Healthcare Policy and Leadership

1. Identify and describe practice barriers for all four APN roles in the state of Virginia, USA and discuss these barriers on a state and national level. The four roles include the nurse-midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.

Advanced practice nurses (APNs) are primary care providers who play a forefront role in treating, diagnosing illnesses and educating the public about health issues and preventive behaviors. Although APNs like nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives provide care in different care settings, they face state and national-level challenges that compromise their operational scopes (Mayo et al., 2017). At the national level, APNs grapple with multiple problems, including staff shortages, value-based purchasing, inconsistencies in laws that regulate their practice, a lack of a national consensus for enacting a multistate license agreement, and regulatory limitations that prevent APNs to operate in their full capacity, skills, and knowledge.

At the state level, APNs face a restrictive nursing policy that allows them to engage in at least one element of NP practice under supervision, delegation, and team management by an outside health discipline or professionals. According to Peterson (2017), Virginia is among 12 restrictive states, meaning APNs like clinical nurse specialists cannot fully practice without physician agreement and supervision. Therefore, they have limited prescriptive authority. Further, nurse midwives face a barrier to practice due to a lack of comprehensive clarification of the scope of practice and clarification of midwifery roles (Hastings-Tolsma et al., 2018). Consequently, a lack of a criterion for distinguishing nursing and midwifery creates confusion when pushing for legislation at state and national levels.

2. Identify forms of competition on the state and national level that interfere with APNs’ ability to practice independently.

Physicians, physician assistants, and APNs are forefront healthcare professionals who provide care for patients in different clinical settings and with multiple health concerns. Despite their role in improving public health, they exhibit varying levels of autonomy to act according to the extent of their education, skills, and competencies. For instance, APNs are more susceptible to state laws that limit their scope of practice by requiring collective agreement, supervision, and delegation by external care providers (Peterson, 2017). Conversely, physicians and physician assistants are autonomous and can provide much-sought-after care services, including medication prescription and administration. The subsequent inconsistencies in state laws regarding the scope of operation of healthcare professionals create a competitive market for providers and interfere with APNs’ ability to practice independently.

While restrictive state laws compromise APNs’ operational scopes, they lead to additional ramifications, including reducing the professionals’ capacity to provide primary care to older adults. According to Brom et al. (2018), advanced practice nurses (APN) are qualified and experienced to the extent of providing cost-effective and convenient care services. However, states must review nursing policies that create role competition between APNs, physicians, and physician assistants to capitalize on the benefits of the autonomous role of APNs.

3. Identify the specific lawmakers by name at the state of Virginia level (i.e., key members of the state’s legislative branch and the executive branch of government).

The Virginia state’s head of the executive branch of government is the current governor, Glenn Youngkin. A cabinet consisting of the most senior appointed officers of the executive branch helps the governor to deliver his official mandate. For example, the current secretary for health and human resources is John Wittel. On the other hand, the legislative branch of the Virginian government comprises a 100-member house of delegates and the 40-member Senate. The current senators are Tim Kaine and Mark Warner.

4. Discuss interest groups that exist in the state Virginia and national levels that influence APRN policy.

Various interest groups influence nursing policies at the state and national levels. For example, the Virginia Council of Nurse Practitioners (VCNP) is a state-level professional association that proposes and influences state and national health policies through legislative actions and evaluation of government regulations (Virginia Council of Nurse Practitioners, n.d.). Further, it provides opportunities for life-long learning and professional development to its members.

At the national level, the American Association of Nurse Practitioners (AANP) is a profound example of interest groups that influence national policies that affect nursing practice. According to the American Association of Nurse Practitioners (AANP, n.d.), the association represents nursing practitioners on national committees and health organizations to bring the NP perspective to healthcare leaders and policy-makers.

5. Discuss methods used to influence change in policy in the forms of competition, state legislative, and executive branches of government, and interest groups.

Undeniably, APNs can use various methods the influence change and impact health policies. In essence, they can practice patient advocacy, encourage change, and pursue higher education to enhance their knowledge and expertise regarding policies (Marymount University, 2021). Patient advocacy activities can convince policy-makers to consider patient-centered health interventions when drafting health policies. On the other hand, acting as change advocates enables healthcare professionals to mentor and share knowledge necessary for transforming health policies. Finally, pursuing higher education is a strategy for enhancing nurses’ reputation, expertise, and credibility necessary for influencing health policies.


American Association of Nurse Practitioners. (n.d.). Federal advocacy.

American Nurses Association. (n.d.). Advanced Practice Registered Nurses (APRN). Retrieved May 3, 2022, from

Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120–130.

Hastings-Tolsma, M., Foster, S. W., Brucker, M. C., Nodine, P., Burpo, R., Camune, B., Griggs, J., & Callahan, T. J. (2018). Nature and scope of certified nurse-midwifery practice: A workforce study. Journal of Clinical Nursing, 27(21-22), 4000–4017.

Marymount University. (2021, May 6). 5 ways nurses can shape policy.

Mayo, A. M., Ray, M. M., Chamblee, T. B., Urden, L. D., & Moody, R. (2017). The advanced practice clinical nurse specialist. Nursing Administration Quarterly41(1), 70–76.

Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology8(1), 74–81.

Virginia Council of Nurse Practitioners. (n.d.). About the VCNP.

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