CHAMBERLAIN UNIVERSITY –DOCTOR OF NURSING PRACTICE

WEEKLY DISCUSSIONS

WEEK 1:

Hello to all classmates and Professor,

1. Identify and describe practice barriers for APNs in your state and discuss these barriers on a
state and national level.

In today's society, Advanced Practice Nurses play an imperative role in healthcare. According to the
American Nurses Association, APN's "provide primary, acute, and specialty health care across the
lifespan through assessment, diagnosis, and treatment of illnesses and injuries in different healthcare
settings." (ANA, n.d.). As of 2015, Maryland passed the nurse practitioner full practice authority law,
expanding patient access to quality healthcare across the entire state, making it more accessible to its
citizens. (NPAM, 2015). According to the Scope of Practice Policy, After the first 18-months of licensing
and practicing under a full authority physician or nurse practitioner, Nurse Practitioners are allowed to
practice independently by law. They are recognized to be primary care providers in the state of Maryland.
(SOPP, 2020). This allows the nurse practitioner to diagnose illnesses, order further testing, prescribe,
treat, refer, and advise patients regarding health issues.

I consider myself fortunate to live in a state where APN's have full practice authority. There are many
barriers from state to state that limit practice and action is needed at both the state and national levels.
APN's can have either full authority practice, reduced practice or restricted practice depending on the
state and their scope of practice laws. There are many states in the fight for full practice as many believe
it should be granted nationwide. It is vital to achieve full practice authority nation wide in order to keep
healthcare cost down, provide effective healthcare services services, and most importantly to help meet
the growing demands for providers, especially those needs of rural communities. According to Peterson
(2017), only 44% of states allow full authority practice to APNs and identifies restrictive scope-of-practice
regulation of APNs as one of the most serious barriers to accessible care. (para 5). As the aging
population and the need for providers increases, it is clear that APN can help fill in the gaps and are
valued members of the healthcare team. Moreover, the fight for universal healthcare in the United States
has been on the spotlight and more accessible healthcare continuous to be a right to all Americans. If in
the near future healthcare becomes available for more individuals, the need for providers will only
continue to increase. This will impact the nation as a whole and will impact access to care due to a lack of
providers available. If NPs have full practice authority nationwide, the concern of lack of providers will be
greatly relieved.

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

One example of a form of competition that interfere with APN’s ability to practice independently is push
back from some physician professional organizations, such as the American Medical Association. These
organizations believe that physicians have more extensive and specialized training than NPs and
therefore NPs lack the ability to provide quality care that is safe like physicians can. (Hain and Fleck,
2014). Additionally, Hain et al. (2014) further identified the lack of knowledge physicians have of the
scope of practice of APNs as a barrier for successful collaboration of APNs with physicians. The
traditional medical hierarchal model of practice fails to cultivate effective teamwork between APNs and
physicians and a more collaborative model should be implemented. (Hain et al., 2014). As long as
physicians believe APNs to lack competence, the collaboration between members of the healthcare team
will not be successful and the barrier to accessible healthcare and lack of primary providers will continue
to exists.
3. Identify the lawmakers at the state level (i.e., key members of the state’s legislative branch and
executive branch of government)

In the state of Maryland where I reside and plan to practice, there are three branches of government. The
executive branch implements and enforces laws and it is overseen by the chief executive officer which is
our Governor Larry Hogan. The legislative branch consist of the senate and house of delegates who pass
laws to be signed by the governor who signs them into law. Finally there is the judicial branch that consist
of judges who resolve all matters regarding civil and criminal law. The lawmakers in the legislative branch
are elected by the people of the state of Maryland which has 47 senators 141 representatives. (Maryland
Manual on-line, 2020). It is vital for NPs to participate in the process of lawmaking by advocating for their
proposed laws or against unreasonable laws that may affect NP practice. It is our duty to be in touch with
legislators in our states to advocate for our right to practice and be the voice needed to make changes.

4. Discuss interest groups that exist at the state and national levels that influence APN policy.

Some interest groups making a difference in the sate of Maryland are the Nurse Practitioner Association
of Maryland, The Maryland Academy of Advanced Practice Clinicians, and The American Association of
Nurse Practitioners Region 3. All of these organization were involved in the fight for APNs full practice
authority law implemented in 2015.

