3: REFLECTIVE RESPONSE 1 ■ 105happen as the physician shortages increase. Clearly, the AMA and ACP have different
views regarding a pilot of NPs as the leader of a medical home model— one that will, in
the future, hopefully be called a “health home.”
And in 2013 a paper for the National Institute of Health Care Reform by Yee,
Boukus, Cross, and Samuel titled Primary Care Workforce Shortages: Nurse Practitioner
Scope of Practice Laws and Payment Policies continued to discuss the influence of SOP
and payer policies on effective care delivery. They outline how payer policies now have
more impact than SOP laws on how and where NPs practice. In addition, the systematic
review by Xue, Yee, Brewer, and Spetz (2016) of NP SOP shows promise that removing
the remaining SOP restrictions could be one way to increase primary capacity in the
United States.
One aspect of DNP education, accreditation, certification, and licensure about
which the AMA and ACP do agree is that DNP certification should not be obtained
through Step 3 of the medical licensing exam of the National Board of Medical Examiners.
The discipline of nursing should certify and license the DNP, APRN, and CNP.
■ CONCLUSION
Our physician colleagues are alerted to four critical trends to keep in mind in 2016 by
the Ray and Norbeck (2016). Perhaps we also should track them: (a) evidence- based
policies regulating our practice; (b) health insurance market consolidation; (c) value-
based care versus volume for Medicare payments; and (d) leadership challenges
including administrative burdens (re- reporting requirement and prior authorization
problems), financial pressures, and multiple health system changes influencing our
practice.
Finally, the December 2015 Institute of Medicine Progress Report titled The Future
of Nursing wants us to be sure to focus our attention on five important areas:
- Removing APRN SOP restrictions and increasing interprofessional collabora-
tions - Expanding educational opportunities for both baccalaureates and doctoral
degrees as well as fostering lifelong learning - Collaborating and leading in the redesign of health care delivery and pay-
ment systems - Continuing to promote diversity
- Improving workforce data collection by including all states and federal gov-
ernment in order to better measure and monitor the numbers of health profes-
sionals needed, where employed, and what roles
The challenges of APRN practitioners and their role in the delivery of client- care
services to individuals in our society throughout their life span will go on for years; but
clearly the time has come for better communications, collaboration, and commitment
on the part of all health professionals in order to foster health care reforms in the 21st
century.
■ NOTES
- The center’s website at the University of Pennsylvania School of Nursing: http://www.nursing
.upenn.edu/history/Pages/default.aspx