APRN prescribing in Georgia: An evolving environment.

PURPOSE: While it took over 20 years to achieve legal authority to write prescriptions in Georgia, effective July 1, 2006, nearly 40% of Georgia advanced practice registered nurses (APRNs) are still not using this method of prescribing. An investigation was conducted to identify the current practice environment and barriers to practice in order to identify causes for this lack of participation and implications for advanced practice nursing and the provision of health care. DATA SOURCES: A survey of APRNs in Georgia in 2011 describes demographics, practice environment, APRN education, barriers to practice, and prescribing activity. CONCLUSIONS: Georgia is one of the most restrictive states in terms of APRN scope of practice, and has an anticipated escalation of underserved population with health disparities demanding attention. IMPLICATIONS FOR PRACTICE: Many of the identified barriers are common to APRNs nationwide, but specific barriers to Georgia APRNs are being strategically addressed. Policy changes are recommended to enhance the practice environment of APRNs to support the delivery of quality care.

The Affordable Care Act: Primary Care and the Doctor of Nursing Practice Nurse.

The passage of the 2010 Patient Protection and Affordable Care Act (ACA) initiated the transformation of the United States healthcare system. The ACA fosters a preventive healthcare model that emphasizes primary care, funds community health initiatives, and promotes quality care. These changes increase the need for well-prepared healthcare professionals. Advanced Practice Registered Nurses (APRNs) who hold the Doctor of Nursing Practice (DNP) degree are prepared to meet this increased need by providing leadership in community health centers, serving on interdisciplinary teams, and advocating for and directing future policy initiates. In this article, the authors consider how the ACA will serve as a prevention model, describe the role of DNP nurses as primary care providers, explain how preventive healthcare can be enhanced through the use of a primary care model, and address associated challenges related to increasing preventive care in our healthcare system. They also discuss DNP nurse leadership opportunities related to community-based programs and policy strategies to strengthen primary care delivery. The authors conclude by noting the professional and legal barriers that need to be removed before DNP nurses will be able to provide the care they have been prepared to offer.

Hypertension management in patients receiving hemodialysis: the benefits of home blood pressure monitoring.

Patients with end stage renal disease on hemodialysis are at risk for cardiovascular events and increased mortality. Hypertension contributes to these risks and can be difficult to assess due to unreliable blood pressure (BP) measurements at dialysis centers. A clinical practice grant from the American Nephrology Nurses'Association allowed for the purchase of 35 home BP monitors to study the use of these monitors to provide additional information for BP management. Findings indicated that home BP monitoring can be an effective tool in hypertension management.

Are regulations more consumer-friendly when boards of nursing are the sole regulators of nurse practitioners?

The widely varied regulations in the 50 states often limit consumer access to nurse practitioners (NPs). In 22 states, the Board of Nursing (BON) must share NP regulatory authority with another profession, usually physicians. This study examines the relationship between the BON as the sole authority regulating NPs or sharing that authority with another profession and the NP regulatory environment. Independent t tests compared the NP regulatory environments for consumer access and choice in states with sole BON regulation with those in states with involvement of another profession. The states' NP regulatory environments were quantified with an 11-measure tool assessing domains of consumer access to NPs, NP patients' access to service, and NP patients' access to prescription medications. BON-regulated states were less restrictive (P < .01, effect size 1.02) and supported NP professional autonomy. Entry into practice regulations did not differ in the two groups of states. Having another profession involved in regulation correlates with more restrictions on consumer access to NPs and more restrictions to the full deployment of NPs.