identify a health issue requiring advocacy from the nursing profession on a local, regional, state, national, or international level.

Analyze treatment options used for children and adolescents
October 15, 2021
Examine the similarities and differences between CBT and REBT.
October 15, 2021

identify a health issue requiring advocacy from the nursing profession on a local, regional, state, national, or international level.

identify a health issue requiring advocacy from the nursing

profession on a local, regional, state, national, or international level.
Health Issue and Advocacy Assignment

The purpose of this assignment is to identify a health issue requiring advocacy from the nursing

profession on a local, regional, state, national, or international level. This topic can be related to

health promotion, population health, disease management, or patient safety in the community or

other healthcare setting. You are assuming the role of advocate in various capacities. Health Issues and Advocacy Assignment. The topic

you select for this paper will be the subject of your Policy Brief and Advocacy Letter

Assignment. Therefore, research thoroughly your topic of interest to ensure that it can be applied

across both assignments.

In this paper you will identify a health issue which may or may not already be represented in the

form of legislation or health policy. Individuals may just take a position on an issue affecting

local policy with decision makers.

An example of this with legislation includes:

Health issue: primary care access for patients
Health policy: increasing primary care providers using nurse practitioners; support of PA
HB 765 for CRNP independent practice

An example of this without legislation includes:

Health issue: increased chronic back pain from integration of technology in healthcare
Health policy: ergonomic evaluation of work environments for all employees; letter of
support to employers for new healthcare organization policy

This assignment is worth 25% of your grade. Using APA format and criteria from the Grading. Health Issues and Advocacy Assignment

Rubric for Written Assignments, in 5 double spaced pages (excluding the title page and reference

page) present the following details:

Criteria for Your Advocacy as a Nursing Professional


Outline of health issue and existing or necessary health policy

and/or politics. Why is this significant to nursing?

List and discuss any other stake holders who would be concerned

with the health issue, in favor or opposition.

Propose a plan on this health issue advocacy:

Effect of the health issue on health policy and politics

Interventions to be implemented in this advocacy to enact
change; incorporate health politics as pertinent

Identify opposition which can be encountered.

Primary Health Care (PHC) as a Health Policy Issue in the US: Advocacy towards Policy Implementation of Full Practice Authority (FPA) across all States for Certified Registered Nurse Practitioners (CRNPs) as the Solution to Universal Access. Health Issues and Advocacy Assignment


The certified registered nurse practitioner (CRNP) or the advanced practice registered nurse (APRN) or simply the nurse practitioner (NP) is a cadre of health care provider in the United States that is highly trained. They are educated and trained to diagnose, prescribe, educate, and treat effectively at the primary care level. A CRNP must have a postgraduate degree from an accredited course in a recognized university and requisite practical hours of experience to get credentialing and licensure to practice (ANCC, n.d.; 2U, Inc., 2018). In effect, the CRNP serve to complement the work of the primary care physician at the grassroots level where health care access is limited due to physician shortage. However, the practice of CRNPs is heavily regulated by different states in the US. This is because many states require a CRNP, despite their education and experience, to be supervised by a physician with which they have to enter into a collaborative contractual agreement (Blore, 2019a; Blore, 2019b; Blore, 2019c; Peterson, 2017). The APRN therefore can only diagnose, prescribe, and follow up patients at the pleasure of the physician who has to countersign on any prescription and notes by the APRN (Blore, 2019c). According to the American Association of Nurse Practitioners (AANP), different states in the US have thus allowed one of the following for the APRN: restricted practice, reduced practice, or full practice authority/ autonomy (Peterson, 2017). Of these three forms of practice, full practice authority or FPA is the best as it gives the nurse practitioner complete autonomy from any physician oversight, and allows them to practice to the full extent of their education, training, skills, and capabilities (Kristen, 2015; Peterson, 2017; Dillon & Gary, 2017). From a nurse advocacy perspective, therefore, full practice authority (FPA) for the APRN in relation to effective primary health care provision is a pertinent health issue that requires advocacy on both the state and national level. This paper takes a look at the advocacy pathways to effecting necessary policy changes in favour of FPA for APRNs of CRNPs as key providers of primary health care. It recognizes that APRNs are vital players in the provision of universal primary health care for all. Health Issues and Advocacy Assignment

Existing Health Policies and Politics Surrounding Full Practice Authority for APRNs

The concept of the nurse practitioner came into being in the 1960s with the realization that primary health care was an important factor to ensuring a healthy population. The NP was to be an important pillar of primary care at the grassroots level (Marsden & Street, 2004). With the development of the field, numerous studies have showed that these professionals are competent and offer satisfactory care to patients at par with or even better than physicians (Marsden & Street, 2004; Dillon & Gary, 2017). However, as of 2017 only 22 states and the District of Columbia had granted full practice authority to their APRNs. The remaining 29 states place limitations to APRN practice (Peterson, 2017). According to the American Association of Nurse Practitioners (AANP), full practice authority is the presence of state legislation and rules favorable to NPs and giving them authority to review, diagnose, prescribe, and treat patients from authority conferred by licensure from the practice state’s nursing authorities (Peterson, 2017; Dillon & Gary, 2017). In some of the restrictive states to practice, the APRN cannot even prescribe schedule II controlled substance – not even under their collaborative physician supervision (Dillon & Gary, 2017). In the state of Georgia, for instance, the NP is not only prevented from prescribing schedule II medications, but also not allowed to request or interpret diagnostic tests like CT scan or MRI (Blore, 2019a). In the restrictive state of Texas, the APRN is regulated by the Texas Board of Medicine in addition to the Texas Board of Nursing as should be the norm. This is notwithstanding the fact that to obtain licensure, the NP must show written proof of a collaborative contract agreement with a supervising physician (Blore, 2019c). Health Issues and Advocacy Assignment

