition, reached out to colleagues from Vanderbilt University and the University of Tennessee Health Sciences Center to create what she describes as a “dream team.” They fielded the survey between June 1 and September 23, 2020, and heard back from 7,467 APRNs representing every state. “The support and encouragement we received from national and state nursing groups, including the Center to Champion Nursing in America (CCNA), was phenomenal,” said Myers. (The Tennessee Action Coalition is a state coalition of the Future of Nursing: Campaign for Action, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation. CCNA is an initiative of those same organizations.)
A major finding was that nearly 85 percent of respondents said practice barriers continued to limit their ability to provide care during the pandemic.
Most respondents identified that practice barriers and restrictions in place prior to the pandemic further limited their ability to provide care during the COVID-19 pandemic. Barriers most frequently reported in this study among all states – including full practice authority (FPA), reduced and restricted states – included hospital admitting privileges, home health approval, and orders for durable medical supplies.
Of significance is that APRNs working in states with full practice authority reported similar barriers, although less frequently. As documented in other studies (the researchers cite several), even in these states, organizational bylaws and insurance and reimbursement issues continue to be barriers, as do Centers for Medicare and Medicaid Services (CMS) regulations. Other practice barriers include public and private reimbursement practices and various institutional and organizational policies related to credentialing as providers; clinical, admitting, and/or staff privileges.
In their conclusion, the researchers note that “additional research is needed to examine persistent non-regulatory barriers to practice and derive actionable strategy recommendations to remove the barriers.” They also recommend: additional research to examine the effect of executive orders, cost-effectiveness of APRN-provided care across different geographic areas and circumstances, and regulatory and non-regulatory barriers to care, and; continued exploration about how ongoing APRN barriers to practice effect patient access to care and the quality of patient care.