Issues in NP Practice In spite of changes in Nurse Practice Acts in many states, barriers to NP practice remain.23 In a comprehensive review of states’ regulations, Safriet (1992)24 identified three major barriers to practice: the lack of third-party reimbursement, prescriptive authority, and hospital admission privileges. Without third-party reimbursement to ensure a financial base, NPs are unable to provide direct services for the care they provide. Instead, cost increases are generated by supervision requirements, complex billing services, and lack of autonomy in decision-making. When NPs are unable to prescribe medications for client needs, there can be a delay in treatment. Otherwise, sophisticated systems are required to provide for prescription disbursements such as pre-signed prescription pads, call-in services, and prescription writing by other providers who have not themselves assessed the client’s needs. When NPs are not allowed to admit their clients to the hospital, follow them during their stay, nor obtain referral information when clients are
discharged, the concept of primary care services is altered. A multi-tiered system results , in which the client encounters delay and lack of follow up. These barriers hinder autonomous and holistic health care practice, both in a collaborative practice based on a team approach and in independent health care practice.