hello, please see instructions below. I only need responses. So please respond to the two classmates below:

Reply to two of your classmates, either classmates from different states or classmates who identify a different political issue from what you identified.
 

My initial post: (just to have an idea)

I live in the state of Texas and I will address retiring Delegation requirements and expanding patients access to care. 

Retiring Delegation Requirements: Under current laws, several states require Nurse Practitioners to work alongside or delegate tasks to a physician, restricting their freedom and interfering with their capacity to provide complete patient care. Variances in regulations between states might hinder timely medical care, leading to more paperwork and reduced access to healthcare services in some areas (Texas Nurse Practitioners, 2020). Resolving this issue and retiring delegation needs may grant Nurse Practitioners more self-governance in their field. Greater independence would enable them to detect illnesses and administer treatment without needing medical director approval and expand their repertoire of offered services. Expanding healthcare access is a primary objective of this proposal, especially in remote or underprivileged regions. With NPs poised to make a significant difference through skill optimization, improving patient care is a direct result.

Expanding Access for Patients: Restricted access to medical care is a persistent issue in several regions, stemming mainly from a scarcity of general practitioners. Advocating for policy changes can expand patient access. By enabling NPs to practice in diverse healthcare environments, retail clinics, urgent care centers, and telehealth platforms are included. Enabling NPs to utilize their complete training and instruction enables them to provide more comprehensive care, leading to enhanced patient outcomes and financial benefits (Texas Nurse Practitioners, 2020). A successful expansion of patient access would empower NPs to meet urgent healthcare demands, particularly in underprivileged regions. These professionals prioritize proactive healthcare by emphasizing preventive measures, managing chronic conditions, and offering educational support. Enhanced well-being outcomes are likely to occur due to this measure. In addressing these political movements, Nurse Practitioners can play an active role in their state NP association’s advocacy team. They can attend legislative assemblies and contribute their voice (Texas Nurse Practitioners, 2020). Through local activism, they can reach out to lawmakers and foster greater comprehension of the significance of these projects. Building alliances with key partners, including healthcare professionals and patient advocates, can help them gain momentum for their campaigns.

Respond to 1: Kelly 

The Massachusetts Coalition of Nurse Practitioners is a professional membership organization that provides representation and support for practice and regulatory issues for Nurse Practitioners in Massachusetts. A current issue that is being advocated for and that has been introduced to the joint committee revolves around determining capacity for health care proxies. The act is titled  “H.1539 An Act Relative to Determining Capacity and Invoking the Health Care Proxy”. This act will give NP’s the legal authority to determine capacity regarding medical decision making and the ability to invoke the health care proxy for patients who are determined to lack such capacity (MCNP, n.d.). Currently, this issue is authority is limited to fall under the scope of an attending physician. For the NP, this would involve the utilization of assessment skills to determine whether a patient is able to make their own medical decisions based on factors such as mental status, intellectual functioning, and overall hemodynamic stability. 

This issue restricts my future practice as a FNP because it denies my ability to assess patients who may be at risk for serious harm. In Massachusetts, NP’s have full practice authority and can prescribe independently without a physician. The same should be said for decisions regarding health proxies and MOLST forms. Further, this issue has the potential to negatively affect the personal relationships I will aim to make with patients and families. Rai et al. (1999) note that one of the harms of banning physician proxies is the fact that the ban reflects a constricted view of the physician-patient relationship. It would feel as though I would not be able to appropriately counsel and educate my patient and their family members regarding advanced care planning, which is a very prominent issue in healthcare that often brings up ethical dilemmas. Van der Plas et al. (2021) note that a lack of trust or negative prior experiences with advanced care planning may be a reason for older individuals not wanting to participate in these types of conversations. 

To address this issue, along with other political movements in my state and community, my role as a future FNP wil be to advocate for change. Jacobs (2007) notes that advanced nursing practice comes with the potential to pave the way for more opportunities and innovative approaches across health systems. It will be important to keep myself updated on current and active state issues so that I can educate myself in these areas and develop appropriate approaches to seek change.

Carmen: 

I live in Massachusetts, a state that grants nurse practitioners (NPs) full practice authority (FPA). However, Medicare restrictions established by the federal government were not modified because of the enactment of the FPA. In Massachusetts, a physician of record or signature is still needed to certify the need for diabetic shoes, to request cardiac and pulmonary rehab, to provide initial hospice certification, and to conduct the admitting examination as well as the first and alternate monthly assessments of patients in skilled nursing facilities (Massachusetts Coalition of Nurse Practitioners [MCNP] n.d.). This topic is now being lobbied for and has been advocated for by the American Association of Nurse Practitioners (AANP), and it was introduced in the United States Senate and the House of Representatives on July 20, 2023, by Senators Merkley (D-OR) and Lummis (R-WY). The Act is known as the ICAN ACT, and it is designated H.R. 2713/S.2418. It supports patient access to health care services given by the provider of their choice by removing obsolete Medicare and Medicaid constraints on NPs and other advanced practice registered nurses (AANP, 2023). APRNs are essential in the delivery of healthcare, particularly services for the public’s preventative care and to promote effective management of chronic diseases which are becoming more prevalent as baby boomers age and will continue to trend upward due to anticipated longer life spans (Holstein, 2018). Diabetes, for example, is an epidemic in the United States; in Massachusetts, 8.4% of adults have diabetes, 3% have diabetes but are unaware of it, 31.7% have prediabetes, and its management costs Massachusetts billions of dollars each year (American Diabetes Association, 2022).

These NP constraints limit my capacity to provide patient care follow-up as a future APRN, limit patients’ provider options, and reduce my credibility in the healthcare system. They also have a negative impact on my productivity capacity and the amount of healthcare services I can provide to those in need, such as patients with chronic medical conditions and the elderly. (Kleinpel et al., 2023). In rural areas, where there is a physician shortage and an increase in NPs as a result, removing the outdated Medicare and Medicaid restrictions on NPs and other APRNs will increase access to care and utilization of healthcare services, lower costs without sacrificing care quality (Yang et al., 2021).

As a future AGPCNP, it is my responsibility to prepare for political engagement, with a focus on both the national and state levels, to promote the development of legislation that recognizes APRNs as essential contributors to the provision of high-quality healthcare to the American public. Maintaining responsibility to my community to offer high-quality and reasonably priced care is a part of my social contract (Joel, 2022).