Discussion: Federalism’s Impact on Policy NURS 8100
Discussion: Federalism’s Impact on Policy NURS 8100
Discussion: Federalisms Impact on Policy NURS 8100
In the state of Maryland some of the advanced practice registered nurses (APRNs) include certified midwives, nurse anesthetist, certified nurse practioner (NP) and a clinical nurse specialist. This should be similar to other states too. At a minimum and from personal experience Maryland board of nursing has to give permission to practice as an NP and there are basic requirements that have to be met to qualify to be certified. Not all the regulations that are set forth by the state of Maryland for APRN to practice are recent but they are however all currently used.
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Code of Maryland regulations (COMAR) are the compilation of the state of Maryland regulations that help govern the state, (Maryland.org, n.d). Health care is not an exception and APRNP have to abide by the COMAR regulations. According to COMAR, (2020), APRNs can perform multiple functions independently.
These include comprehensive assessments, complete a death certificate, do not resuscitate orders, interpret diagnostic and laboratory tests, prescribe medications, provide care and give referrals to other providers. An NP can also practice as a registered nurse and for those who have certifications for mental health, they can admit a client on an involuntary basis for treatment.
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How State Regulations Are Supported within Place of Employment
The place of employment has set standards at the same level of practice as expected by the state but for some treatment approaches the expectation is to defer to the primary physician or the medical director. Establishing this baseline helps achieve the expected standards and also remain in compliance with the COMAR and federal regulations. The place is very supportive that when the NP completes an admission assessment, the doctor does not have to double check unless there is a concern.
As a nurse practioner, at the place of work there are multiple activities that can be performed independently. These tasks include but not limited to giving orders for medications and treatment, reviewing diagnostic tests, and responding to families as required. One task that is permitted by the state of Maryland but not encouraged at the place of work is signing of certificates of incapacity. (A. Speer, personal communication, July 26, 2021). The primary physician and the psychiatrist sign the Maryland order for life sustaining treatment (MOLST) also and only encourage the NP to sign it if they are not available. This is a task that is authorized by COMAR regulations.
How States Differ in Terms of Scope of Practice
Different states have different prescriptive authorities and conditions that they give to their APRNs. There are those states that are referred to as independent states which allow APRN independent prescribing and there are those which do not, (Schirle & McCabe, 2016).
Barriers to practice are not uncommon even when the states are flexible, health care settings can still impose different strict policies and procedures. This leads to restriction of some aspects of patient care and limited access to providers despite the states having full practice authority, (Schorn, Myers, Barroso, Hande, Hudson, Kim & Kleinpell 2022).
Impact on Professional Nurses across the United States.
Some nurses have opted to relocate or work where there is more prescriptive authority. Some nurses also have opted not to relocate but get licensures in neighboring states that can give them more autonomy. There are also nurses who have opted to work in other areas where they are needed. These areas include working as lobbyists, researchers, nurse educators and consultants. In this aspect their full potential is more effectively utilized.
References
COMAR 10.27.07.00 (2020) Practice of the Nurse Practitioner , http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm
Maryland.org (n.d), Division of state documents. http://www.dsd.state.md.us/COMAR/ComarHome.html
Schirle, L., & McCabe, B. E. (2016). State variation in opioid and benzodiazepine prescriptions between independent and nonindependent advanced practice registered nurse prescribing states. Nursing Outlook, 64(1), 86–93. https://doi.org/10.1016/j.outlook.2015.10.003
Schorn, M. N., Myers, C., Barroso, J., Hande, K., Hudson, T., Kim, J., & Kleinpell, R. (2022). Results of a National Survey: Ongoing Barriers to APRN Practice in the United States. Policy, Politics & Nursing Practice, 23(2), 118–129. https://doi.org/10.1177/15271544221076524
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Discussion: Federalism’s Impact on Policy
The fragmentation of the U.S. health care system, with its differing modes of financing
and service delivery, is a reflection of a dispersed government structure. Policy making
is shared and distributed across various branches and levels of government. As a
result, policy making processes can be slow to respond, manipulated towards personal
interests, and often redundant.
