The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. The fours roles of advanced practice nursing, nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist all face barriers that hinders these APNs from practicing to the full extent of their education, licensure, and certification.This happens at a national level, but also a state level, as many states have differing regulations for the practice of APNs.The American Association of Nurse Practitioners (AANP) classifies state laws and regulations impacting APN practice as full, restricted, and reduced.In full practice authority (FPA) states, APNs can evaluate, diagnose, order and interpret diagnostic tests, initiate and manage treatments, such as prescribing medications and controlled substances.In reduced practice states, state licensure and laws reduce the APN from practicing in at least one of the four APN elements as mentioned previously.Some state laws require collaborative requirements with other healthcare providers to provide care, otherwise one or more of the elements are limited.Restricted states APNs are unable to practice in at least one of the four APN elements, as well as have career-long supervision, delegation, and team management, most often by a physician, to provide care. These barriers significantly reduce the abilities of APNs practicing to their fullest extent and being productive in healthcare, which has implications such as addressing the disparities in healthcare (Kleinpell et al., 2022)
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