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

One method that can be used to influence change in policy is through evidence and research. In order to
get involved in policy, one must follow policy debates, gain knowledge of current issues and get involved
by getting to know the policy makers. Exercising your right to vote as an American is another way to
influence policy as you can vote for legislators who care about the issues you want to see reform and
move forward. In order to create change one must know the issues at hand, the goals for change you'd
like to see and the opposition arguments. One must also be knowledgeable of the policy process, and
policy makers. There are many factors that influence policy, including interest groups, social, political and
economic conditions, public opinion, knowledge and innovation, new scientific discoveries, traumatic
events, business lobbying, and different non-governmental organizations. Finally, to create policy and
change, find those people who share your same goal and join forces. Together we can make a difference
and become a louder voice.

Cristina

References:

American Nurses Association. (n.d.). Advanced Practice Registered Nurse (APRN). Retrieved
from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/ (Links to an external
site.)
Hain, D., Fleck, L., (2014) "Barriers to Nurse Practitioner Practice that Impact Healthcare
Redesign" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2. Retrieved
from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofCo
ntents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html (Links to an external site.)

Maryland Manual On-line. (2020, February). MARYLAND AT A GLANCE. Retrieved from

https://msa.maryland.gov/msa/mdmanual/01glance/html/mdgovt.html#legislative

Nurses Practitioner Association of Maryland (NPAM). (2015). Nurse Practitioner Full Practice Authority
Act of 2015 SB 723/ HB 999. Retrieved
from https://www.npamonline.org/page/FullPracticeAuthorit/Nurse-Practitioner-Full-Practice-Authority-Act-
of-2015-SB-723-HB-999.htm (Links to an external site.)
Scope of Practice Policy (SOPP). (2020). Maryland Scope of Practice Policy: State Profile. Retrieved
from http://scopeofpracticepolicy.org/states/md/ (Links to an external site.)

WEEK 2:

Hello Class and Professor Lilly,

According to the American Association of Medical Assistants (2020), in the state of Maryland, Medical
Assistants (MA) are individuals who are delegated technical acts from a physician or nurse practitioner.
Medical Assistants are not certified by the state health occupation board and do not hold certification,
registration, or license granted by the state health occupation board, acting solely under the supervision
of a licensed provider. (AAMA, 2020). This means that the physician and nurse practitioners in this
practice are ultimately responsible for any mistakes made by any of their medical assistants. Authorizing
prescription refills or prescribing medication is not in the scope of practice of an MA, and it is Stephanie's
responsibility to act within her scope of practice, ethical, and legal standard of practice.

In this scenario, Stephanie overstepped her duties as an MA and violated the nurse practitioners' trust
and ethical code of conduct by prescribing medication to a patient. As an employee of the practice,
Stephanie had a responsibility to make ethical decisions. She should have communicated with the
patient's provider and discussed the patient's request. As a result of her failure to act ethically, there could
be many legal and ethical implications in these situations. As the NP in this situation, I would address
Stephanie and ask for an explanation. I would explain the severity of her decision to prescribe a patient
medication and failure to discuss and communicate with me, the patient's provider, and licensed
professional responsible for overseeing her duties. Due to her poor decisions, the patient could have
been hurt/injured, and the patient could lawfully sue me and the practice. Now that the trust has been
broken, the providers in that practice have every right to question all of Stephanies' actions, how many
times has she prescribed medications? How else has she breached her scope of practice and made
ethically wrongful decisions? Stephanie will most likely lose her job.

As the nurse practitioner responsible for the MA's unethical actions, I know legal action could very well
be taken against my license, risking a lawsuit against myself and the practice. According to this week's
reading, Buppurt (2017) suggests that nurse practitioners should consider the total picture into account,
including patient condition, symptoms, and further testing if it applies. (p. 279). This means that when the
patient called and spoke to Stephanie, the patient should have been scheduled to see the NP as soon as
possible before any decisions about her care were made, especially given the fact she had not been seen
in a year's time. Additionally, Buppurt (2017) further discusses that an equipped nurse practitioner should
eliminate any serious concerns first; therefore, it is prudent for the NP to thoroughly assess the patient
before making any recommendations or prescriptions. In this scenario, the responsibility falls in the nurse
practitioners' hands could potentially get sued by the patient. The medical director and the entire practice
also run the risk of being sued by this patient, and severe measures have to be taken to ensure this kind
of ethical issue does not happen again. This would affect all the providers in the practice, and all would
endure financial burdens of the costs of legal representation in the patient decided to sue.