Consider, for example, the public entitlement programs
such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS),
and the PPACA of 2010. Where is there overlap between these policies? How do they
demonstrate a dispersed government structure?
This week, you will analyze the role of the federal government in health care policy
making.
Discussion Federalism’s Impact on Policy NURS 8100
To prepare:
Review this week’s Learning Resources focusing on the France article and the textbook
readings.
Identify two nursing or health care policies that address similar needs, one passed at
the federal level and the other at another level of government (state or local).
By Day 3
Post a cohesive response that addresses the following:
Provide an example of two policies that address similar needs, passed at two levels of
government (i.e., federal, state, or local).
What are the advantages and/or disadvantages of this duplication? How does this
example reflect the implications of federalism? Provide support from the literature for
your position.
To what degree should the federal government get involved in health care policy
making? Provide concrete examples to support your position.
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues in one or more of the following ways:
Ask a probing question, substantiated with additional background information, evidence
or research.
Share an insight from having read your colleagues’ postings, synthesizing the
information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from
your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after
synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting
perspectives based on readings and evidence.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question
posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting.
Note what you learned and/or any insights you gained as a result of the comments
made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning
Resources and any additional sources.
Submission and Grading Information
https://nursingmasters.blog/discussion-federalisms-impact-on-policy-nurs-8100/
Grading Criteria
To access your rubric:
Week 8 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 8 Discussion
Assignment 1: Issues in Health Care
Reform (Interview)
Continue to work on this Assignment, assigned in Week 2 and due in Week 9.
By Day 7 of Week 9
Submit this Assignment.
Assignment 3: Policy Analysis Paper
[Major Assessment 2]
Continue to work on this Assignment, assigned in Week 4 and due in Week 11. Analyze
the politics and issues surrounding your selected health care policy. This information
should be included in Part 1 of your analysis paper.
By Day 7 of Week 11
Submit this Assignment.
Week in Review
This week, you assessed the implications of federalism in health care policy making
and analyzed the politics and issues surrounding a current health care policy.
Next week, you will focus on the role of state and local government in policy making,
with particular attention to the function of state boards of nursing in the regulation of
practice.
ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Federalism’s Impact on Policy NURS 8100
Learning Resources
Note: To access this week’s required library resources, please click on the link to the
Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical
approach (7th ed.). New York, NY: McGraw-Hill Medical.
Chapter 15, “Health Care Reform and National Health Insurance”
Chapter 15 discusses the history of legislating national health care insurance in
the United States. The chapter focuses on the different methods of financing a
national health care reform, from a single-payer government fund to employer
and individual mandates.
Chapter 16, “Conflict and Change in America's Health Care System”
Chapter 16 highlights the historical relationships between health care
purchasers, insurers, providers, and suppliers. Over the decades, these
stakeholders have battled for control of the U. S. health care system, as health
care costs increase and more people remain uninsured.
France, C. (2008). The form and context of federalism: Meaning for health care
financing. Journal of Health Politics, Policy & Law, 33(4), 649–705. doi:
10.1215/03616878-2008-012
Note: You will access this article from the Walden Library databases.
The author argues that the United States’ unique form of federalism works negatively
within a fragmented societal context to create an equally fragmented and dispersed
health care system. The article highlights the United States health care system by
comparing it with systems in Canada, Germany, and Australia.
Frankel, M. S. (2009). Commentary: Public outreach by the FDA: Evaluating oversight
of human drugs and medical devices. Journal of Law, Medicine & Ethics, 37(4),
625–628.
Note: You will access this article from the Walden Library databases.
Kennedy, E. M. (2005). The role of the federal government in eliminating health
disparities. Health Affairs, 24(2), 425–428.
Note: You will access this article from the Walden Library databases.
