{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T02:17:42Z","timestamp":1783563462150,"version":"3.55.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Policy, Politics, &amp; Nursing Practice"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing\u2014the largest healthcare workforce with diverse roles\u2014operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health.<\/jats:p>","DOI":"10.1177\/15271544241268411","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T14:50:15Z","timestamp":1724338215000},"page":"254-259","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Overcoming Barriers to Healthcare Reform: A Call to Action"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0293-0079","authenticated-orcid":false,"given":"Marcy","family":"Ainslie","sequence":"first","affiliation":[{"name":"Department of Nursing, University of New Hampshire, Durham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia F.","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Nursing, United States University, San Diego, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Hebert","sequence":"additional","affiliation":[{"name":"UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne","family":"Moore","sequence":"additional","affiliation":[{"name":"The Catholic University of America, Conway School of Nursing, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan P.","family":"Schriefer","sequence":"additional","affiliation":[{"name":"Department of Nursing, Cedar Crest College, Allentown, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret Hadro","family":"Venzke","sequence":"additional","affiliation":[{"name":"The George Washington University School of Nursing, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"bibr1-15271544241268411","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurpra.2020.11.009"},{"key":"bibr2-15271544241268411","unstructured":"American Association of Colleges of Nursing. (2021).\n                      The essentials: Core competencies for professional nursing education\n                      . https:\/\/www.aacnnursing.org\/Portals\/42\/AcademicNursing\/pdf\/Essentials-2021.pdf"},{"key":"bibr3-15271544241268411","unstructured":"American Association of Nurse Practitioners. (2023).\n                      State practice environment\n                      . https:\/\/www.aanp.org\/advocacy\/state\/state-practice-environment"},{"key":"bibr4-15271544241268411","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.1158"},{"issue":"2","key":"bibr5-15271544241268411","volume":"33","author":"Berntsen G. 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M.","year":"2005"},{"key":"bibr11-15271544241268411","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-018-4679-0"},{"issue":"1","key":"bibr12-15271544241268411","first-page":"10","volume":"28","author":"Fagan C.","year":"2020","journal-title":"Virginia Nurses Today"},{"key":"bibr13-15271544241268411","first-page":"117","volume":"35","author":"Fernandopulle N.","year":"2021","journal-title":"Medical Journal of the Islamic Republic of Iran"},{"key":"bibr14-15271544241268411","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2834.2010.01163.x"},{"issue":"2","key":"bibr15-15271544241268411","first-page":"7","volume":"29","author":"Hajdari R.","year":"2024","journal-title":"Academic Coordination Centre (ACC) Journal"},{"key":"bibr16-15271544241268411","doi-asserted-by":"publisher","DOI":"10.1177\/1077558709331812"},{"key":"bibr17-15271544241268411","volume-title":"Core competencies for interprofessional collaborative practice: 2016 update","author":"Interprofessional Education Collaborative.","year":"2016"},{"key":"bibr18-15271544241268411","volume-title":"Core competencies for interprofessional collaborative practice: Report of an expert panel","author":"Interprofessional Education Collaborative Expert Panel.","year":"2011"},{"key":"bibr19-15271544241268411","volume-title":"Understanding healthcare delivery science","author":"Jackson C. 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A decade of data: An update on the primary care and mental health nurse practitioner and physician workforce.\n                      Health Affairs Forefront\n                      ."},{"key":"bibr29-15271544241268411","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17124267"},{"key":"bibr30-15271544241268411","unstructured":"Rodziewicz T. L., Houseman B., Hipskind J. E. (2023). Medical error reduction and prevention. StatPearls Publishing. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499956\/"},{"key":"bibr31-15271544241268411","doi-asserted-by":"publisher","DOI":"10.4103\/joacp.JOACP_364_19"},{"key":"bibr32-15271544241268411","doi-asserted-by":"publisher","DOI":"10.1097\/HMR.0000000000000229"},{"key":"bibr33-15271544241268411","unstructured":"Schneider E. C., Shah A., Doty M. M., Tikkanen R., Fields K., Williams I. I., D R. (2021, August 4).\n                      Mirror, mirror 2021: Reflecting poorly\n                      . 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(1946).\n                      Constitution of the World Health Organization\n                      . https:\/\/www.who.int\/about\/governance\/constitution"},{"key":"bibr35-15271544241268411","doi-asserted-by":"publisher","DOI":"10.1177\/1077558719901216"}],"container-title":["Policy, Politics, &amp; Nursing Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15271544241268411","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15271544241268411","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15271544241268411","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:49:24Z","timestamp":1777700964000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15271544241268411"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1177\/15271544241268411"],"URL":"https:\/\/doi.org\/10.1177\/15271544241268411","relation":{},"ISSN":["1527-1544","1552-7468"],"issn-type":[{"value":"1527-1544","type":"print"},{"value":"1552-7468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,22]]}}}