One Peer Responses Per Each Discussion Total 4. The Response Should Be At Least One Paragraph With No Less Than Five Sentences Strongly Supporting Your Peer Input. Remember To Including The Citation And At Least One APA Reference. Discussion Attached


While working as a nurse practitioner, one could impact the healthcare reform, not only in our patients but personally as well. In the United States, the Affordable Care Act has made an attempt to make health care available to everyone. Part of that legislation involved penalties and taxes attached to individuals who did not purchase the health insurance (Price & Norbeck, 2017). The initial plan of the Affordable Care Act was to increase competition of the insurance companies. Many insurance companies were forced out of business. To stay in business the insurance companies needed to cut costs and regulate utilization. This process involved placing rules and regulations on preauthorization, referrals, increasing deductibles and copays (Price & Norbeck, 2017). 

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           From my experience, I have found that many times the care that needs to be provided to patients is run by the insurance company, not the provider. This becomes frustrating when it becomes a battle over money and not what is best for the patient. This affects the nurse practitioners in that evidence-based practice is sometimes pushed to the side to accommodate what the insurance company deems necessary. This is time-consuming and detrimental to patient care. With research and policymakers both agreeing that nurse practitioners are a viable resource to bridge the gap in access and quality care as well as cost containment in healthcare (Poghosyan, 2018). Additionally, if the nurse practitioner is mandated to be working in the same office as a physician, will decrease the potential for new offices being opened to support patient overcrowding in the current primary care provider offices.  State scope of practice laws that are not congruent in all fifty states also poses limitations to the nurse practitioner. To mitigate this issue, all fifty states should have a uniform scope of practice for the nurse practitioner. The more our legislative bodies make healthcare more accessible to the general public demand for new primary care providers will increase exponentially (Yang & Meiners, 2014). Studies have shown that when NP’s practice autonomously, patients benefit and the organizations that employ them show more favorable teamwork and relationships with leadership (Poghosyan & Liu, 2016). 

           According to the FLANP (2020), the law HB 607: Direct Care Workers in our state of Florida states that NPs seeking to be licensed for Independent practice must meet some qualifications. First, 3,000 hours of clinical practice hours, which may include clinical instructional hours, within the 5 years immediately preceding the application request. Besides, they need to have completed 3 graduate-level semester hours, or the equivalent, in differential diagnosis and pharmacology within the 5 years immediately preceding the application request. Also, the NP must obtain and maintain professional liability coverage (malpractice insurance) in the amount of at least 100k per claim / 300k aggregate or obtain and maintain an irrevocable letter of credit in the amount of at least 100k per claim / 300k aggregate.

           Once the APRN license of independent practice is successfully issued, the NP is granted signature authority which includes the Baker Act involuntary examination, signing death certificates, admitting/discharging patients from a facility and “provide a signature, certification, stamp, verification, affidavit, or endorsement that is otherwise required by law to be provided by a physician (except for medical cannabis). This is known as signature authority. Nurse Practitioners who obtain a license to practice independently, need to star in such practice only in primary practice, including family medicine, general pediatrics, and general internal medicine, as defined by board rule. On the other hand, if an APRN desires to continue practicing under a collaborative/supervisory protocol, nothing changes from previous standards. No additional restrictions exist for those APRNs providing care with a protocol in place (FLANP, 2020).


Florida Association of Nurse Practitioners. (2020). New Laws for 2020. Retrieved from

Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioners

workforce and practice. Nursing Economic$, 36(1), 43-45. Retrieved from

Poghosyan, L., & Liu, J. (2016). Nurse practitioner autonomy and relationships with leadership

affect teamwork in primary care practices: A cross-sectional survey. Journal of General Internal Medicine, 31(7), 771-777.

Price, G., & Norbeck, T. (2017). Forbes. Retrieved from

Yang, T. T., & Meiners, M. R. (2014). Care coordination and the expansion of nursing

scopes of practice. The Journal of Law, Medicine & Ethics: A Journal of The American Society of Law, Medicine & Ethics, 42(1), 93-103.

Maritza Leon Cosme

1/9/21, 2:39 PM 


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Healthcare Reform and role of NP

      Healthcare reform has implemented policies and programs as well as healthcare outcomes which have models to accomplish management of care addressing chronic care and preventive care across the inter-professional team of healthcare providers, which included NP. However, there are several factors driving healthcare reform. Fragmentation, unsustainable costs, and access problems are some of the major driving factors. According to Bernazzani (2016), the available primary care providers’ workforce is not enough to meet the growing healthcare demands resulting from these healthcare transformations. That is why an increasing number of health policy experts are encouraging state and federal governments to broaden the role of  family nurse practitioners  (FNPs) and other advanced practice nurses in the primary care setting.

