Advanced Practice Nursing Environments: Critical Elements for Effective Management

CRITICAL ELEMENTS IN MANAGING ADVANCED PRACTICE NURSING ENVIRONMENTS

The healthcare arena is increasingly fluid and changeable; some would even say it is chaotic. Advanced practice nursing does not exist in a vacuum or a singular environment. Rather, this level of practice occurs in a wide variety of healthcare delivery environments. These diverse environments are complex admixtures of interdependent elements. The term environment refers to any milieu in which an APRN practices, ranging from a community-based rural healthcare practice for a primary care NP to a complex tertiary healthcare organization for an ACNP. Certain core features of these environments dramatically shape advanced practice and must be managed by APRNs in order for their practices to survive and thrive.

Although not technically part of the core definition of advanced practice nursing, these environmental features are essential to understand, as APRNs must be aware of these key elements in any practice setting. Furthermore, APRNs must be prepared to contend with and shape these aspects of their practice environment to fully enact advanced practice nursing.

Table: Critical Elements in Managing Advanced Practice Nursing Environments

Managing Reimbursement and Payment Mechanisms

Managing the business and legal aspects of practice is increasingly critical to APRN survival in the competitive healthcare marketplace. All APRNs must understand current reimbursement issues, even as changes related to the Patient Protection and Affordable Care Act (2010) and the Medicare Access and CHIP Reauthorization Act (2015) are being debated, re-debated, and advanced. Payment mechanisms and legal constraints must be managed, regardless of setting. Understanding reimbursement models, insurance structures, and the financial mechanisms of healthcare delivery is crucial for APRNs.

Dealing with Marketing and Contracting Considerations

Given the increasing competition among physicians, APRNs, and nonphysician providers, APRNs must be prepared to market their services assertively and knowledgeably. Marketing oneself as a new NP in a small community may look different from marketing oneself as a CNS in a large health system, but the principles are the same. Marketing considerations often include the need to advocate for and actively create positions that do not currently exist. Contract considerations are much more complex at the APRN level, and all APRNs, whether newly graduated or experienced, must be prepared to enter into contract negotiations.

Understanding Legal, Regulatory, and Credentialing Requirements

Health policy at the state and federal levels is an increasingly potent force shaping advanced practice nursing. Regulations and policies that flow from legislative actions can enable or constrain APRN practices. Legal, regulatory, and credentialing requirements vary significantly across different regions and specializations. APRNs need to stay informed about changes in healthcare laws, maintain their credentials, and ensure compliance with local and federal regulations.

Understanding and Shaping Health Policy Considerations

Variations in the strength and number of APRNs in various states attest to the power of health policy as an environmental factor. APRNs must be active in policy discussions, advocating for changes that support their practice and the broader healthcare system. By understanding the intricacies of health policy and participating in legislative processes, APRNs can help shape the future of healthcare.

Strengthening Organizational Structures and Cultures to Support Advanced Practice Nursing

Organizational structures and cultures, whether those of a community-based practice or a hospital unit, are important facilitators of or barriers to advanced practice nursing. APRN students must learn to assess and intervene to build organizations and cultures that strengthen APRN practice. Effective management of organizational structures and fostering a supportive culture are essential for the success of APRN roles. Leadership skills are crucial for navigating and influencing these organizational elements.

Using Technology to Optimize Patient Care

Common to all of these environmental elements is the increasing use of technology and the need for APRNs to master various new technologies to improve patient care and healthcare systems. Electronic technology in the form of electronic health records (EHR), coding schemas, communications, Internet use, and telehealth practices is changing healthcare practice. Proficiency in the use of new technologies is increasingly necessary to support clinical practice, implement quality improvement initiatives, and provide leadership to evaluate outcomes of care and care systems.

Enabling Outcome Evaluation and Performance Improvement

APRNs are accountable for the use of evidence-based practice to ensure positive patient and system outcomes. Measuring the favorable impact of advanced practice nursing on these outcomes and effecting performance improvements are essential activities that all APRNs must be prepared to undertake. Continuing to demonstrate the value of APRN practice is a necessity in chaotic practice environments.

FAQs on Managing Advanced Practice Nursing Environments

Q1: What are the key elements in managing advanced practice nursing environments? A: The key elements include managing reimbursement and payment mechanisms, marketing and contracting, legal and regulatory compliance, health policy considerations, organizational structures and cultures, technology integration, and outcome evaluation.

Q2: Why is technology integration crucial in advanced practice nursing environments? A: Technology integration is crucial because it optimizes patient care, supports clinical practices, and enables the implementation of quality improvement initiatives.

Q3: How does health policy impact advanced practice nursing? A: Health policy at state and federal levels can either enable or constrain APRN practices, making it vital for APRNs to understand and influence policy decisions.

Q4: What role does organizational culture play in advanced practice nursing? A: Organizational culture significantly affects the success of APRN roles, requiring strong leadership to foster a supportive environment for advanced practice nursing.

Q5: How can APRNs ensure effective outcome evaluation? A: APRNs can ensure effective outcome evaluation by using evidence-based practices, measuring the impact of their work, and continuously improving performance.