Doctor of Nursing Practice Program

Cassen Uphold, DNP, MSN, FNP-C, ENP-C, CCRN, CNL

Cassen Uphold
  • Committee Chair Name & Credentials:
    Anna Richmond, DNP, FNP-C, CPNP-PC, and Donna McArthur, PhD, FNP-BC, FAANP
  • Committee Member Name & Credentials:
    Ruth Kleinpell, PhD, RN, FAAN, FAANP, FCCM, and Ty Williams, DNP, RN, ACNP-BC, FNP-BC, CNE


DNP Project Abstract

Impact of State Practice Barriers and COVID-19 on APRN Practice in Louisiana

Louisiana has reduced APRN practice by means of a career-long collaborative practice agreement (CPA). Physician oversight reduces the ability of APRNs to practice to the full extent of their abilities, education and training by restricting at least one element of APRN practice: evaluation, diagnosis, ordering and interpretation of diagnostic tests and initiation and management of treatment. During the COVID-19 pandemic, Louisiana enacted temporary suspension of all APRN practice restrictions by Executive Order creating de facto full practice authority. This provided a unique opportunity to evaluate the effect of COVID-19 on APRN practice and the effect of the temporary suspension of the CPA on APRN practice and perceived practice barriers.

National APRN Practice and Pandemic Survey was open to APRNs (NP, CRNA, CNS, Midwife) in all 50 states, Washington D.C. and US territories from June 1 through September 23, 2020. Twenty item descriptive survey included demographic information, qualitative and quantitative data. Quantitative demographic data analyzed using descriptive statistics. Qualitative data analyzed with a thematic analysis to identify patterns or themes from the free responses.

There were 725 Louisiana respondents. Prior to COVID-19 pandemic, the most significant barriers to APRN practice physician oversight and difficulty obtaining a CPA. The pandemic impacted APRN practice the most through change in practice hours, responsibilities and resources and increase in telemedicine. The temporary suspension of practice restrictions did not significantly change APRN practice.

Implications for Practice
Physician oversight appears to be a burden as opposed to an asset in APRN practice which brings into question the necessity for continued practice restrictions. Telemedicine was utilized to reduce potential COVID-19 exposure but now it is likely to continue and change how care is delivered.