Numerous advancements ranging from engineering marvels to novel products in the field of medicine, among other advances, have greatly and positively impacted modern society especially in relation to enhancement of people’s lives. Consequently, this has led to increased income levels where people can afford specialized healthcare services as well as a burgeoning aging population that creates increased demand for individualized medical services best offered by family or primary care nurse practitioners (NPs). As Brown (1997) asserts, primary care NPs play a vital role in family and children’s health inspite of the various challenges they face; which have been amplified by negative trends in healthcare provision in the country especially pressing nursing shortages. This paper discusses the political, legal, economic and ethical issues that face family nurse practitioners presented as current and future challenges and opportunities likely to influence family nursing practice.

Donelan’s (2013) study on primary care NPs and physicians’ perspectives about their roles in primary care reveals the reduced scope of practice facing primary care NPs which includes lack of hospital admitting privileges and reduced remuneration for clinical services, among others. This state of affairs can be traced to the regulations instituted by various medical organizations on primary care NPs roles and responsibilities despite their abilities in provision of primary healthcare services similar to physicians as acknowledged by Poghosyan (2013). These regulations present both current and future challenges to primary care health provision as well as for providers; amidst a pressing primary care health providers’ shortage, which is bound to reduce these limitations as primary care NPs are the best candidates to address the problem. Despite similar challenges in Canada, as expressed by Donald et al. (2010), primary care NPs have larger scopes of practice which means that those in the United States (US) are bound to face similar legal and political challenges involving regulation and liability involving scope of practice and malpractice. As such, family nurse practitioners (FNPs) will have to petition for scraping of regulations that limit their scope of practice while also bracing themselves for increased responsibilities and the legal hurdles that accompany them especially malpractice lawsuits, in an increasingly regulated medical environment.

The authority to bill and receive direct payments from patients and restrictions in starting independent primary care practices as highlighted by Yee (2013) exposes the extent to which regulation limits primary care NPs roles and responsibilities including economic benefits. This is because primary care NPs are required to work in teams that are headed by physicians to take lead in almost all the relevant healthcare roles ranging from ordering medical tests to reception of payments from the patients; roles that primary care NPs are capable of performing. If these limitations are lifted as advocated for by Naylor & Kurtzman (2010), FNPs will face new economic challenges as well as opportunities in relation to establishing a practice as well as increased direct revenues from quality service provision. Additionally, challenges involving relationships between patients and primary care NPs will have to be faced as already established family physicians are seen as Medicare approved healthcare providers that Van der Horst (1992) calls informal gatekeepers of the healthcare system. As such, FNPs will be forced to cater to individuals who are not insured by Medicare, which has the most customers, meaning that the FNPs will not have many economic opportunities. Moreover, family physicians will continue to feel threatened because the FNPs will dilute the economic opportunities available.

With relaxation of regulations on limitations of scope of practice for FNPs, they will have to face the ethical considerations that family physicians have to face in their practice. In a case presenting obesity by Caulfield (2007), the author discusses the legal and potential ethical issues that primary care NPs will be faced with, which will be similar to those faced by family physicians. One of the ethical considerations required of family nurse practitioners involves standard of care which they will be required to extend to their patients by providing the best care possible inspite of varied patients characteristics. This will include issues involving differences in culture or other elements that may inhibit the primary care NPs in providing primary care which may compromise a patient’s health and wellbeing. Another major issue would have to involve the facility of informed consent which acts as an obligation of providing all information related to a patient’s condition so that he/she can make a well-informed decision about their treatment options. Though more legal than ethical especially when the outcome involves negligence and potential lawsuits, it would be unethical if a patient’s life would be threatened by treatment of his condition based on incomplete information.

Changes in advances involving technology have positively changed a lot of lives especially in terms of healthier lives and increased economic independence that increases access to individualized care as that offered by family nurse practitioners. However, FNPs face a lot of political, legal, economic and ethical issues which are firmly tied to regulations that limit the scope of practice of FNPs such as the lack of hospital admitting privileges and reduced remuneration for clinical services among others. The ethical and political issues are highly related to legal considerations involving informed consent and standards of care among others, which would create more challenges involving negligence and potential lawsuits. Further, the economic issues also revolve around the prevailing political and legal issues of regulation which first and foremost require physicians to lead and informally preside over FNPs despite having similar expertise and abilities. As such, all these issues present not only current challenges but also future ones if they are not addressed.