Lioce Theoretical framework presentation
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This document proposes a theoretical framework for legislative changes to advance practice nursing in Alabama. It identifies Alabama as having the most restrictive environment for nurse practitioners and several counties as underserved. It also notes that Alabama ranks in the top five states for obesity, heart disease, and stroke deaths. The document discusses concepts from Conger's organizational change theory and Lewin's change theory and assumptions, variables, and how the pieces fit together for a proposed framework. The goal is a healthier future for Alabama through legislative changes.
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Lioce Theoretical framework presentation
- 1. Legislative Changes in Advanced Practice Nursing A Theoretical Framework Proposal Lori Lioce, MSN, FNP-BC, APRN-BC August 3, 2009
- 2. Top Five List Alabama has been identified as the most restrictive environment for nurse practitioner practice (Lugo, Hodnicki, & Hanson, 2007). 65 of 67 counties in Alabama declared as underserved (HRSA, 2007). Top five states for death related to obesity, heart disease and strokes (Alabama Rural Health Association, 2007). Limited third party reimbursement was listed as the number one barrier to utilization of APNs in Alabama (Nurse Practitioner Task Force (NPTF), 2004. Lack of primary care provider status is a barrier insurance companies have been using to deny APN claims for reimbursement (Heins, 2007).
- 3. Concepts
- 4. Conger’s Organizational Change(Conger, Spreitzer, & Lawler, 1999).
- 5. Lewin’s Change Theory(Schein, 1995)
- 6. Overview
- 7. Assumptions
- 8. Variables
- 9. Fitting the pieces together
- 10. A healthier brighter futurefor Alabama
- 11. References American College of Physicians. (2009). Nurse practitioners in primary care. [Monograph]. Retrieved July 10, 2009 from http://www.acponline.org/advocacy/where_we_stand/policy/np_pc.pdf. America’s Health Rankings. Retrieved on July 30, 2009 from http://www.americashealthrankings.org/2008/pdfs/al.pdf. Conger, J.A., Spreitzer, G.M. & Lawler, III, E.E. (eds.). (1999). The leader's change handbook: An essential guide to setting direction and taking action. San Francisco:Jossey-Bass. Health Resources and Services Administration (HRSA). Retrieved June 15, 2009 from ftp://ftp.hrsa.gov/bhpr/workforce/scope1992-2000.pdf. Heins, K. Heins, A. (2007). Plan to improve the health and health care of the people of Alabama at a lower cost. Retrieved September 10, 2008 from http://gulfcoastmedicalclinic.com/political_advocacy. Lewin, K. (1951). Field Theory in Social Science. New York: Harper & Row. Lugo, N.R., Ogrady, E.T., Hodnicki, D.R. & Hanson, C.M. (2007). Ranking NP regulation: Practice Environment and Consumer Healthcare Choice. The American Journal for Nurse Practitioners 11:8-24. Nurse Practitioner Task Force. (2004). A proposal to increase the Utilization of Nurse Practitioners in underserved Alabama. Retrieved on July 12, 2009 from http://www.arhaonline.org/PDF%20Files/NPTFreport.pdf. Schein, E.H. (1995). Kurt Lewin’s change theory in the field and in the classroom: Notes toward a model of managed learning. Retrieved on July 5, 2009 from http://www.entarga.com/orgchange/lewinschein.pdf.
Editor's Notes
- The unnecessary restrictions on APNs, creates decreased access to care for patients whom are underserved or have no access to healthcare. The Kaiser Foundation reports Alabama’s cost of health care has increased and the number of uninsured sky rocketed to 1.2 Million in 2008. Alabama had 839,000 citizens on Medicaid and 740,000 on Medicare in 2008 (State Health Facts, 2009). All with only a population of 4,661,900 reported for 2008. These statistics alone represent 2,779,000 Alabamians in need of healthcare reform, over half of the states’ total population.Preventative primary care will make a difference in all of theses areas and APNs can provide this increased access if primary care provider status is achieved in statute.Supporting the need for change in Alabama
- Right combination of concepts…. Professional Advocacy—empowerment of the nurse to advocate for the professional role objectives while championing social justice in healthcare. Participants—nurses, legislators, voters, healthcare consumers. Change—legislative change in scope of practice of the APN and change in perception of the APN role.
- Further explanation for clarity of Lewin’s theory (Schein, 1995) is explained in stages. In stage one, the unfreezing stage, disconfirmation of the present conditions for APNs in Alabama has already taken place. Survival anxiety becomes pertinent to the APN to help motivate change. Stage two, the prioritizing of needed change is continual based on needs and trial and error learning in the legislative process continues.The final stage, stage three refreezing, has only begun evolving in Alabama, a new identity for APNs in the state. if each of us participate and mentor another the coalition and professional strength will build year to year.
- Many pieces of the pie to fit together. It takes us all to put them in the right place. This theoretical framework will serve as a guide decisions for planned change.
- On the road to…..a healthier brighter future for Alabama