         However, barriers to NP practice continue to prevent these practitioners from achieving their full potential. The most challenging of these is undoubtedly the  scope-of-practice regulations  established by Medicaid agencies, state licensing boards, and hospitals themselves. A 2012 study found major differences in NP scope-of-practice requirements across US states. In some states, NPs are fully authorized to evaluate, diagnose, and initiate and manage patient treatment. Yet while certain states allow NPs the freedom to work independently of physician oversight, others place tight restrictions on select activities (e.g., diagnosing a patient’s condition or prescribing medications).

         Another obstacle facing NPs is reimbursement. In many states, the amount of Medicaid reimbursement for NP services is considerably less than those services provided by a physician—up to 25% less. Additionally, a quarter of HMOs do not recognize nurse practitioners as primary care providers, which also impacts coverage. While the barriers are significant, there are some glimmers of hope on the horizon. More states are working to expand the role of NPs in primary care, including granting full practice authority and improving reimbursement.

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Yulei Castellanos

Advanced Family Practicum III

Since the improvement of the job of nurse (NP), NPs have advocated policies which let them perform throughout the training of theirs. The goal of the analysis ended up being to find out if the endorsement of the Affordable Care Act (ACA) had an influence on growing the range of the process of NP 8 American states followed the Full Practice Authority (PLA) from 2011 to 2016, a rise of two times as most of as the prior ten years, 7 states have followed drug development (Pittman, Leach, Everett, Han, & McElroy, 2020). Nursing politicians and interest groups have formed the arguments of theirs in favor of the PLA all over the progressively insured population due to the ACA, the scarcity of issues and providers of a chance to access rural overall health.

The roles, education and responsibilities of nurses have in order to change significantly to meet up with the higher need for attention which will be made by health reform and then to advance the enhancement of the increasingly complicated U.S. healthcare system, based on an innovative article from the Institute of Medicine. Nursing staff must be completely interested with some other healthcare professionals and also participate in a top role in overhauling attention in the United States, said the committee which published the article. To make sure that its participants are well prepared, the career must institute residency education for nurses, boost the portion of nurses that acquire a bachelor’s degree to eighty % by 2021 and increase the amount of physicians (Pittman, Leach, Everett, Han, & McElroy, 2020). Additionally, institutional and regulatory barriers – including boundaries on the scope of nurses’ practice – should be eliminated therefore the process is able to make use of the instruction, knowledge and skills of nurses in patient care.

American states, federal health and agencies companies must eliminate the scope of sensible barriers which stop nursing staff from learning throughout their training and training, the article states. Barriers to perform are especially tricky for Advanced Practice Registered Nurses (APRN). In the hope that large numbers of individuals has use of health coverage with the ACA, the healthcare system should use the abilities of APRN s to meet up with the increased need for primary care, the committee stated (Kirkman, Wilkinson, & Scahill, 2018). Information from the experiences and APRN studies of health organizations with improved the job as well as duties of nurses in patient care, like the Veterans Health Administration, Geisinger Health System and Kaiser Permanente, indicate that these nursing professionals offer safe, high quality primary care.


Pittman, P., Leach, B., Everett, C., Han, X., & McElroy, D. (2020). NP and PA privileging in acute care settings: Do scope of practice laws matter?. Medical Care Research and Review, 77(2), 112-120.

Lizandra Alvarez Hernandez

1/8/21, 1:07 AM

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The Affordable Care Act is a subsidized health insurance marketplace that allows individuals to shop for health insurances (Salmond, & Echevarria, 2017).  This service allows people to obtain an affordable insurance that will help them to maintain a healthy lifestyle. One of the primary successes of the Affordable Care Act is that set up to prevent health insurance companies from denying health an individual with previous health conditions. The insurance plans are categorized into four main categories, bronze, silver, gold, and platinum. One other feature of ACA is that it includes an individual mandate that requires individuals that did not apply for insurance to pay a fee (Corry, 2017). This has been done to encourage people that did not feel that they needed insurance to apply for an insurance and assist them to obtain it in an affordable way. 

As more and more people are able to have health insurance, the demand for primary care physicians also increases (Sophia, 2016).  The demand for health care professionals has given way to NPs to be able to provide their services to full extent. NPs are advanced educated individuals that are able to perform the duties in a primary care setting. Even though there are some obstacles with the scope of practice that does not allow NPs to give their full potential, there are plans of expanding them as they are clearly the future of healthcare. 


Sophia, B. (2016). How Healthcare Reform IsImpacting Primary Care. Retrieved from

Corry, N. (2017). Healthcare Reform 101: What the Health is Going On in 2018?! [Video file] retrieved from

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles fornursing. Orthopedic

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