In this article, the late Senator Kennedy discusses health care disparities among
marginalized groups in the United States. He proposes the expansion of Medicaid and
State Children’s Health Insurance Program (SCHIP), increased cultural competency
among health care providers, health care research related to marginalized groups, and
an increased public health investment by the United States. He includes a brief history
of government involvement in reducing health care disparities.
Week 8: Federal Role in Health Care Policy
How does the organization and structure of government, including the existence of multiple levels (federal, state, local), promote or hamper effective policy making and implementation? What role does the federal government, in particular, play in the development of policies that affect nursing practice in today’s health care organizations? This week, you will examine how federalism has influenced the current health care system. You will consider the positive, or negative, implications of redundancy in health policy resulting from different levels of government.
Learning Objectives
Students will:
- Assess the implications of federalism in health care policy making
- Analyze the politics and issues surrounding a current health care policy
Learning Resources
Required Readings
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8th ed.). McGraw-Hill.
- Chapter 15, “Health Care Reform and National Health Insurance”
Chapter 15 discusses the history of legislating national health care insurance in the United States. The chapter focuses on the different methods of financing a national health care reform, from a single-payer government fund to employer and individual mandates.
- Chapter 16, “Conflict and Change in America’s Health Care System”
Chapter 16 highlights the historical relationships between health care purchasers, insurers, providers, and suppliers. Over the decades, these stakeholders have battled for control of the U. S. health care system, as health care costs increase and more people remain uninsured.
The author argues that the United States’ unique form of federalism works negatively within a fragmented societal context to create an equally fragmented and dispersed health care system. The article highlights the United States health care system by comparing it with systems in Canada, Germany, and Australia.
In this article, the late Senator Kennedy discusses health care disparities among marginalized groups in the United States. He proposes the expansion of Medicaid and State Children’s Health Insurance Program (SCHIP), increased cultural competency among health care providers, health care research related to marginalized groups, and an increased public health investment by the United States. He includes a brief history of government involvement in reducing health care disparities.
Discussion: Federalism’s Impact on Policy
The fragmentation of the U.S. health care system, with its differing modes of financing and service delivery, is a reflection of a dispersed government structure. Policy making is shared and distributed across various branches and levels of government. As a result, policy making processes can be slow to respond, manipulated towards personal interests, and often redundant.
Consider, for example, the public entitlement programs such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS), and the PPACA of 2010. Where is there overlap between these policies? How do they demonstrate a dispersed government structure?
This week, you will analyze the role of the federal government in health care policy making.
To prepare:
- Review this week’s Learning Resources focusing on the France article and the textbook readings.
- Identify two nursing or health care policies that address similar needs, one passed at the federal level and the other at another level of government (state or local).
By Day 3
Post a cohesive response that addresses the following:
- Provide an example of two policies that address similar needs, passed at two levels of government (i.e., federal, state, or local).
- What are the advantages and/or disadvantages of this duplication? How does this example reflect the implications of federalism? Provide support from the literature for your position.
- To what degree should the federal government get involved in health care policy making? Provide concrete examples to support your position.
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues in one or more of the following ways:
- Ask a probing question, substantiated with additional background information, evidence or research.
- Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
- Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
- Validate an idea with your own experience and additional research.
- Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
- Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
Submission and Grading Information
Grading Criteria
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Assignment 1: Issues in Health Care Reform (Interview)
Continue to work on this Assignment, assigned in Week 2 and due in Week 9.
By Day 7 of Week 9
Submit this Assignment.
Assignment 3: Policy Analysis Paper [Major Assessment]
Continue to work on this Assignment, assigned in Week 4 and due in Week 11. Analyze the politics and issues surrounding your selected health care policy. This information should be included in Part 1 of your analysis paper.
By Day 7 of Week 11
Submit this Assignment.
Week in Review
This week, you assessed the implications of federalism in health care policy making and analyzed the politics and issues surrounding a current health care policy.
Next week, you will focus on the role of state and local government in policy making, with particular attention to the function of state boards of nursing in the regulation of practice.