32008: Prior to IOM ReportUniformity -to enable APRNs to practice to the full extent of their education and licensureEase of mobility across state linesNCSBN APRN Advisory and APRN Work Groups collaborated to form APRN Consensus Model 2008
42008L A C E Model=Movement across State LinesGoal is align interrelationships among Licensure, Accreditation, Certification, Education (LACE)APRN Consensus Model-85 Nursing OrganizationsIncludes NAPNAP, ANA, AFPNP, AANP…support.
5Institute of Medicine: Future of Nursing 2010 KEY MESSAGES Nurses should practice to the full extent of their education and trainingNurses should achieve higher levels of education and trainingNurses should be full partners, with physicians and other health professionals in redesigning health care in the USAEffective workforce planning and policy making require better data collection and an improved information infrastructure
6IOM Recommendations Remove scope of practice barriers Expand opportunities for nurses to lead and manage collaborative improvement efforts and diffuse successful practicesImplement nurse residency programsIncrease baccalaureate nursing proportionsDouble doctorate level nurses by 2020Ensure that nurses engage in lifelong learningPrepare and enable nurses to lead change to advance healthBuild an infrastructure for the collection and analysis of interprofessional healthcare workforce data
7Practice DefinitionsIndependent (Full) - no requirement for a written collaborative agreement, no supervision, no conditions for practiceCollaborative (Reduced) - a written agreement exists which specifies scope of practice and medical acts allowed with or without a general supervision requirement by a MD, DO, DDS, podiatristSupervised (Restricted) - direct supervision required in the presence of a licensed, MD, DO, DDS, podiatrist with or without a written practice agreementThere is often debate about wording in the practice act that may require a supervision agreement but, in practice, our discriminator is the requirement of any written agreement of supervisionWe value the independent role as having no such restrictionsHave seen abuse of the required collaboration
8AANP 2013 Nurse Practitioner Practice Environment 1-29-13
9NCSBN APRN Consensus Model The Consensus Model supports independent practice and independent prescriptive authority for the APRNs.The Consensus model is inter-professional collaboration amongst independent practitionersOverlapping practicse with regulation by own professionThe AMA is making a strong argument for interprofessional collaboration in which they supervise both the PA and APRN. The Consensus Model is one of independent practice and independent prescriptive authority for the APRNs. The model is not one of required collaboration and this push back against APRN independence will be our greatest hill to climb.
10Expected Response The model is not one of required collaboration Push back against APRN independence will be our greatest hill to climbAmerican Medical Association-SOPP
14Sponsors for H2009Petitioners: Kay Khan, Paul Donato, Ellen Story, Bradley H. Jones, Stephen Kulik, Bruce J. Ayers, Matthew A. Beaton, Paul Brodeur, William N. Brownsberger, Thomas J. Calter, Christine E. Canavan, Edward F. Coppinger, Marcos A. Devers, Stephen L. DiNatale, Benjamin B. Downing, James J. Dwyer, Sean Garballey, Denise C. Garlick, Anne M. Gobi, Thomas A. Golden, Kenneth I. Gordon, Bradford Hill, Jay R. Kaufman, Peter V. Kocot, David P. Linsky, Brian R. Mannal, James R. Miceli, Kevin J. Murphy, Alice H. Peisch, Denise Provost, Dennis A. Rosa, Tom Sannicandro, John W. Scibak, Carl M. Sciortino, Frank I. Smizik, Thomas M. Stanley, Aaron Vega, Daniel B. Winslow, Jonathan D. Zlotnik, Benjamin Swan, William S. Pignatelli, John H. Rogers, Paul McMurtry, Randy Hunt
15Why are names of sponsors important to you as a NP? Recognize those legislators who are serving youWrite them a letter, make a phone call to thank themWhen you run into them at an event, note you appreciate their sponsorship and let them know your available to answer any questions
16SB 1079 - HB 2009 Three Prong Approach Nursing Practice will be regulated by Board of Nursing onlyRemoval of supervision of prescription writingRemoval of collaborative practice agreements
17“Change the Language and not the Care” Nurse practitioners will continue to refer when necessary and refer to any specialist, whether a physician, respiratory therapist, behaviorist, or dentist in order to provide the best care for their patientsNurse practitioners will continue to collaborateNurse practitioners will continue to practice in settings they are in now and be able to expand these settingsNurse practitioners will not change the care yet arbitrary and artificial barriers to care will be removed
18Then Why Change Law? Improved access to care for all Americans Increased consumer choice and value of careMeet demands of chronic care with new opportunities for advanced practice nurses to develop innovative practices for the chronically illProvides access to care for mental health services otherwise not available due to lack of providersImprove the quality of health care services to population of 30 million in need of health care in the coming years (well documented for 50 yrs)
19Benefits to Consumers if Remove Scope of Practice Barriers for APN supervision and delegation requirements create administrative costs linked to APRNs, and these costs would be reduced under the Billgreater choice among settings where health care is providedstimulates competition thus driving costs down
20ANA Nursing Code of Ethics 2001 8.2 Responsibilities to the publicNurses, individually and collectively, have a responsibility to be knowledgeable about the health status of the community and existing threats to health and safety. Through support of and participation in community organizations and groups, the nurse assists in efforts to educate the public, facilitates informed choice, identifies conditions and circumstances that contribute to illness, injury and disease, fosters healthy life styles, and participates in institutional and legislative efforts to promote health and meet national health objectives.