Ethical training and understanding are vital for all healthcare employees. Ethics is defined by DeNisco
and Barker (2015) as dealing with values related to human conduct and being capable of making sound
judgments, good decisions, and the right choices, focusing on the rightness or wrongness of one's
actions. (p. 652). The public relies on healthcare professionals to help them make sound decisions
regarding their care, including acting within their scope of practice. Implementing mandatory ethical
training and reviewing everyone's role and scope of practice will be essential to prevent another incident
such as this one. Although Stephanie has been there for ten years, she made an illegal decision that
could have cost a patient their life, and with this severity, there are no excuses or justifications for such
actions. The other MAs in the practice should see this as an example and learn from it as it does not
 matter how long you have been employed in your profession, one ethically poor decision could cost you
your job. Moreover, I would implement training of tasks within a medical assistant's scope of practice to
re-educate the employees. Additionally, I would restrict the medical assistants' ability to refill prescriptions
without a specific code that only a provider must sign off on. This is a way of making sure the providers
authorize all prescriptions and refills.

In this scenario, I would lead by example. The first step to take would be to educate the staff so that the
providers and medical assistants learn from this incident. As previously mentioned, implementing the
above measures would be essential to prevent any other similar incidents where an individual is acting
outside of their scope of practice. This issue had to be addressed with the seriousness it deserved, and it
was a blessing that the medical assistant's wrongful decision did not harm the patient. Moving forward
from this incident, as a leader, it would be a priority to implement team-building training and activities. It is
vital to cultivate teamwork and trust between the providers and medical assistants. Medical assistants are
an essential part of the healthcare team and work closely with providers and patients. For the benefit of
the practice, it is imperative to promote effective communication, implement team-oriented goal setting,
encourage respect and trust in one another, and making sure each member of the teams knows their
defined role as part of the team. It is well known that working together reduces medical errors and
increases patient safety. Safety is of priority, and providing safe, quality care to our patients is the ultimate
daily goal and the bottom line.

Cristina

References:

American Association of Medical Assistants. (2019). State scope of practice law: Maryland. Retrieved
from https://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant (Links to an external site.)

Buppert, C. (2017). Nurse Practitioner's Business Practice and Legal Guide. [VitalSource Bookshelf].
Retrieved from https://online.vitalsource.com/#/books/9781284143003/

DeNisco, S. M., Barker, A. M. (2015) Advanced Practice Nursing: Essential Knowledge for the
Profession. [VitalSource Bookshelf]. Retrieved
from https://online.vitalsource.com/#/books/9781284099133/

WEEK 3:PAPER DUE

WEEK 4:Kaltura Presentation due

WEEK 5:

Hello Professor and Classmates:

1. Contrast the potential effects for each member of the healthcare team based upon the required
readings from the week. Discuss the potential ethical and legal implications for each of the
following practice members:

o Medical assistant- The medical assistant failed to notify the NP of an abnormal value of a patient's
vitals. This could have resulted in a missed opportunity for further assessment, or if the patient's blood
pressure was abnormally low, the patient could have fainted and hurt themselves. Not only was the
medical assistant neglecting her responsibility, but the MA was also displaying inappropriate behavior
in what should be a professional setting. This could result in corrective counseling, and if not corrected,
she could lose her job.
o Nurse Practitioner- According to the American Association of Medical Assistants (2020), in the state of
Maryland, Medical Assistants (MA) are individuals who are delegated technical acts from a physician
or nurse practitioner. The MA practices under the NPs license. Given this fact, if the patient ended up
having a poor outcome due to the NP not being notified of the patient's BP, then the NP would
ultimately be held responsible. Additionally, due to the MAs lack of professionalism and ability to do her
job, the NP no longer trusts the MA will provide her with critical information, creating a hostile work
environment. In this scenario, I do not believe there was a malpractice issue. According to Letz (2017),
the only element that could apply in this situation is "breach of duty," in which a provider failed to act or
do something that was necessary for their patient. (p. 134). Furthermore, Lentz (2017) explains that
injury must have resulted directly from the breach of duty for a malpractice lawsuit to be valid. (p. 134).
Finally, If an NP is found guilty of gross negligence, the board of nursing could suspend or revoke an
NP’s license (Buppert, 2017, p. 299).
o Medical Director- The office medical director's primary responsibility is to ensure the efficient operation
of the practice. This means making sure high quality and safe care are being provided. In this scenario,
if no adverse effects resulting from the MAs failure to report an abnormal BP, the only way the medical
director would find out about this situation would be through the NP.
o Practice- For the practice as a whole, these types of situations can lead to unsafe and inadequate
quality patient care. If conflicts are happening in patient areas, patients may be noticing such behavior
and making their assumptions of such action. This could lead them to write bad reviews for the
practice, which would be bad for business. If any patient would get hurt due to the lack of care
provided, this will also hinder the reputation of all staff and the practice as a whole, resulting in poor-
quality ratings.

