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  1. Barrier in practice


    Discuss the barriers in Nursing Pactise


Subject Nursing Pages 3 Style APA


Barriers to Advance Nursing Practice (APNs)


The increasing demand for quality care and focus on patient-centered treatment aspects implies that the nursing profession has to evolve. Introduction of Advanced Practice Nursing (APN) provides leverage in how healthcare settings promote outcomes. Advanced practice nurses serve numerous functions in the clinical setting, including diagnosis of conditions, evaluation of patient progress, maintaining patient records, and promoting privacy. Incorporation of APN in clinical practices improves patient advocacy and response to patient needs. Despite the contribution of APNs in the clinical environment, practice barriers both at state and national levels still persist.

The practice barriers in the State of New Jersey comes in the form of legal move that prevents APNs from carrying out diagnosis and drug prescription. In 2020, NJ stroke down Bill A854 that sort to increase the discretion of APNs in health practices. The Consumer Access to Health Care Act proposes to grant APNs the ability to prescribe medication independently without physicians’ choice (Brusie, 2020). This means that NJ offers significant barriers of practice to APNs in the form of denying independence of practice in medication and diagnosis. For instance, the State presents barriers to privileges of unrestricted prescription authority in the APN’s scope of practice (Poghosyan et al., 2017).

The barriers faced in practice for APNs at the State of NJ and at the national level have various similarities, especially in terms of how they require APNs to engage in the practice. Notably, restrictive regulations and issues of licensure subject APNs’ practice to limitations Moreover, observations of APNs practice in NJ and the United States indicate the existence of physician issues, including assumptions that APNs are incapable of providing quality and safe care (Brusie, 2020). These issues impact the practice of APNs in the clinical setting, which means State, and national regulations must establish new directions that would allow an integrated approach to care using the capabilities of Advance Practice Nurses (APNs).

The issue of competition, especially those related to physicians, presents primary concerns regarding how frameworks in the care environment can be designed to optimize the skills of APNs (Poghosyan et al., 2017). Competition from physicians is an inherent issue at national and State levels where reported cases in New Jersey and California suggest that physician professional organizations, such as the American Medical Association, do not fully support APNs in diagnosis and prescription of medications. In most cases, physicians believe in having more technical awareness on the needs of the clinical setting; therefore, considering APNs less qualified to deliver quality and safe care (Poghosyan et al., 2017). Restrictive physician supervision remains to be one of the fundamental factors negatively affecting outcomes of care involving APNs. Observations indicate that the potential competitive harm of physician supervision requirements undermines APNs’ access to the marketplace and may deprive healthcare consumers the benefits of competition (Adams & Markowitz, 2018). American Medical Association played a central role in shutting Bill A854 in New Jersey, and similar moves have been witnessed elsewhere in the United States, including the State of California.

Lawmakers play crucial roles in defining the scope of legislation in nursing practice. Following the recent developments that led to the shutting down of Bill A854, it is essential to assess critical figures in New Jersey’s legislative and executive branch of government. Future developments regarding the alleviation of legal barriers against APNs practice will significantly rely on their positions. The key members of New Jersey’s legislation and executive branches include Loretta Weinberg, Ronald Rice, Gerald Cardinale, Mike Ferguson, and Phil Murphy.

Policy enactment and implementation regarding Advanced Nursing Practice receive influence from numerous interest groups at the state and national levels. Looking at the State of New Jersey and developments that preceded the stroke down of Bill A854, we recognize the influence of interest groups such as the American Medical Association, which represents the physicians. Furthermore, the Institute of Medicine (IOM) plays a critical role in influencing policy enactment, especially in terms of how they are meant to lead change and advance health outcomes at National and state levels. New Jersey Nurses Association Forum of Nurses in Advanced Practice also influences policy measures in support of APNs. Other interest groups that operate at national and State levels include the American Association of Nurse Practitioners and Doctors of Nursing Practice. AANP, for example, plays a vital role in supporting nurses in areas of practice, and thus its influence in policy aims to achieve optimized aspects of APNs.

Policy change in any area is a political issue, and this means that interest groups must apply political strategies to influence outcomes. Similar to operations in the political sphere, the success of a policy proposition relies on how interest groups use lobbying, public opinion, scientific findings, and political activity. Lobbying presents one of the most effective strategies in the promotion of policies. It involves establishing advocacy to influence decisions. In lobbying, interest groups develop campaigns that attempt to influence legislators and officials in the law-making committee to vote. The use of scientific evidence to change policy implies that interest groups use scientific knowledge and evidence to support and influence the enactment of specific policies. The groups also use science as the basis of the determination, although public opinion can also be used to change policy in some cases.



Adams, E. K., & Markowitz, S. (2018). Improving efficiency in the health-care system: Removing anticompetitive barriers for advanced practice registered nurses and physician assistants. Policy Proposal8, 9-13.

Brusie, Chaunie. (2020). NJ Strikes Down Bill to Allow Nurse Practitioners to Prescribe Medication. Retrieved from: https://nurse.org/articles/new-jersey-nurse-practitioners-aprn-prescriptions/

Poghosyan, L., Norful, A. A., & Martsolf, G. R. (2017). Primary care nurse practitioner practice characteristics: barriers and opportunities for interprofessional teamwork. The Journal of ambulatory care management40(1), 77.


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