Health Issue Advocacy Support Of PA HB 765 Bill for CRNP Independent Practice essay

HealthIssue Advocacy: Support Of PA HB 765 Bill for CRNP IndependentPractice

HealthIssue Advocacy: Support Of PA HB 765 Bill for CRNP IndependentPractice

Theshortage of primary care providers is a critical issue that has beentroubling the stakeholders in the health care sector. The legalsystem that denies the Certified Registered Nurse Practitioners(CRNPs) to practice independently has contributed towards thisshortage. This is because the law requires CRNPs to collaborate withphysicians in nearly all activities. Different states have also beenexperiencing a shortage of physicians, which implies that CRNPs havea less number of doctors to collaborate with (Kennedy, 2015). Thispaper will address the limitation of CRNPs to practice independentlyand the impact of the P.a. House Bill 765 on this health issue.

Thehealth issue and the existing policy

Themain health issue that the P.a. House Bill 765 is expected to addressis the limitation of the Certified Registered Nurse Practitioners(CRNPs) to practice independently. The current legislation hasresulted in a chronic shortage of the primary care providers, whichhas limited the delivery of care to a growing population of patients.The sponsor of the bill, Representative Topper, intends to amend theexisting Professional Nursing Law that guides nurses who practice inthe state of Pennsylvania (Pennsylvania House of Representatives,2016). Under this law, the Certified Registered Nurse Practitionersare required to practice by collaborating with physicians. Section1.8 (b) of the existing law allows CRNP to perform medical diagnosis,but this can only be done with the authorization of a physician (ThePennsylvania Code, 2016). This section also requires CRNP to restricttheir practice within the promulgations that are made by theirprofessional board. This leads to an overall shortage of health careprofessionals since CRNPs cannot offer critical services in theabsence of physicians, in spite of their academic qualification andwork experience.

Significanceof the health issue to nursing

Theissue of limiting the capacity of CRNP to practice is important tothe field of nursing because it denies the registered nurses anopportunity to put their knowledge and experience into practice. Theprimary goal of all registered nurses is to use their knowledge andskills to enhance the well-being of their clients. However, the lowand the licensing bodies limit their ability to practiceindependently, which deny patients the opportunity to receive qualityhealth care services in a timely manner. For example, it is estimatedthat the state of Pennsylvania ranks the sixth in terms of the sizeof the population. However, it ranks 10thinthe number of qualified physicians and 18thin the number of health care providers who are trained to deliverprimary care (Kennedy, 2015). Pennsylvania has 155 physicians, whoare expected to serve a population of about 12 million people(Kennedy, 2015). This indicates a chronic shortage of physicians,which implies that the CRNP will have a few physicians who areavailable for collaboration. This limits the capacity of CRNP topractice and deliver care to their clients. This is a major concernfor the stakeholders in the field of nursing and the entire healthcare industry.

Theconcerned stakeholders

StateLicensure: The state licensure has the responsibility of regulatingthe functions of CRNPs. For example, the state board of nursinglimits the scope of CRNPs using the established state laws (Hain &ampFleck, 2014). However, it is not possible to state whether thelicensure will oppose or support the idea of allowing the CRNPs topractice independently since the body is only expected to licensenurses as per the established law.

Nursesand the PA Nurse Association: The association plays the roles ofadvocating, leading, connecting, and educating nurses across thestate of Pennsylvania (Hain &amp Fleck, 2014). It is likely that theassociation will support the idea of allowing the CRNPs to operateindependently, since it is mandated to take care of the welfare ofthe nurses.

Physiciansand their organizations: Physicians feel that allowing the CRNPs tooperate independently will undermine their profession. Physicians andtheir organizations (such as the Pennsylvania Medical Society) arelikely to oppose the bill that intends to allow CRNPs to operatewithout necessarily having to collaborate with them (Hain &ampFleck, 2014).

Statehealth insurance agencies: These agencies limit the ability of nursesto practice independently and bill for different health care services(Hain &amp Fleck, 2014).

Legislators:The lawmakers formulate laws that regulate the scope of theregistered nurses (Hain &amp Fleck, 2014). This category ofstakeholders is likely to support the idea of allowing the CRNPs tooperate independently since it plays the role of addressing the issueof the shortage of the primary care providers.

