1. “What Policymakers Ask About Advanced Practice Registered Nurses”
The National Forum of State Nursing Workforce Centers
2017 Annual Conference
June 9, 2017
Andrea Brassard, PhD, FNP-BC, FAANP
Senior Strategic Policy Adviser Center to Champion Nursing in America

2. What Policymakers Ask About APRNs
Learner Objectives:
Identify questions posed by policymakers and the public about the APRN workforce.
Identify challenges and opportunities in existing and future APRN workforce data sources. 2

3. What Policymakers Ask About APRNs3

4. What Policymakers Ask About APRNs
Has removing legislative barriers in other states increased the supply of nurse practitioners (NPs) and other APRNs?
In primary care?
Do NPs (and other APRNs) practice in rural areas?
Do NPs (and other APRNs) practice in underserved areas?
What are the impacts or outcomes of APRN care?
Oklahoma “As you might know, Oklahoma is working on a bill for full practice authority. One of the arguments we’ve heard is that, even if the bill passes, there’s no guarantee that nurse practitioners will set up shop in rural areas and improve access. I’ve been searching for some sort of study or statistic that shows that rural health care access improved in a state after it allowed full practice authority. I’ve haven’t had much luck.
Is there any research out there that you could share with me or point me to?”
North Carolina “Do y’all have any data on the positive effects modernizing rules has had in other states? Hopefully red states.” 4

5. The Case for Removing Barriers to APRN Practice5

6. Campaign for Action.org
Resources
Issues: Improving Access to Care
“Improving Access to Care: What You Need to Know”
Webinars
“The Evidence Shows: Better Laws Mean Better, More Accessible Care”
“Lessons Learned: Gaining Full Practice Authority in Nebraska 6

7. Sources of APRN Workforce Data
Professional Organizations
Federal Government
Nursing Workforce Centers
Boards of Nursing 7

8. Professional Organizations
AANP
National NP Sample Survey
National NP Practice Site Census
AANA
Membership survey
ACNM
NACNS
CNS census
AMA
AMA Health Workforce Mapper
Uses AMA Master File and NPPES/NPI (CMS) file 8

9. HRSA – Bureau of Health Workforce
Federal Government
HRSA – Bureau of Health Workforce
National Center for Health Workforce Analysis
National Sample Survey of Nurse Practitioners 2012
National Sample Survey of Registered Nurses 2008
National and State Level Projections of Supply and Demand for Primary Care Practitioners:
Federal Office of Rural Health Policy
Census – American Community Survey
Bureau of Labor Statistics
Estimates 150,230 NPs
AANP estimate 222,000 NPs
CMS - NPPES/NPI
Update from George Zangaro – National Sample Survey of Registered Nurses is underway. NCSBN is helping with sampling frame. Going out in January Will over sample NPs. Will be a paper format but could respond on mobile device or PC. 9

10. Workforce Data
Improving workforce data collection is a goal I know we all share.
Almost half of the Campaign’s Action Coalitions have made workforce data their main focus.
And more than 70 percent of State Nursing Workforce Centers are partners with Action Coalitions in their states—a step toward creating a comprehensive collection of workforce data that integrates the diverse sources of statistics. 10

11. Workforce Data Target
Target 1: Increase by three the number of nursing education, supply, or demand data elements collected by states.
As we look forward, working in collaboration with you we are aiming to increase the number of nursing education, supply, or demand data elements collected by the states by three.
Source: National Forum of State Nursing Workforce Centers 11

12. State APRN Workforce Reports
California’s Primary Care Workforce: Current Supply, Characteristics, and Pipeline of Trainees
Colorado’s Future Healthcare Workforce and the Role of Advanced Practice Registered Nurses
Georgia Distribution of Nurse Practitioners According to Region and County
2015 Hawai’i Workforce: APRN Infographic
Illinois Healthcare Action Coalition Advanced Practice Nursing Workforce Survey 2014
Data Report 2015 Indiana Nursing Licensure Survey 12

13. State APRN Workforce Reports
Advanced Practice Registered Nurses in Louisiana According to Role 2014
Oklahoma Health Workforce Data Book
South Dakota Center for Nursing Workforce: Nursing Workforce Supply & Employment Characteristics 2017
2015 Nursing Workforce in Texas: Demographics and Trends
Utah’s Advanced Practice Registered Nurse Workforce: 2013
2015 Washington State Advanced Registered Nurse Practitioner Survey Data Report 13

14. Rural
Jakobs & Bigbee (2016) “The Distribution of Advanced Practice Nurses and Population Health in US Frontier Counties” Online Journal of Rural Nursing and Health Care
Lower premature deaths and teen births in frontier counties where APRNs or physicians are present
Grow-your-own recruitment and retention
Xue, Ye, Brewer & Spetz (2016) “Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review” Nursing Outlook
States granting NPs greater SOP authority tend to exhibit an increase in the number and growth of NPs…especially among rural and vulnerable populations
Spetz, Skillman & Andrilla (2017) “Nurse Practitioner Autonomy and Satisfaction in Rural Settings” Medical Care Research and Review
Rural analysis of NSSNP found rural NPs provide primary care, very satisfied, and plan to stay 14

15. State Data Post-Modernization
Lessons Learned: Gaining Full Practice Authority in Nebraska
Minnesota Licensed APRN Growth
Nevada Growth Update: Changes after Implementation of Full Practice Authority 15

16. Colorado APRN Workforce/License Information: 1996 to 2016

17. Colorado APRN Workforce/License Information: 1996 to 201617

18. 2017 Louisiana MSN Survey
The work group created by House Resolution 199 of the 2014 Legislature is charged with developing a study to demonstrate nurse practitioners’ ability to increase access by healthcare consumers to high-quality, safe, and affordable care in medically underserved areas of the state. The work group also proposes surveying future APRNs to learn their willingness and ability to practice in underserved areas.
Method
The work group would like to work with Louisiana colleges and universities with masters and doctorates in nursing programs to administer a Survey Monkey to collect responses from graduate students.
Intent of survey
To learn the willingness of graduate students enrolled in masters and doctorates in nursing programs in Louisiana to practice in medically underserved areas of Louisiana; and
To learn the barriers that exist in nurse practice.
Contact: 18

19. Nurse practitioners make most of the nation’s house calls.
“The Evidence Shows”
August 2, 2017 Webinar
Nurse practitioners make most of the nation’s house calls.
NP care in health centers is comparable to physician care. NP care does not vary by states SOP laws.
Medicare payments for beneficiaries managed by NPs costs less than care for similar beneficiaries managed by MDs.
Yao et al (2016) Increasing Role of Nurse Practitioners in House Call Programs JAGS NPs are now the largest type of provider delivering residence-based care and NPs provide care over the largest geographical service area.
Kurtzman et al (2017) Does the Regulatory Environment Affect Nurse Practitioners‘ Patterns of Practice or Quality of Care in Health Centers? Health Services Research
Perloff, DesRoches, Buerhaus (2015) Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians Health Services Research 19

20. Master file of APRN data
Wish List
Master file of APRN data
Home address
Employment address
Employer specifics
State BON data addresses labelled home or business
Research to examine how inter-state regulatory differences affect APRN workforce distribution, practice patterns, consumer access to healthcare, and clinical and economic outcomes
End “incident-to” billing 20

21. Q&A

22. Contact Information
Andrea Brassard, PhD, FNP-BC, FAANP Senior Strategic Policy Adviser Center to Champion Nursing in America