1. You Can Do It! Representative Melvin Neufeld Kansas

2. Look to the Future What will the Healthcare System look like? –Shortage of primary care providers –Shortage of dental primary care –Increased demand in geriatrics Where do APRNs fit?

3. Where are you now? From the Overview of AMA Scope of Practice Data Series: Nurse Practitioners, fighting words… It is the AMAs intention that these Scope of Practice Data Series modules provide the background information necessary to challenge the state and national advocacy campaigns of limited licensure health providers who seek unwarranted scope-of-practice expansions that may endanger the health and safety of patients. -Standards of States vary greatly

4. How do you get there? In December of 2009, the American Nurses Association and other nursing organizations responded to the AMA report with a strongly worded letter characterizing the report as misleading. In January of 2010, the Engleberg Center for Health Care Reform, part of the Brookings Institution, issued a report encouraging states to increase the use of nurse practitioners and other health professionals to improve access and to reduce costs.

5. On November 17, 2010, the Institute of Medicine (IOM) released its report, The Future of Nursing: Leading Change, Advancing Health. The report calls for: –Increasing the use of nurse practitioners; –Improving and increasing educational opportunities for nurse practitioners; and –Increasing the number of nurse practitioners.

6. Nurses should: –practice to the full extent of their education and training. –achieve higher levels of education and training through an improved education system that promotes seamless academic progression. –be full partners, with physicians and other health professionals, in redesigning health care in the U.S. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

7. Remove scope of practice barriers. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Implement nurse residency programs. Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Double the number of nurses with a doctorate by 2020.

8. Ensure that nurses engage in lifelong learning. Prepare and enable nurses to lead change to advance health. Build an infrastructure for the collection and analysis of interprofessional health care workforce data.

9. Current State of Affairs Physician Supervision - Diagnosing/Treatment –According to the Pearson Report, with respect to diagnosing and treating, states are almost evenly split between those which require no physician involvement (23 states and the District of Columbia) and those which require written documentation of physician involvement (24 states). Four states require physician involvement, but do not require written documentation of a relationship.

10. Physician Involvement – Diagnosis and Treatment None Required Alaska, Arizona, Colorado, District of Columbia, Hawaii, Idaho, Iowa, Kentucky, Maine, Michigan, Montana, New Hampshire, New Jersey, New Mexico, North Dakota, Oklahoma, Oregon, Rhode Island, Tennessee, Utah, Washington, West Virginia and Wyoming. Physician Involvement Required Alabama, Arkansas, California, Delaware, Florida, Georgia, Illinois, Kansas, Louisiana, Maryland, Massachusetts, Mississippi, Missouri, Nebraska, Nevada, New York, North Carolina, Ohio, South Carolina, South Dakota, Texas, Vermont, Virginia, and Wisconsin. *Connecticut, Indiana, Minnesota, and Pennsylvania do not require written documentation.

11. Physician Involvement-Prescribing Only 14 states and the District of Columbia allow nurse practitioners to prescribe without written documentation of physician involvement. The states are: Alaska, Arizona, Colorado, Idaho, Iowa, Maine, Montana, New Hampshire, New Mexico, Oregon, Rhode Island, Utah, Washington, and Wyoming.

12. Work Force Development Nursing Shortage –Practice –Education (Severe shortage of PhDs for teaching) Health Reform –Concerns about health workforce shortage Rising Health Care Costs Focus on Primary Care –Health Promotion/Disease Prevention Rise in the Use of Ambulatory Care Settings –Retail Clinics

13. Whats Next Develop and Implement a National/State Plan of Action Address the Concerns of Physicians and Elected Officials –Identify weaknesses in training and preparation –Review credentialing –Build relationships with your State Legislators Reciprocity

14. Final Thoughts Circumstances require us to move forward, pragmatism requires us to move forward with all deliberate speed and common sense requires us to do it well.

15. Questions?? Melvin Neufeld 7405 15 Road Ingalls, KS 67853 620-338-4915 mneufeld@ucom.net