Policy development must align with the agenda it advocates for, in nursing the competing needs of the workforce, resources and patients cannot all be met to the satisfaction of all the stakeholders, there will always be an opportunity cost where one thing is given up for another. Policies can have negative or positive impact that is why stakeholder involvement is crucial to its success, engaging nurses and other stakeholders in the decision-making process will ensure the needs of all concerned are addressed in the policy development process.
Healthcare is now based on a business model rather than a service, this business model requires reducing the cost through standardizing the care delivery systems which is often “accompanied by inflexible organizational policies, regulations and operating procedures.” (Kelly and Porr, 2018). This new model has led to many physicians leaving healthcare, accompanied by retirement and the long training process the shortage of primary care providers will continue to impede access to care. Nurse Practitioners (NPs) are the solution to this shortage but competing needs like barriers to practicing at full extent of their training and education, the lack of knowledge of NP’s competencies and the physicians who are resistant to change will continue to impact access to primary care for the growing number of patients seeking healthcare (Poghosyan, Norful and Laugesen, 2018).
Barrier to practice for NPs include the lack of uniformity among the 50 states regarding scope of practice, prescriptive authority, and practice requirements (Kleinpell et al., 2014). There has been some success in advancing efforts at uniformity with one third of the states granting NPs full authority to practice, state legislature changes are needed with Florida joining the ranks recently. Physicians along with their professional organizations believe that NPs lack the rigorous training and so are incapable of providing safe quality care (Hain and Fleck, 2014). This is due to lack of knowledge by physicians and other healthcare providers of the scope of practice and training of NPs. This can be rectified by education and organizations formalizing the job descriptions for NPs making it clear of the expectations.
With the looming shortage of access to primary care and the rapid growth of an aging population, federal, state and healthcare organizations will need to develop