Barriers to Practice in California and the APN Role Practice Barriers for APNs Roles in California

Barriers to practice for APNs roles such as nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist may vary from state to state and at the national level. These barriers have determined how APNs can practice to their full potential and training as recommendations of IOM with a negative impact on access to essential care services (Germack, 2020). California has been among the states restricting APNs’ practice requiring them to work under physicans’ supervision. However, such restrictions are selective based on the APNs’ role. For instance, nurse midwives require full physician supervision to practice. On the other hand, Nurse Practitioners will be granted full practice authority to practice independently in California from January 2023; however, they will be required to complete three years in nursing settings with independent practice (Hughes, 2021).

Forms of Competition Interfering with the Ability of APNs to Practice Independently

APNs face a lot of competition at the state and national levels, which interferes with their ability to achieve authorization for full practice authority. APNs and physician assistants perform similar roles, such as carrying out diagnoses, educating and counseling patients, as well as in specialized medicine such as family care, pediatrics, and oncology. APNs may face competition from physician assistants to fill in the roles available in the practice of general or specialized medicine. Besides the competition from physician assistants, physicians also view the recognition of APNs as primary care providers to be a threat to the physician’s role. The physicians have pushed to bar the recognition of nurses as primary care providers and push against the awarding of APNs full practice authority. Physicians through related professional associations such as the American Medical Association (AMA) have openly fought against the expansion of practice authority granting independent practice for APNs, citing patient safety risks (American Medical Association (AMA), 2022). However, policymakers believe that APNs strategically improve the quality-of-care patient experiences (Begley et al., 2014).

Specific Lawmakers

The key members of California’s state executive branch of the government are; Governor Gavin Newsom, a Democrat and the 40th governor of California since 2019, and Eleni Kounalakis, a Democrat who has been the 50th lieutenant governor of California since 2019. She was the first female lieutenant governor of California. Shirley Weber, Democrat and current secretary of the state of California; Rob Bonta, a Democrat and current attorney general of California state; Fiona Ma, a Democrat and the current California State Treasurer; and Betty Yee, a Democrat and current California State Controller. Other key members of the legislative and executive brand of the California State government include Tony Thurmond, the current State Superintendent of Public Instruction, and Ricardo Lara, the current Insurance Commissioner and both Democrats.

Interest Groups that Influence APN Policy

Various interest groups exist in California and the state nationally that are continuously pushing to influence levels of APN policy. These include various stakeholders in support or against policies that grant APNs in California and at the national level to be certified for independent practice and recognized as primary care providers. The major interest groups in California and at the national level lobbying for policies that grant APNs full practice, diagnosing, and prescription authority include the California Association for Nurse Practitioners (CANP), American Association of Nurse Practitioners (AANP), the Federal Trade Commission (FTC), Centers for Medicare & Medicaid Services (CMS), and Veterans Health Administration (VHA). The interest groups lobbying against policies that grant APNs full practice authority include the California Medical Association (CMA), the American College of Physicians (ACP), and the American Medical Association (AMA).

Methods for Influencing Change in Policies

The two major methods interest groups and the government use to change policies are lobbying and participation. Lobbying may include sensitization of the members of the legislature and executive branches on the need for policy change. The interest groups may also lobby for policy changes by targeting relevant members of the policy committee and providing the information needed for policy change or providing the necessary funding to support the policy change. Additionally, interest groups may take advantage of their influence to conduct insider lobbying using their colleagues, making it easy to initiate policy changes. This approach to lobbying creates bias during policy change an