2. What strategies would you implement to prevent further episodes of potentially dangerous
patient outcomes?

To avoid any further episodes of potentially dangerous patient outcomes, the entire practice must
change their culture of practice. It sounds like the clinical staff has gotten complacent with their care and
now lack professionalism and respect for one another. All clinical employees must review and know what
their responsibilities and expectations are. For the benefit of the practice, it is imperative to promote
effective communication, implement team-oriented goal setting, and encourage respect and trust in one
another. This will require a review of the organizational policies, training, and facilitating team-building
activities. Ethical training would have to be implemented, and this situation must be addressed with the
seriousness it deserves if the practice wants to see any change occur. This practice is a representation of
the entire organization, therefore employees must aim to accomplish organizational goals as a team and
provide safe and quality care.

3. What leadership qualities would you apply to effect positive change in the practice? Focus on
the culture of the practice.

A culture of ethical practice is defined by Rushton (2016) as the values, norms, and structures that
support moral agency and integrity. Furthermore, Rushton describes a culture of discipline as a culture
that "aligns individual and organizational values, decision-making practices, and priorities to create an
environment where ethical values are used as benchmarks to assess alignment, progress, and gaps" (p.
29). I would implement leadership qualities such as honesty, commitment, trust, teamwork,
communication, respect, and a positive attitude. Leaders must resolve conflict promptly and effectively to
save time, productivity, resources, and cultivate a culture of ethical practice. Leadership must come from
the top of the chain and serve as an example for all employees, setting the gold standard. Implementing
these leadership qualities will create positive change within the practice.

Cristina

References:
 American Association of Medical Assistants. (2019). State scope of practice law: Maryland. Retrieved
from https://www.aama-ntl.org/medical-assisting/what-is-a-medical-assistant

Buppert, C. (2017). Nurse practitioner's business practice & legal guide (6th ed.). Burlington, MA: Jones &
Bartlett. Retrieved
from https://online.vitalsource.com/#/books/9781284143003/cfi/6/42!/4/2/6/14/4/4@0:0 (Links to an
external site.)

Letz, K. (2017). The NP guide: Essential knowledge for nurse practitioner practice. (3rd ed.). American
College of Nurse Practitioner Faculty. Las Vegas, NV.

Rushton, C. H. (2016). Creating a Culture of Ethical Practice in Health Care Delivery Systems. Hastings
Center Report, 46, 28–31. doi: 10.1002/hast.628

WEEK 6:

