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Interview Assignment

Student Name

University

Advanced Role Development in Nursing

September 19, 2021

Abstract

Prior to the coming of Advanced Practice Nurses (APRNs), physicians were the only ones

recognized as having the ability to prescribe and act as gatekeepers of patient’s healthcare.

However, with the allowance of APRNs to become primary care physicians, and most

states, allowing them to be able to work independently due to emergency authorizations

given to them due to the COVID-19 Pandemic, APRNS are able to step in to fill the gaps in

the healthcare system that was expanded by the enactment of The Patient Protection and

Affordable Care Act (ACA) of 2010. Despite the enactment of the above-mentioned law,

APRNS are still facing challenges in the pursuit of their careers. This paper looks to

discover the role of the advanced professional nurse in depth as they discharge their duties

in the context of the institution in which they are employed. I will also be comparing and

contrasting the observed /evaluated role to that cited in professional guidelines, theory, and

research. To achieve this feat, an APRN will be interviewed for this assignment.

Keywords: APRNs, ACA, healthcare, research, Evidence-based practice

Interview Assignment

The role of Advanced Practice Nurses (APRNs) has become an integral part of the

American healthcare system and they have come to stay. Their role in the healthcare industry

was enhanced by The Patient Protection and Affordable Care Act (ACA) of 2010 which

expanded the role of APRNs in areas that physicians could not reach. In addition, APRNS are

known to be better provider of care to patients, are more empathetic, showed more patience in

dealing with patients, and had better interpersonal relationships (Woo et al., 2020). Due to the

prevalence of APRNS, hospitals are now making use of them as case managers as they have the

ability to “diagnose and treat, prescribe medications and utilize their expanded training reduces

the need for many physician consultations and referrals, which can take large amounts of time to

complete” (Feyereisen et al., 2021, p. 598). Due to the shortage of primary care physicians and

the expansion of Medicaid patients, many more people need primary care providers which

APRNS have been able to fill the gaps in the diagnosis, treatment, prescribing of medication, and

following up with patients for treatment (Klein et al. 2020).

Despite the numerous opportunities available to APRNs, there are challenges that they

face in carrying out their duties. They are expected to be collaborators with physicians, but some

physicians see them as incompetent and not up to par with them in the provision of treatment.

Research has shown that their work is at par with physicians and even sometimes outperform

them in the treatment of patients (Miranda Neto et al., 2018). Some states require that they

collaborate with physicians, and when this does not happen, their work is not accepted when

physicians refuse to endorse it. Some collaborating physicians can move out of the state APRNs

are practicing or end their relationships that impact their ability to be reimbursed for the work

they do (Barnes et al., 2017). However, the coming of COVID-19 has been a blessing in disguise
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for APRNs as states granted them full temporary authority to practice without collaboration due

to the need for the care of people affected with the virus (Stucky et al., 2021). In order to have a

better understanding of these issues affecting APRNs, OA, a Doctor of Nursing Practice (DNP),

who has been practicing as a APRN for the past six years was interviewed. The mission

statement and vision of her institution was reviewed prior to this interview. The mission of her

institution is to provide optimal care to people in communities where the standard of living is

low.

Interview

What professional expectations did you envisage on your transition from being a

Registered Nurse to become an Advanced Practice Nurse? (APRN)?

“Ok, as an Advanced Practice Nurse (APRN), you are the decision maker. You are a

primary care provider. As an RN, you have to wait for the orders of the doctor, and do whatever

the order that they give you. In this role as an APRN, you are the decision maker. You are the

one authorizing other people as what you want done for the patient. So, it’s a big role, it’s a very,

very big role. You need to know what you are doing because people are more dependent on you.

You are the gatekeeper of their health now. It’s a big gap” (OA, Personal communication,

September 12, 2021).

How will you view the relationships between physicians and APRNs?

“It depends on the physician you are. Oh my God! The last one I worked with… I can’t

tell you how unbelievable she is. She believed I needed to run my orders by her. In the state of

New Jersey, we are independent providers. Though, we don’t have full authority. It is a

collaboration. It’s not that everything we do has to be run by them. But she does not understand

that. The bottom line is that it depends on the physician you are working with. Some of them are
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accepting, and some of them are not there yet, and they can be very, very, hostile” (OA, Personal

communication, September 12, 2021).

What do you think is the value of APRNs to the healthcare industry?

“The value of APRN to the healthcare industry is that as APRN, we closed the gap in

healthcare. The reason I said that is that so many people who do not have access to care. APRNs

are the ones filling that gap. For instance, in the local community, many people have no access to

care. As APRNS, we the training that we get, we are expected to go those communities and

provide those care that are needed. We are improving people’s lives, we are improving their

standard of living. We are even in a way improving the longevity of people. So, we support them

in every way so that they can attain that optimal health. Also, we have a lot of APRNS

functioning in specialist roles as well like in orthopedics, cardiology, etc. APRNS are

functioning in that role now” (OA, Personal communication, September 12, 2021).

What is the attitude of patients, insurance companies towards having APRNS as

primary care providers?

“There are no problems in those areas these days. Ok, in New Jersey, one insurance

company that I know that had problems with APRNS was CIGNA. But in the state of New

Jersey, since Murphy gave APRNS full authority because of COVID-19 in New Jersey,

temporarily. Because of the emergency authorization… we are fighting for it to become

permanent, CIGNA now accepts it.” (OA, Personal communication, September 12, 2021).

“It impacted the whole healthcare system. So many people did not have access to

healthcare before, but they now do with the Affordable Care Act (ACA). So, there is more

market for APRNs. Those that didn’t have insurance before due to them not qualifying for
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Medicaid and do not have private insurance, they can buy insurance through the ACA and get

their care through that” (OA, Personal communication, September 12, 2021).