21AANP/NAPNAP/ACNP/NONPF/NPWH APRNs practice infinite variety of settings, ranging from the intensive care unit of trauma centers to schools, patients’ homes, prisons, long-term care facilities, nursing homes, and private practicesDo not support creating statutory or regulatory requirements that link an individual clinician’s ability to obtain state licensure to the formation of care teams with other disciplinesTHIS IMPEDES TRANSPARENCY, ACCOUNTABILITY, FLEXIBILITY, AND EFFICIENT USE OF INDIVIDUAL CLINICIAN MANPOWER
22Reducing Costs: Improving Quality, RAND STUDY 2009 Allow NPs and PAs to practice independently, without physician oversight.Allow greater practice autonomy for NPs by eliminating the requirement that theBoard of Registration in Nursing consult and reach consensus with the Board of Registration in Medicine to promulgate its Advanced Practice Nursing regulationsReimburse NPs and PAs directly for their servicesAllow consumers to designate a PA or NP as their primary care provider$ Billion in savings costs in next 10 years for MassachusettsReimburse the same amount for basic medical services, whether provided by aphysician, a PA, or an NP.
23August 2012 Massachusettseffective 11/5/2012 Chapter 224 of the Acts of 2012“providers not physicians” in languageGlobal Payment System-TransparencyAllows a nurse practitioner (NP) to sign, certify, stamp, verify, and endorse forms as well as provide affidavit that was previously required a physician to signShortfall of Chapter 224 of the Acts of 2012: Does not expand the scope of practice of NPs as recommended by IOM
24National Governors Council Review of Quality Care Components, December 2012 NPs were found to have equal or higher patient satisfaction rates than physicians and also tended to spend more time with patients during clinical visitsNPs are better able to provide preventive education through the delivery of anticipatory guidancePatient satisfaction found to be linked to quality of care
25An Act Improving The Quality of Health Care and Reducing Costs SB HB 2009An Act Improving The Quality of Health Care and Reducing Costs
26Current Status Joint Committee on Public Health Collective job to explain why the bill is neededRefute misinformation from opposition- MedicineBill will go either:Favorable releaseAmend with favorable releaseSend to studyOppose
27All along this Process there will be opponents trying to kill the bill Joint Commission on Public HealthJoint Committee on Health Care FinancingOR / andCommittees on Ways and MeansSenate or House FloorsSecond and Third ReadingsEnactment by one chamber then repeats in the other chamber
29Writing A Letter/Calling Name and number of the BillWho you areWhere you practice and location by street cornerConstituent who cares about what he/she is doing to represent youOffer to have come see you practiceKeep the focus on patient and not profession
33Campaign for APRN Consensus RESOURCE https://www.ncsbn.org/2276.htm
34Educate peers, patients, legislators, family, colleagues ready for dialogue/conversationsexamples of care“can and may” based on education and training not on state regulationsEducate yourself and others, quality of care, cost effectiveness, outcome dataNCSBN, APRN ToolkitSupport MCNP and lobbyists
37ResourcesIOM REPORT:Change-Advancing-Health.aspxAPRN Consensus Talking Points:https://www.ncsbn.org/2010_APRN_TalkingPoints_web.pdfAPRN Legislative Handbook: https://www.ncsbn.org/2010_APRN_HandbookforLegislators_web.pdfBauer, J. Nurse practitioners as an underutilized resource for health reform: Evidence-based demonstrations of cost-effectiveness. Journal of the American Academy of Nurse Practitioners 22 (2010) 228–231Newhouse, R. et al. Advance practice nurse outcomes : A systematic review, Nursing Economics, (2011), 29:5Rand Corporation, Controlling health care spending in Massachusetts: An analysis. (2009).Schiff M. National Governors Association, Health Division Report, 12/12/12. Center for Best Practices,