Professor Lilly and Class,

1. To practice as a nurse practitioner in Maryland, one must hold an active Registered Nurse (RN)
license by the board of nursing in the state. One must then complete a board-approved NP program and
pass the board-approved examination in order to be certified (Nursinglicensure.org, n.d.). If a nurse
practitioner wishes to practice in a specialty that differs from their original NP program, they must
complete and submit documentation of additional education and training completed. According to the
Maryland Board of Nursing, advanced practice nurses must renew their licenses on a biennial basis.
(MBN, 2017). Furthermore, as of 2015, Maryland passed the nurse practitioner full practice
authority law, expanding patient access to quality healthcare across the entire state, making it more
accessible to its citizens. (NPAM, 2015). According to the Scope of Practice Policy (2020), After the first
18-months of licensing and practicing under a full authority physician or nurse practitioner, Nurse
Practitioners are allowed to practice independently by law. They are recognized to be primary care
providers in the state of Maryland. (SOPP, 2020). This allows the nurse practitioner to diagnose
illnesses, order further testing, prescribe, treat, refer, and advise patients regarding health issues. Nurse
practitioners have the authority to prescribe and dispense drugs, including controlled substances, also
known as scheduled II-V drugs (SOPP, 2020). Additionally, to comply, the NP must record the
dispensing of the prescription drug on the patient's chart, adhere to the labeling requirements of Health
Occupations Article, and allow the Division of Drug Control to enter and inspect the nurse practitioner's
office when appropriate (SOPP,
2020).
2. If you live in a full practice, how has independent practice of the APN resulted in improved patient
access to
healthcare?
Independent practice of nurse practitioners is a necessity in the United States. Rural, urban and all
undeserved regions in the United States lack access to primary providers and specialists. These rural
towns depend on clinics to see patients or patients must drive a long distance to have access to care.
According to Ortiz, Hofler, Bushy, Lin, Khanijahani, & Bitney (2018), "collaborative models of practice, in
which all health professionals practice to the full extent of their education and training, optimize the
efficiency and quality of care for patients and enhance the satisfaction of healthcare providers” (para 4).
Nurse Practitioners are members of the collaborative healthcare team that are qualified to fill in the gaps
where there are lack of providers or access to healthcare. In some towns, NP are the only ones who
serve their community as primary healthcare
providers. Additionally, Nurse Practitioners who reside in independent
practice states are able to start their own practices and serve as primacy care providers to underserves
communities. Relaxing scope of practice restrictions across all states could help nurse practitioners
meet the critical demand for primary care services in rural and urban areas (Ortiz et al., 2018). In the
state with full practice authority, nurse practitioners have proven to decrease patient hospitalizations, ER
visits and lengths of stay at various facilities, keeping healthcare costs down for patients and increasing
patient satisfaction.
3. How does access to NPs impacts any healthcare disparities?

Providing access to healthcare for all Americans is a priority in this country. Although the
Affordable Care Act opened up coverage for many more Americans, there are still Americans who have
no insurance or access to healthcare. Nurse practitioners reduce healthcare disparities by providing high
quality, affordable and accessible care to those in rural, urban and medically underserved communities
that lack primary care providers. This results in healthier communities by providing preventative care,
disease management and referrals to patients who otherwise would not have had access to any care at
all.

Cristina

References:

Maryland Board of Nursing (MBON). (2017). Schedule of Renewal Fees. Retrieved

from https://mbon.maryland.gov/Pages/services-fees.aspx (Links to an external site.)
Nurses Practitioner Association of Maryland. (2015). Nurse Practitioner Full Practice Authority Act of 2015
SB 723/ HB 999. Retrieved from https://www.npamonline.org/page/FullPracticeAuthorit/Nurse-
Practitioner-Full-Practice-Authority-Act-of-2015-SB-723-HB-999.htm (Links to an external site.)
Nursinglicensure.org. (n.d.). Advance Practice Registered Nurse License Requirements in Maryland.
Retrieved from https://www.nursinglicensure.org/np-state/maryland-nurse-
practitioner.html#education (Links to an external site.)

Ortiz, J., Hofler, R., Bushy, A., Lin, Y. L., Khanijahani, A., & Bitney, A. (2018). Impact of Nurse Practitioner
Practice Regulations on Rural Population Health Outcomes. Healthcare (Basel, Switzerland), 6(2), 65.
https://doi.org/10.3390/healthcare6020065

Scope of Practice Policy. (2020). Maryland Scope of Practice Policy: State Profile. Retrieved
from http://scopeofpracticepolicy.org/states/md/

WEEK 7

• Explanation of how healthcare policy can impact the advanced practice nurse profession:

Healthcare policies affect resource allocation to support the delivery of healthcare for patients. Not
only are there state-level regulations that influence APN practice, but also at a federal level. After the
implementation of the Affordable Care Act (ACA), millions of Americans gained access to healthcare,
creating a need for primary healthcare providers throughout the nation (Barnes, Brooks Carthon, &
Altares Sarik, 2015). Additionally, the ACA provided nurse practitioners funding for education, training,
and incentives for nurse practitioners to work in medically underserved communities (Barnes et al., 2015).
Although the federal government laws recognized nurse practitioners as potential primary care providers,
the law defers to state regulations to decide whether NPs can practice to their full authority (Barnes et al.,
2015).