Slow progress is however being made despite resistance from particular quarters. For instance, in 2015 legislator Topper presented a motion seeking to amend The Professional Nursing Law (Act) of 1951 (P.L.317, No.69) to provide for more autonomy for nurse practitioners in the state of Pennsylvania(Pennsylvania General Assembly, n.d.). Similar efforts are underway in the remaining restrictive states to accord NPs FPA and enable more access to primary health care as required by the World Health Organization or WHO (Phillips Jr. &Bazemore, 2010). Of note in all this is the resistance by physicians and their professional bodies to granting NPs FPA. This is partly motivated by selfish financial gain as NPs have to pay a lot of money to physicians in the so-called collaborative agreements for oversight, and they would not want to lose this (Blore, 2019a; Dillon & Gary, 2017). Health Issues and Advocacy Assignment

Why Granting FPA to CRNPs is Important to Nursing

As stated earlier, NPs are vital in the provision of primary health care since demand for health care is higher than supply, especially in marginalised and deprived communities. Therefore, FPA will ensure that NPs practice without restrictions and take care of their patients with all the skills, education, and experience that they have. NPs are thus crucial in bridging the workforce gap in primary healthcare provision (Poghosyan et al., 2014). From the foregoing, it is quite evident that there have been significant capacity gaps in policy for empowerment of the NP. It is primary care physicians, physician assistants (PAs), and NPs that are responsible for providing primary care. However, it is estimated that by 2025, the demand for primary health care (PHC) in the US will outstrip the supply of this workforce by 20%. In the same light, an estimated 250,000 APRNs will be providing PHC across the US in 2025 (Poghosyan et al., 2014). This is why FPA as a health policy issue is so important to nursing and NPs in particular, given their significant role in PHC provision. Health Issues and Advocacy Assignment

Primary Health Care (PHC)

The concept of PHC was first officially adopted by the WHO at its International Conference on PHC in Alma-Ata in 1978. The Alma-Ata Declaration defined PHC then as basic healthcare that is evidence-based and that is made easily available to everybody at the first point of contact with a healthcare professional. It must be socially and culturally sensitive, affordable, and involve the input of the recipient.The US has notably consistently failed to fully implement PHC tenets in its healthcare system (Phillips Jr. &Bazemore, 2010). In fact, healthcare in the US is the most expensive in the world, yet not the most effective compared to other developed nations (Bates, 2010). Failure of PHC in the US is evidenced by the fact of restrictions and denial of FPA to NPs in many states, despite evidence that they are the key to unlocking lack of universal access to PHC at the grassroots.

The Stakeholders Concerned with the FPA Primary Health Issue

Those in favor of universal FPA for NPs in the US are definitely first and foremost the nurse practitioners themselves. This they do through their professional bodies like the American Association of Nurse Practitioners (AANP) and the American Nurses Association (ANA). In this they are supported by various other bodies and organizations which include the National Governors Association, the Josiah Macy Foundation, the Bipartisan Policy Centre, the Federal Trade Commission, and the Department of Veterans Affairs, amongst others (Blore, 2019b; Dillon & Gary, 2017). Also supporting the effort at universal PHC through FPA are the Institute of Medicine (IOM) and the National Conference of State Legislatures (Blore, 2019c). Health Issues and Advocacy Assignment


The forces that are against the granting of FPA as an important step in the provision of universal access to PHC are practicing physicians and their professional bodies. One such notable body is the American Academy of Family Physicians (AAFP). This professional body for physicians has gone to the extent of producing a lopsided report disparaging NPs and FPA, claiming that they are not competent enough. It was however noted by industry stakeholders that the report was not based on solid facts. In fact, it went against the propositions of the American Institute of Medicine (IOM) which recommended more autonomy to NPs in ensuring PHC provision (Dillon & Gary, 2017).

Plan for FPA Health Issue Advocacy

APRNs or CRNPs must educate patients and the community about their role in PHC delivery. They must always demonstrate competence and skill and make their contributions noted. They should participate in conferences and seminars and present and publish papers on their work and role. They need to also lobby legislators, government ministries, certification agencies, and physician colleagues for support on the matter of FPA. On this, media and community campaigns will also help in achievement of the goal (Dillon & Gary, 2017). On top of these measures, NPs should be active in their professional associations and take an interest in legislative issues at both the federal and national platforms (Blore, 2019a).

All these measures will work synergistically to change the health policy and politics around the matter of FPA as it relates to the access to PHC, especially to the underprivileged. This is especially urgent given the passing of the Affordable Care Act of 2010, which brought on board health coverage another estimated 32 million previously marginalised patients (Kristen, 2015; Dillon & Gary, 2017). Expected opposition will be from the traditional physician bodies and lobby groups motivated by financial gain and not affordability of care. Health Issues and Advocacy Assignment


Primary health care is akin to a human rights issue. It should be the minimum accessible care to even the most disadvantaged. FPA to CRNPs in the US seeks to enable the realization of this right to the wider grassroots population in fringe communities


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Kristen, A. (2015). Implementing evidence-based health policy: A focus on Pennsylvania’s nurse practitioner full practice authority legislation [Doctoral dissertation]. Available from the UMB Digital Archive. Retrieved 22 June 2019 from;jsessionid=59DC6793F065C1E9490D1308AAE69526?sequence=1

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