Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Dr. Debra Arnow, DNP, RN, NEA-BC
• Committee Member Name & Credentials:
  Dr. Mavis Schorn, PhD, CNM, FACNM, FAAN,
  Dr. Ruth Kleinpell, PhD, RN, FAAN

DNP Project Abstract

The Effect of COVID-19 State Executive Orders on APRN Scope of Practice in the State of Tennessee

Purpose
The impact of the COVID-19 Executive Orders on Advanced Practice Registered Nurse (APRN) in the state of Tennessee. This analysis aimed to describe APRN perceptions of executive orders and how they affected their APRN practice.

Methods
Tennessee data was extrapolated from a 20-item nationwide web-based survey for analysis. The survey was opened from June 1, 2020 through September 23, 2020. A secondary analysis was conducted of Tennessee state specific data and trends. Inclusion criteria were licensed and practicing APRNs, APRN perception of pandemic effects on APRN practice, APRN knowledge of TN executive orders and its impact on APRN practice and significant change to APRN inpatient vs outpatient practice. Exclusion criteria were survey items related to patient symptoms.

Results
A total of 553 APRNs responded from Tennessee, including nurse practitioners (n = 503, 91%), certified registered nurse anesthetists (n = 21, 4%), certified nurse-midwives (n = 29, 5%), and clinical nurse specialists (n = 7, 1%). Key results demonstrate that although 71% of APRNs were aware of the executive orders, only 22% ended collaborative physician chart reviews and site visits during the pandemic. Additionally, only 9% of APRNs felt the executive orders changed their APRN practices. Reasons for not following the executive order varied. Executive orders did not have a directly beneficial effect on APRN practice.

Implications for Practice
Despite practice barriers in Tennessee being waived because of the executive orders, most APRNs did not benefit from them. This highlights the need for further study into the nuanced relationship between APRNs and their collaborative physicians and deeper study into qualitative reasons why executive orders were ineffective. These results also point to the need for further study into the effects of learned helplessness and the possible need for further support once full practice authority is achieved.