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The article by Hain and Fleck (2014) describe multiple barriers to APN practice. State practice and licensure is identified as a challenge as each state has its own guidelines that outline an NPs scope of practice (Hain & Fleck, 2014). This does not allow for a general standard of care expected for NPs to evaluate and diagnose patients, order diagnostic tests or initiate and manage treatment plans. Approximately 20 states grant NPs full practice authority licensure, which allows NPs to practice independently of a physician or hospital. Most states reduce the NPs practice and licensure, which means NPs can either engage in at least one element of the NP practice through a collaborative agreement or with an outside health discipline or under supervision of a physician (Hain & Fleck, 2014). The next challenge the article mentions is physician related issues. The problem here is that physicians do not feel NPs have received enough training or education to administer the same type of treatment as a doctor. Physicians are also confused about the role of nurse practitioners in a collaborative environment (Hain & Fleck, 2014). Physicians may fe
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