Patients:Patients expect to receive quality and sufficient care, which can beachieved if CRNPs are given a chance to operate independently.Therefore, patients are likely to support the PA HB 765 bill, inorder to authorize CRNPs to serve them without waiting for theauthorization by physicians.

Aplan for health issue advocacy

Effectof authorization of CRNPs to operate independently

Theintroduction of amendments that will allow CRNPs to operate withoutconsulting physicians will lead to a drastic increase in the numberof primary care providers in the state of Pennsylvania. This willreduce the shortage that the state is currently experiencing.Moreover, a decision to authorize CRNPs to practice independentlywill increase their satisfaction, which will increase the quality ofcare. This is because the enactment of the bill will give the CRNPsan opportunity to put their knowledge and experience to serve clientsto their full capacity (Bock, 2015). Moreover, the enactment of thebill will reduce the cost of care by removing the amount that CRNPsare required to pay for collaboration agreements (Bock, 2015).Therefore, patients will be able to access quality, efficient andaffordable primacy care.

Interventionsto be implemented in the advocacy


Thedoubt on whether CRNPs are well prepared to offer quality and costeffective care is among the key factors that have contributed to thelimitation of the scope of their work. This challenge can beaddressed through policy measures that seek to standardize thequality of education and training for all nurses (Hain &amp Fleck,2014). Quality and consistency in the educational programs will bringuniformity among the nurse graduates. This should be followed by asecond policy that will facilitate the measurement of the quality ofservices offered by CRRP. The policy should facilitate performancemeasurement for nurses who are practicing independently and those whochoose to collaborate with physicians (Hain &amp Fleck, 2014). Thetwo policy measures will ensure that nurses who will be allowed topractice independently will be able to deliver quality, efficient,and reliable primary care.

AdvancedEducational programs

Apartfrom enhancing uniformity in the educational programs, thestakeholders should reform the current system of education in orderto equip the CRNPs with the skills that they need to serve as primaryhealth care providers. According to Hain &amp Fleck (2014) thecurrent educational system does not prepare advanced nurses todeliver primary care duties. In addition, the CRNPs should undergo aninter-professional education (IPE) program, which will involvelearning in the same settings with health care providers from otherareas of specialization. This will enable CRNPs to collaborate withother health care providers without being forced by the law. Thenurses will consult with physicians when the need arises, instead ofbeing required to seek for the authorization of physicians in allcases.

Oppositionthat is likely to be encountered

Theopposition for the authorization of CRNPs to practice independentlyis likely to come from physicians and their organizations, includingthe Pennsylvania Medical Society. Physicians hold that they have arigorous and longer training program than their counterpart nurses(Hain &amp Fleck, 2014). Physicians who hold this view believe thatCRNPs do not have the capacity to deliver quality primary care, whichimplies that they should not be allowed to practice independently.


Theshortage of primary care providers has become a chronic issue in manystates, including Pennsylvania. The PA HB 765 bill is an effectivetool that will address this shortage by allowing CRNPs to practicewithout looking for the authorization of physicians. The existinglaws require CRNPs to make agreements with physicians beforeestablishing independent practices, which increases the cost of care.This implies that allowing the CRNPs to practice independently willnot only increase the number of primary care providers, but it willalso lower the cost of delivering primary care. However, this canonly be achieved if the stakeholders in the health care sector willformulate policies that will standardize educational programs andestablish inter-professional training programs.


Bock,L. (2015, October 22). Pennsylvania should give nurse practitionersmore independence. PGPublishing CO, Inc.Retrieved May 27, 2016, from

Hain,D. &amp Fleck, M. (2014). Barriers to NP practice that impact healthcare redesign. TheOnline Journal of Issues in Nursing,19 (2), 2.

Kennedy,S. (2015, April 21). Steps proposed to avoid physician shortage. TheMorning Call.Retrieved May 27, 2016, from

PennsylvaniaHouse of Representatives (2016). House co-sponsored memoranda.PennsylvaniaHouse of Representatives.Retrieved May 27, 2016, from

ThePennsylvania Code (2016). Chapter 21: State Board of Nursing. ThePennsylvania Code.Retrieved May 27, 2016, from