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Please reply to Josiah Nich –
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Jennings et al. discuss how advanced practice registered nurses (APRNs) can be a cost effective solution to poor and underfunded access for people living in rural areas (2021). Having less autonomy than physicians, APRNs need to work as an extension of and under the authority of a physician. This can end up costing much needed money in rural areas that are already struggling to keep up with the high demand for health care; if APRNs were able to practice completely independent from a physician, it is likely that more money could be spent on medical supplies versus having to pay the salary of a physician. Casey et al. report that care provided by APRNs, in some cases, has shown to be as good and safe as care given by primary care doctors (2022). By setting unnecessary limits on the ability of APRNs to care for patients in rural communities, lawmakers are making it harder to deliver care to more people for less money. 

The North Carolina Nurses Association’s (NCNA) Council of Nurse Practitioners engages in discussions with state legislators as well as works to educate the public and APRNs on current practice information (North Carolina Nurses Association, 2022). It is important that nurses as well as APRNs advise and discuss healthcare policy with state legislators as they have the clinical insight to bring to light areas of focus; for example, enhancing APRNs ability to provide thorough medical management of patients. State legislators by nature have cost cutting and management of resources as part of their agenda as there limited amounts of resources available in both healthcare as well as all government undertakings. The North Carolina Institute of Medicine’s Task Force on Rural Health would be an important resource as they use research to discuss healthcare needs and issues with policy makers; they could help argue the case for increased autonomy in North Carolina (North Carolina Institute of Medicine, 2014). 

When it comes to stakeholders specifically, it seems as though the most important people to include in the conversation would be the people who need to benefit from the healthcare itself; the general population. People that pay tax dollars towards the state government and need to benefit from healthcare delivery are the most important voice to be heard when it comes to affecting state policy and changes. Educating the public on what changes are necessary and how this can free up funding for either more or different government resources could likely be very important. Incorporating the help of a non-profit think tank to help provide research would be important too; if an organization is not just out to make a profit but to help solve a problem then they can be better trusted to provide objective advice or data. 

Casey, M., O’Connor, L., Rohde, D., Twomey, L., Cullen, W., & Carroll, Á. (2022). Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland. Health Science Reports, 5(2)https://doi.org/10.1002/hsr2.555

North Carolina Institute of Medicine. North Carolina Rural Health Action Plan: A Report of the NIOM Task Force on Rural Health. September 13, 2022. 


North Carolina Nurses Association. Council of Nurse Practitioners. September 13, 2022. 


Please reply to Linda Mil –
Please note minimum of 200 words. No sources citation needed.

People living in rural areas are more likely to experience a shortage in healthcare services and care providers than other populations in urban areas (Ortiz et al., 2018). The shortage presents a challenge for prevention, immunization and basic care for illnesses. Advanced Practice Registered Nurses (APRNs) help in reducing the shortage and addressing the populations’ health care needs. Nursing autonomy is critical for APRNs working in rural areas because it gives them the freedom to work in healthcare environments and manage healthcare issues based on their knowledge and experience and allows them to ask for help when necessary. Considering the shortage of healthcare providers in rural areas, nursing autonomy is essential for the continuity of care. The New York Board of Nurses (BON) promotes nurses’ autonomy. APRNs have the authority to order, prescribe and dispense medication for patients’ treatment. The lack of nursing autonomy negatively impacts the populations’ access to healthcare because patients have to seek help in facilities with physicians. A limited number of physicians limits access to healthcare. 

NY laws do not require APRNs to work under doctors and physicians. They are allowed to make decisions on minor incidences and consult physicians when the need arises. The New York State Education Law allows APRNs to practice more autonomously. The law provides that they can practice with a collaborating physician and have collaborative relationships with physicians or work independently and only consult physicians when they need help. The NYS Senate Bill S2309A allowed qualified APRNs to diagnose and prescribe the treatment without a physician’s authorization (NYSED-OP, 2022). Brian Kavanagh proposed the bill and was also its greatest advocate. He argued that the bill would reduce healthcare shortages in areas with healthcare disparities. Nursing autonomy empowers nurses to make key healthcare decisions, allowing them to provide care to more patients. Therefore, a shortage of physicians will not affect healthcare access. 

As a healthcare professional in an advocacy role, the resources I could use for guidance when changing the policies that affect APRNs in my state include my leadership skills, support from professional healthcare organizations and other healthcare providers, and the members of the public’s support for the policy changes. Watson (2019) noted that nurses are highly trusted healthcare providers and have a great opportunity to lead the community and create a significant impact on the local government. Because they are key community leaders, they can use the public’s trust and support in impacting state policies that affect healthcare. Moreover, securing support from healthcare organizations and other healthcare providers increases a healthcare provider’s influence on government policies. 


NYSED-OP. (2022). Nursing. NYSED-OP. 



Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of nurse practitioner practice regulations on rural population health outcomes. Healthcare, 6(2), 65. 



Watson, J. (2019). Nurses as advocates. Nursing Made Incredibly Easy, 17(3), 42-46. 

Jennings, N., Lowe, G., & Tori, K. (2021). Nurse practitioner locums: a plausible solution for augmenting health care access for rural communities. Australian Journal of Primary Health, 27(1), 1-5. 


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