Advanced practice nurses are healthcare leaders who have not only the expertise but also the
educational background to aid in presenting appropriate legislation to bring solutions to current health
care issues through policy. APNs are on the front lines of their communities, treating patients that have a
variety of different problems such as chronic illnesses, financial hardship, lack of access to care, no
health insurance, and many other needs. As primary healthcare providers, APNs have the responsibility
of promoting public health within their communities as well as advocating for their right to practice to their
full capabilities. This means that APNs need to be involved in policy making as they carry significant
influence to create change. APNs have first-hand knowledge of how diseases impact communities in
different ways, and the identified needs of the communities they serve. They also know all the benefits of
practicing to their full authority can be for both public health and for nurse practitioners around the nation.
 APNs can create change together and have a voice when healthcare policies directly affects nursing
practice.

• Explanation of why advocacy is considered an essential component of the advance practice

nurse's role:

Advanced Practice nurses have a huge responsibility to advocate for their patients and what they
believe to be just and necessary to providing high-quality care to the people they serve and those
communities in which they promote public health. APNs are the ones who are in direct interactions with
patients, not politicians. Policy-making is an essential determinant of health because policy in all levels of
government affect every citizen, whether they are aware of such policies or not. Policy influences the
health of all individuals and populations. The role of APNs is vital, and every community has a need "for
effective health policy and utilization of resources for improving public health." (Edelstein et al., 2010, pp.
2).

Policies are not only created by the government but also by Health Care Organizations (HCO), health
departments, healthcare agencies, and other stakeholders to obtain desired health care outcomes.
Edelstein (2010) further argues that "the role of nurses in policy development activities is well delineated
as a professional standard in the Scope and Standards of Practice for Public Health Nurses." (Edelstein
et al., 2010). Advanced Practice Nurses are in a position where they are actively involved in identifying
issues in the community. APNs are advocates who can bring community issues to the attention of critical
policy-makers who are decision-makers. Working together, they can come up with reasonable solutions
and put in place policies and laws that will ultimately be of best interest to the community, its healthcare
providers, and for the promotion of public health.

• Discuss the four pillars of Transformational leadership and the effect it may have on influencing
policy change:

The four pillars are based on the foundation of Transformational Leadership theory and trust. The first
pillar is Professionalism. For the advance nurse to have Professionalism, he/she must engage in self-
reflection of their "experiences, skills, knowledge, values, and feedback from other s" (DeNasco and
Barker, 2015, p. 119). It is through self-reflection the nurse practitioner can achieve an understanding of
their strengths and areas that need further development to be a better leader (DeNasco et al., 2015, p.
119). The next pillar is inspirational motivation. Nurse practitioners can be transformational leaders by
incorporating inspirational motivation into their leadership style. This is done by cultivating an environment
where others work, and efforts are recognized; team members are engaged, challenged, and know the
work they do has meaning and purpose (DeNasco et al., 2015, p. 119).

The third pillar is Interpersonal Relationships. This pillar consists of building relationships based on
trust, open communication, honesty, and active listening (DeNasco et al., 2015, p. 119). Furthermore, to
create such relationships, the nurse practitioners should avoid gossiping and harmful rumors that will
hinder the development of interpersonal relationships. Finally, the last pillar discussed in our assigned
reading is Business Competency. Advanced practice nurses should have an understanding of business
competencies such as the healthcare delivery system, policies, Understanding the organization, Care
delivery system, and much more (DeNasco et al., 2015, p. 119). One can better help the organization and
its goals when they understand business concepts. Being knowledgeable of these competencies can aid
the nurse practitioners in understanding policy and which policies affect them and their organization.

Cristina

References:

Barnes, H., Brooks Carthon, J. M., & Altares Sarik , D. (2015). Federal Polices Influence Access to
Primary Care and Nurse Practitioner Workforce. The Journal of Nurse Practitioners, 11(5), 526–530.
doi: https://doi.org/10.1016/j.nurpra.2015.01.028 (Links to an external site.)
DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the
Profession. (3rd ed.) Burlington, MA: Jones & Bartlett Publishers.
Edelstein, J., Gallagher, R., Hansen , J. M., Moesch Ebeling, J., & Turner, M. J. (2010). Shaping Public
Health Nursing Practice: A Policy Development Toolkit. Retrieved from
https://dpi.wi.gov/sites/default/files/imce/sspw/pdf/snpolicytoolkit.pdf