Policy Brief and Advocacy Letter essay

PolicyBrief and Advocacy Letter

PolicyBrief and Advocacy Letter


Statementof the problem

Theshortage of primary care providers is a chronic issue that affectsnot only the state of Pennsylvania, but the nation as a whole. Thestakeholders have developed a perception that this shortage resultsfrom different factors, such as the decline in the number of studentstaking health-related courses. However, it is evident that thecurrent body of legislations has played a critical role in increasingthe shortage of the primary care providers. Currently, CRNPs are onlyallowed to practice in collaboration with the registered physicians(Alexander, 2015). This has limited the capacity of CRNPs to utilizetheir knowledge in serving their clients. This is because CRNPs haveto wait for a third party’s (physician) authorization to performeven the simplest therapeutic procedures, which has createdunnecessary shortcake of primary care providers.


Thelack of independence of CRNPs to practice freely can be attributed tothe current legislations that regulate the field of nursing. Forexample, Section 1.8 (b) of the Professional Nursing Law that guidesnurses who operate within the state of Pennsylvania requires CRNPs toconduct diagnosis, only with the approval or in collaboration withthe registered physicians (Alexander, 2015). The legal restriction ofCRNPs to practice contributes towards the shortage of the primarycare providers in two ways. First, the mandatory collaborationbetween the physician and CRNPs leads to duplication of tasks sinceboth of them are qualified to perform medical diagnosis and otherprocedures. Therefore, it would be more prudent to allow the twocategories of health care professionals to serve different clients ata given time and only consult when a given task is beyond thecapacity of the CRNPs.

Secondly,Pennsylvania is recorded as one of the states experiencing a seriousshortage of physicians (O’Grady &amp Brassard, 2011). This impliesthat the CRNPs have a limited number of registered physicians tocollaborate with. Therefore, CRNPs are prevented from serving theirclients or starting their private operations in order to cater forthe growing population of patients. In addition, the market forces ofdemand and supply play the role of increase the cost of starting aprivate operation and the overall cost of health, since a fewphysicians who are available charge high collaboration fee to CRNPs.The shortage of the primary care providers, which is created by thecurrent set of ineffective laws, denies patients the right to accessquality health care whenever they need it.


Thispolicy brief recommends that the legislator should pass the PA HB 765Bill that was tabled before the house by representative Topper. Bypassing this bill, legislators will have allowed the CRNPs topractice without collaborating with the registered physicians. Thiswill unlock the potential of CRNPs to use their knowledge and skillsin addressing the health issues affecting the residents ofPennsylvania, thus reducing the current shortage of primary careproviders. The CRNPs who are able to practice independently candeliver primary care, even in the absence of registered physicians orstart private health care facilities, which will increase patients’access the primary care (Carthon, Barnes &amp Sarik, 2015). Thepolicy brief also recommends that the legislators should reform thecurrent education policy that provide guidance on the training ofnurses in the state of Pennsylvania in order to ensure that allnurses (including CRNPs) are equipped with skills that are requiredto deliver primary care.


Thecurrent law limits the capacity of CRNPs to offer health careservices (such as diagnosis) without collaborating with registeredphysicians, which has created an avoidable shortage of primary careproviders in Pennsylvania. Therefore, the passage of the PA HB 765Bill, which is a legislation that seeks to allow CRNPs to practiceindependently, will result in an instant increase in the number ofprimary care providers. In addition, initiating policy reforms thataim at bringing uniformity in the nurse training programs will ensurethat CRNPs are imparted with the knowledge that they require todeliver primary care.


Hon.Mathew E. Baker,

Representativeof District 68,

TheChairman of the Committee on Health,

74Main Street, Wellsboro, PA 16901, (570) 724-1390, Fax:(570) 724-2168,

11June, 2016.

Re:Support Of PA HB 765 Bill for CRNP Independent Practice


Theobjective of writing this letter is to urge you to support the PA HB765 Bill that is intended to give the Certified Registered NursePractitioners (CRNPs) the independence that will allow them tooperate without necessarily having to collaborate with physicians. Asyou may be aware, the current legislation prohibits the CRNPs fromexercise simple medical and health-related procedures (such as thediagnosis), unless they get the approval of physician. This hasdenied the CRNPs the opportunity to exercise the knowledge that theyhave gained through training and experience. This issue affects medirectly because I am a nurse educator who is in the process ofattaining a Master’s Degree in Nursing and CRNPs.

Iam urging you to support the PA HB 765 Bill because I understand howthe current Professional Nursing Law of Pennsylvania limits the workCRNPs who have many years of training and working experience. Myposition as a nursing educator have given me an opportunity tointeract with CRNPs and inquire more about their perception about thecurrent set of laws and the proposed PA HB 765 Bill. A CRNP who is afriend of mine one day told me, “at times I watch as the queue ofpatients grow, but I cannot offer simple services (such as thediagnosis) until my physician arrives and give me the permission todo so”. From this case, it is evident that there are many healthcare procedures that CRNHs can perform independently, but their handsare tied by the law. This is a great loss to a state that has spent alot of resources to train nurses who cannot use their knowledge toserve the growing population of patients without the authorization ofanother category of professionals.

Itis my belief that you will support and encourage otherrepresentatives to pass the PA HB 765 Bill. However, I wouldrecommend that you go ahead and make the necessary policy reformsthat will bring uniformity in the training of nurses and themeasurement of their performance. The current opposition to theindependence of CRNHs emanates from the accusations that the currenteducation system does not equip CRHNs with the skills that they needto deliver primary care, which can be addressed through reforms ineducation policies that affect the training of nurses in Pennsylvania(Hain &amp Fleck, 2014). For example, CRHNs will be empowered todeliver primary care that meets the quality of services that areoffered by registered physicians, which will be accomplished byreforming the current nurse training programs. Therefore, the peoplewho elected you will have a large number of primary care providers toaddress their health issues, thus increasing their ability to accessquality care.

Istrongly believe that, with the support of an influential and aknowledgeable representative like you in the house, the PA HB 765Bill will be passed. This will give CRNPs the ability to practiceindependently. I look forward to hearing this good news. You maycontact me via phone number ……………… or email me at ………for further information.



Alexander,M. (2015). Advancing nursing excellence for public protection: The2015 environmental scan. Journalof Nursing Regulation,5 (4), 1-36.

Carthon,M., Barnes, H. &amp Sarik, D. (2015). Federal policies influenceaccess to primary care and nursing practitioner workforce. Journalof Nurse Practitioners,11 (5), 526-530.

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

O’Grady,E. &amp Brassard, A. (2011). Health care reform: Opportunities forAPRNs and urgency for modernizing nurse practice acts. Journalof Nursing Regulation,2 (1), 4-9.