What is your view on selective reimbursement by payers towards APRNs (i.e the

Centres for Medicare and Medicaid Services)

“Ahaa… right now we are getting 85% of what they pay physicians for the

reimbursement for now in New Jersey. I think for the state of NJ, the reimbursement is about 80-

85%. For example, if physicians are paid $120, APRNS are going to be paid 85% of that amount

in the state of NJ even though you provide the same care” (OA, Personal communication,

September 12, 2021).

What is the difference in having an APRN in leadership positions in the healthcare

industry?

“Well, we are taking the lead… many of us… myself for example as a DNP, I have the

opportunity to be the leader in my organization, but I am not interested in such a position due to

the politicking involved. But APRNS can be the leader of hospitals, administrative heads like

directors. So, yes, we can function in the leadership role and we mentor our people, we mentor

the nurses, we mentor ourselves. Even in administration, in Biden’s government, the Deputy

Surgeon-General, the lady that was in the interim role was an APRN. Yes, she was in the army

and she was an APRN before they confirmed someone else for that role. So, there are more

opportunities now that many people are learning more about APRNS, they are many

opportunities to climb the ladder” (OA, Personal communication, September 12, 2021).

Do you believe that APRNs are using evidence-based practice and the theoretical

framework of research as the basis for their interventions?

“That is 100% yes. I went to Rutgers University and we were taught evidence-based

practice all through and through. Also, before I make any decision, there are many guidelines.

For example, like diabetes, I already have it in my head. There are many guidelines for treatment

that are accessible to guide APRNS even if they are not sure of what to do that they can refer to.

This is what guides your decisions 100%”

Do you feel that you are involved in upholding the objectives, mission, and vision of

the agency that you work for, and if so, how?

“Well, every organization is different. For my organization, I think their vision is to

provide optimal healthcare for low income people. They want to provide them with the best

possible care. Ok, that is my personal goal to give the best care to anyone that passes through me

either African American, Hispanic, Caucasian, whoever, whatever… I give my best to all of my

patients. So, yes, I am upholding the mission and vision of my organization. It is supposed to be

in the back of your mind what are the policies of the organization that you are working for, what

is their mission, what is their vision. Yes, we have to uphold it” (OA, Personal communication,

September 12, 2021).

To what extent do you think APRNs are susceptible to malpractice suits?

“As our role is expanding, malpractice is also higher, though it is still not as high as physicians,

and physician assistant. They are still in the lead in when it comes to malpractice lawsuits. But

yes, APRNS do get it, but it is not as bad as it is for the physicians and physician assistants. I do

believe the reason that it is not that high for APRNs, we are nurses, we have better bed-side

manners than physicians. We do thorough assessments and we are nicer to the patients. Even

when we make mistakes, the patients may tell us that aren’t you supposed to do this or that
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instead of saying that this is what you did to me and I am going to sue you. The patients will be

like aren’t you supposed to do this” (OA, Personal communication, September 12, 2021).

Conclusion

OA provided enlightening information on the role of APRNs in the healthcare system and how

they are an indispensable part of it. Their role was magnified with the COVID-19 Pandemic as

they were granted in many states temporary full access to provide care without the collaboration

of physicians as the needed primary care providers to fill the gap in the provision of care that was

existing prior to COVID-19, but was exacerbated by the pandemic. She believed that they should

be given full authorization. Stucky et al., (2021) is in support of this too so that they can help in

preparing for future pandemic situations that may arise.

References

Barnes, H., Maier, C. B., Altares Sarik, D., Germack, H. D., Aiken, L. H., & McHugh,

M. D. (2017). Effects of Regulation and Payment Policies on Nurse Practitioners’ Clinical

Practices. Medical Care Research & Review, 74(4), 431–451. https://doi-

org.proxy.libraries.rutgers.edu/10.1177/1077558716649109

Feyereisen, S., Puro, N., Thomas, C., & McConnell, W. (2021). A new kind of

gatekeeper: The increasing prevalence of Advanced Practice Nurses as case managers in US

hospitals. Health: An Interdisciplinary Journal for the Social Study of Health, Illness &

Medicine, 25(5), 596–612.

https://doi-org.proxy.libraries.rutgers.edu/10.1177/1363459320976758

Klein, C. J., Dalstrom, M. D., Weinzimmer, L. G., Cooling, M., Pierce, L., & Lizer, S.

(2020). Strategies of Advanced Practice Providers to Reduce Stress at Work. Workplace health

& safety, 68(9), 432–442. https://doi.org/10.1177/2165079920924060

Miranda Neto, M., Rewa, T., Leonello, V., & Oliveira, M. (2018). Advanced practice

nursing: A possibility for primary health care? Revista Brasileira de Enfermagem, 71(suppl 1),

716–721. https://doi.org/10.1590/0034-7167-2017-0672

Woo, B. F. Y., Zhou, W., Lim, T. W., & Tam, W. S. W. (2020). Registered nurses’

perceptions towards advanced practice nursing: A nationwide cross‐sectional study. Journal of

Nursing Management (John Wiley & Sons, Inc.), 28(1), 82–93. https://doi-

org.proxy.libraries.rutgers.edu/10.1111/jonm.12893

Stucky, C. H., Brown, W. J., & Stucky, M. G. (2021). COVID 19: An unprecedented

opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice
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authority. Nursing Forum, 56(1), 222–227.

https://doi-org.proxy.libraries.rutgers.edu/10.1111/nuf.12515