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During my review for this discussion, I have to admitted I got a little discouraged on the licensing stipulations for Certified Family Nurse Practitioners in the state of Pennsylvania. Until last year, the biggest issues to Nurse Practitioners in the state was the inability to work on their own. In July 2019, they passed legislation that would be initiated and pushed by Representative Jesse Topper (Bedford County) allowing for the “full practice” of Advanced Practice Nurses joining 23 other states that currently allow this (Penn Nursing, 2017). This specific representative understands the need for more accessible healthcare especially in a county that is rural as his County only has one family physician practice.Continuing the research in my own specific state, I noticed that there was a of fight from the Medical Board in relations to full practice authority. This is felt not just on a state level but on a national level as only 23 states allow for an APN to practice within the complete scope of their license (Poghosyan, 2017). Physicians who believe that an APN should not be able to practice to the full extent of their licensing is what is holding us back. I personally will be going into a collaborative agreement with a physician who somewhat echoes those thoughts. Where he is a great physician, trusting me in my own skill, the independent away from physician consult practice as a whole he does not agree with. Physicians have been the force standing in the way of the nation being a full practice authority nation for Nurse Practitioners. Even with the support of organizations like IOM, National Council of State Nursing Boards, NGA, and FTC, the National Board and a lot of state governing medical boards are against it (Brom et al., 2018). Representatives, senators, and congressman have a huge impact on the outcome of Nurse Practitioner practice (Poghosyan, 2017). This was evident on my state level as Senator Bartolotta and Representative Topper worked on getting SB717 passed, making Nurse Practitioners able to work to the full authority after a 3-year collaborative physician agreement. We were able to see it on the national level when Congress passed the Affordable Care Act of 2010. We know that this Act allowed for every American to be insured. However, they did not for what this would do to the healthcare workload. This act increased the need for good healthcare without the applicable workforce, especially in the more rural areas and the already underserved population (Martin & Alexander, 2019).How do these laws come to be? It is through the influence of interest groups. Merriam Webster (n.d), defines interest groups as a group with common interests, that seek to influence public policy. We learn from our readings this can be in the form of patients, clinicians, insurance companies, and organizations striving after the same goal. These can be seen on both the state and national levels as well as lawmakers, and bureaucrats (Buppert, 2017). All of these can be considered special interest groups as they influence healthcare in one way or another, and each of them answer to one another in some sort of fashion.Change is inevitable within the political and healthcare world. Beland & Katapally, 2018, identify change happening through individuals and groups deemed “policy entrepreneurs”. These individuals are made up of many different policy actors both from a political or social scene who are able to get their point across to better healthcare. This can include but is not limited to interest groups, experts, political leaders, and even entertainment actors. These individuals are effective in their acknowledgment of the problem and move throughout the policy agenda to come to the solution. There is a short “policy window” that the political entrepreneur takes advantage of to get the specific problem addressed. Additionally, lobbying is something that is used to get a specific point or policy across. Lobbying groups can be seen in the local, state, and national level. All individuals within these groups are passionate about how to make healthcare better, cheaper, and more accessible. You would think that this would include using APN’s to the full extent of their license throughout the United States, right? Hopefully we will see that in our lifetime.References:Penn Nursing (2017). The state of the scope of practice: When will advanced practice nurses work to the full extent of their expertise, in every U.S. state and territory? University of Pennsylvania School of Nursing Magazine, Fall 2017, 27-31.Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioner workforce and practice. Nursing Economics, 36(1), 43-45.Martin, B. & Alexander, M. (2019). The economic burden and practice restrictions associated with collaborative practice agreements: A National survey of advanced practice registered nurses. Journal of Nursing Regulation, 9(4), 22-30.Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120–130. (Links to an external site.)Buppert, C. (2017). Nurse practitioner’s business practice & legal guide (6th ed.). Jones & Bartlett.Beland, D., & Katapally, T. (2018). Shaping policy change in population health: Policy entrepreneurs, ideas and institutions. International Journal of Health Policy and Management, 7(5), 369-371.Interest Group. (n.d) In Merriam-Webster’s dictionary.

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