1. TRANSITIONS to PRACTICE
Christine Armstrong, MSN, CNP, ACHPN ,

2. What’s Next You chose a certification exam.
You joined a professional organization.
AACN/AANP
You apply to take the exam online.
Submit transcripts electronically.
Wait (patiently) for your OK to test.

3. While you wait… You apply for your APRN License
APRN Modernization Bill went into effect April 4, 2017.
You only need to apply for APRN license.
OBN site states that all applications and payments must be on line.
Can apply before you graduate and before you test. OBN will keep on file for 1 year.

4. Application Ohio Board of Nursing web site. Apply on Line
Pay fees on line.
Submit Electronic Transcripts to the OBN
As there is no CTP or CTP externship, the Board will be paying close attention to your 45 hours of Pharmacology in the last 5 years.

5. Application
The Certifying Agency must submit your test results directly to the Board.
There is no fee to submit results to Board.
New law states that you will then be granted a license as an APRN.
You will be designated a CNP, CRNA, CNM, CNS with automatic prescriptive authority with licensure. Lucky Ducks!

6. Congratulations! You passed your certification exam.
You have been granted a License to Practice as an APRN.
Now you have to find a job!
Where you worked as an RN.
Networking
Speciality

7. Common Mistakes License expiration You must be an RN to be an APRN
ANCC/AANP certification expiration
Lapsed, terminated, or inadequate SCA
Exceeding scope of practice
OBN is NOT your Friend!
OBN is to protect the consumer!

8. Practice Compensation for services rendered. Contract negotiation.
Standard Care Arrangement
National Provider Number.
DEA number.
Medicare Number.
Medicaid Number.

9. Compensation
The average Nurse Practitioner salary in Ohio is $101,126 as of January 31, 2019 according to salary.com.
the range typically falls between $93,836 and $109,856.
Salary ranges vary widely depending on the city, education, certifications, additional skills, the number of years you have spent in your profession.

10. Compensation/Contract
Vacation/PTO
Continuing Ed – Time/Expenses
Malpractice
Licensure Fees
Hospital Staff Fees
Health Insurance
Legal Fees
Disability

11. Compensation/Contract
Life Insurance
Car
Phone/Pager
Subscriptions
Retirement Plans
Moving Expenses
Maternity Leave
OAAPN, AANP, ACNP – dues

12. Post Contract Non-Compete Clause Non-Solicitation Time Geography
Patients
Employees

13. SCA Standard Care Arrangement
Written, formal guide for planning and evaluating a patient’s health care that is developed by a collaborating physician/s and an APRN.
All APRN’s must have SCA even if not Prescribing per Modernization Bill.
Must submit to OBN within 30 days of practice or change in collaborator.

14. APRN Modernization
Collaborating: now 5 APRN’s to one Physician. Ambiguous. ?????
Collaborating Physician/s: SCA with APRN and is continuously available to communicate with APRN in person or with technology.
Psych NP can now collaborate with Psychiatrist or Primary Care Physician.

15. APRN Modernization SCA review and resign every 2 years
No longer required to have a procedure for regular review of referrals by the nurse to other health care professionals and the care outcomes for a random sample of all patients seen by the nurse.

16. APRN Modernization
No longer need a policy for care of infants up to age one and recommendations for collaborating physician visits for children from birth to age three, if the nurse regularly provides services to infants.
APRN verifies collaborator’s license ever 2 years; Can use e-license site
Formulary of Exclusion

17. APRN Modernization
A Certified Nurse Practitioner, Clinical Nurse Specialist and Certified Nurse Midwife shall not prescribe any drug in violation of Federal or Ohio law.
No Schedule I. No Medical Marijuana
The prescriptive authority shall not exceed the prescriptive authority of the collaborating physician or podiatrist.

18. National Provider Identification
NPI number is a 10 digit numeric identifier to be used on claim forms submitted to payors.
Must have it to bill for services.
Medicare, Medicaid and private insurances.
Must update when changing practices.
Must have NPI to Apply for Medicare and Medicaid number.

19. Schedule II Need to have a DEA number to Prescribe Schedule II
DEA $ Employer cover cost?
Need to inform OBN of DEA number.
OARRS Registration.

20. Schedule II
2012 law and rule changes allow APRNs to prescribe schedule II controlled substances.
Must Review OAARS.
Chronic Pain: 80mg Morphine Equivalent daily dose.
New Acute Pain limits. 7 day supply.
Can only prescribe schedule II drugs from select locations.

21. Schedule II Sites
NOTE: APRNs cannot prescribe schedule II controlled substances from a convenience care clinic even if it is owned/operated by one of the select locations listed on the next slides (with the exception of prescriptions limited to a 24 hours supply as set forth in pre-existing law)
Hospital

22. Schedule II Sites
Entity owned or controlled by a hospital or by an entity that owns or controls 1 or more hospitals
Health care facility operated by the Dept. of Mental Health or Dept. of Developmental Disabilities
Nursing home
County home or district home certified under Medicare or Medicaid

23. Schedule II Sites Community mental health facility
Ambulatory surgical facility
Freestanding birthing center
Federally qualified health center or look-alike
Health care facility operated by board of health or an authority having duties of a board of health

24. Schedule II Sites
Medical practice, ONLY IF, practice has 1 or more physicians who are also owners of practice, practice provides direct patient care, and APRN has SCA and collaborates with at least 1 of the physician owners who practices primarily at that site

25. Medicare Number
Internet-based: Provider Enrollment, Chain and Ownership System. (PECOS)
Different for each Employer.
Submit the current version of the Medicare enrollment application (CMS-855)
Submit the correct application for your provider to the Medicare contactor servicing your state. (Palmetto)

26. Medicaid Number Apply on Line. MITTS
Check list of documentation you need to even start application on line.
Must have NPI before you can apply.
Can apply for Medicare and Medicaid simultaneously.
CAQH

27. Practice Professional organizations. AANP OAAPN NEONP
Mentorship/Preceptorship.
Pay it Forward.

28. Nurse Practitioner History
Early 1960’s PCP recruited RN’s with clinical expertise and began collaborating to provide Primary Care.
1965 Loretta Ford and Dr. Silver founded the first NP program at the University of Colorado.
1967 first Master’s Program for NP and Ohio was using NP’s in Public Health

29. Nurse Practitioner History
By 1979 there were 15,000 NP programs in the US.
Ohio, especially Northeast Ohio, had a high number of programs.
Marymount Hospital, Lutheran Hospital and St. Joseph’s Hospital in Lorain, Ohio
1980 Northeast Ohio Nurse Practitioner Group was founded.

30. Nurse Practitioner History
Goal of NEONP was to organize for NP’s.
Legislation for certification and licensure.
Fought to be recognized as a health care provider.
Out of NEONP, founding members went on to establish OAAPN.
This brought together all Advanced Practice. CNS, CNP, Midwife, CRNA

31. Nurse Practitioner History
1997 Title Protection: gave NP’s the right to be paid for their Advanced Practice by Insurance Companies.
2000 Ohio was the last State to obtain Prescriptive Authority.
2008 APRN could prescribe Schedule II
2017 APRN Modernization Act, removed some limits on practice.

32. Practice
Questions???