Aug 21, 2020
Common Ground: Advancing Full Practice Authority During COVID-19
The pandemic has magnified a host of health care issues, from workforce shortages and health care access to the cost of care and widening health disparities. Looking to address the public health crisis, officials have made many policy changes to ensure patient care. One of those changes has been to relax barriers to practice for advanced practice registered nurses (APRNs) – a common sense, bi-partisan approach that policymakers should consider making permanent once the crisis is over.
APRNs are Vital Assets In Improving Health Systems and Crisis Response.
As COVID-19 gained footing in the United States and the World Health Organization declared a pandemic, the containment effort and the need to provide proper protections and resources for patients and health care workers required considerable intervention at the federal, state, and local levels.
Early in the pandemic, voices from the policy community made a case for legal protections, hazard pay, and moral and spiritual support for health professionals. State and federal lawmakers were asked to use the full power of government to ramp up manufacturing and acquisition of personal protective equipment as well as medical devices and supplies—and to distribute them as quickly as possible to frontline workers and patients. Loosening restrictions on how and where APRNs could work was also widely recommended to increase personnel.
The Trump administration and state lawmakers responded to these requests with various executive orders, legislative interventions, administrative rulings and regulatory changes as policy and government leaders worked to develop new strategies to address the crisis. In some states, lawmakers temporarily suspended or waived requirements for APRNs, while others made changes tied to executive orders that have already expired. In states like Georgia, Ohio, and Mississippi, no changes to APRN practice requirements occurred in response to the crisis.
As time wore on, policy and medical experts working on COVID-19 recommendations—such as the National Coronavirus Recovery Commission convened by The Heritage Foundation—proposed that all unnecessary regulations that had been temporarily relaxed during COVID-19 be permanently removed. This position is finding support from state lawmakers, government officials, members of Congress and the Trump administration. A deep recognition of the important work being done by APRNs during the pandemic crisis has renewed hope that unnecessary barriers to APRN practice may be permanently removed.
APRNs Are Urgently Needed to Address Health Disparities and Chronic Disease.
The pandemic has dramatically affected the ability of non-COVID patients to get the health care they need. Many have had to put off preventive care, diagnostics, cancer treatments, immunizations, and surgery to ensure adequate capacity and medical supplies remain available to treat victims of the pandemic. Lack of access to services, as well as fear of catching the disease by entering medical facilities, has resulted in a significant decline in non-COVID medical treatments. Inevitably, this means that chronic conditions are not being managed properly—a situation which only increases the likelihood of severe COVID-19 illness.
Health care providers are suffering as well. The loss of non-COVID patients has dealt a serious financial blow to many, leaving some health systems teetering on the brink of bankruptcy. Economic recovery in the health sector will require a nimble, flexible and cost-saving response—one that involves continued use of technology and telehealth services, and other patient- and provider-friendly changes such as freeing APRNs from limited or restrictive practice.
Preparing for future biothreats requires careful consideration. One strategy that was recently proposed was to protect care for non-infectious patients while also continuing the training of medical professionals by designating hospitals and facilities for pandemics or infectious disease outbreaks. The strategy further supports continued funding for health care workforce education, using all health professionals at the highest level of training and education, and re-examining barriers to practice for APRNs.
With proven experience and success in chronic disease management and a willingness to provide access for vulnerable and economically disadvantaged populations, the health system should favor the use of APRNs to streamline care delivery, increase efficiency, and control costs. With the disproportionate impact of COVID-19 on racial minorities and those with lower socioeconomic status a renewed effort to address vulnerabilities will require community partnerships and local engagement—something APRNs have demonstrated they are willing and able to do.
APRNs are Key to Increasing Health Access Around the World.
Recognizing the global challenges created by COVID-19, the Think Tanks and Civil Societies Program of the Lauder Institute at the University of Pennsylvania recently convened prominent thought leaders and policy experts from more than 75 countries to develop solutions to the unprecedented issues facing communities and countries as a result of the pandemic. Five separate working groups presented action oriented recommendations at the third and final Global Town Hall Meeting. One recommendation from the “Addressing the Public Health Crisis” workgroup is to increase capacity for care by removing barriers to APRNs around the world.
Decades of development in medicine and technology have expanded the professional responsibilities of doctors, nurses, and other medical professionals. Capturing these advancements and enhanced understanding of medical and health science has required greater accountability and broadened the training and education of health professionals.
Improving collaborative education and training, eliminating archaic healthcare cultures, and re-examining long-held mores surrounding professional roles and task allocation will not only bolster advancements in science and care delivery but capture the vision of a modernized system of health—one that is streamlined, efficient, financially viable, and accessible.
Global leaders should leverage the use of APRNs in healthcare to improve their health systems and expand the reach of healthcare providers around the world. This approach will not only improve response to the next pandemic; it will improve the everyday health of people everywhere.
Amy Anderson, DNP, RN, CNE, is an assistant professor in the Harris College of Nursing & Health Sciences at Texas Christian University, an assistant professor & Health Policy & Advocacy Theme Lead at the TCU/ UNTHSC School of Medicine, and a visiting fellow at The Heritage Foundation. She provided expert counsel to the National Coronavirus Recovery Commission on the response to COVID-19. Dr. Anderson is an inaugural member of the Global Think Tank Town Hall convened by the Think Tank and Civil Societies Program of the Lauder Institute at the University of Pennsylvania, where she worked on “Addressing the Public Health Crisis” workgroup recommendations.