The Five Most Common APRN Roles of Senior nurses

Transcription

1 Objectives We have arrived are you ready? Sandra L. Cotton, DNP, RN, ANP-BC, FNAP Director Faculty Practice West Virginia University School of Nursing Morgantown, West Virginia List the five traditional APRN roles. Describe opportunities for APRNs in today s Health Care Reform environment. Describe the Joining Forces Initiative and ways in which APRNs could support National Mandates and Recommendations Pew Commission (1998) 21 st Century Recommendations for Health Professionals Competency Based Higher Education Adult NP Competencies US Dept HHS:HRSA, BHP, DON (April 2002) HHS (2004) Issues "Blueprint For Action To Build Healthier Nation AACN DNP Foundational Competencies (2006) IOM Future of Nursing (2010) Recommendation #1 Remove scope of practice barriers Recommendation #2 Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Recommendation #3 Implement nurse residency programs Recommendation #4 Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020 Recommendation #5 Double the number of nurses with a doctorate by 2020 Recommendation #6 Ensure that nurses engage in lifelong learning Recommendation #7 Prepare and enable nurses to lead change to advance health Recommendation #8 Build an infrastructure for the collection and analysis of interprofessional health care workforce data Health/Recommendations.aspx 1

2 During a day in the hospital, it is frequent that a patient is transferred from another health care facility to my care. To facilitate the transfer, a phone conversation occurs during which I formally accept transfer of the patient. Last week, I handled such a transfer request. On the other end of the phone line, relaying the clinical condition of the patient was someone who provided the most germane information and anticipated my questions before I posed them. What may be surprising to many is that the identity of my counterpart was not a physician, but a nurse practitioner. Sometimes The Best Medical Care Is Provided By Those Who Aren't M.D.s A nurse practitioner performs a routine physical. (Photo credit: Wikipedia) By Amesh Adalja, M.D. Op/Ed 11:39AM 15,877 views Nursing will be best remembered not for what nurses defined, but for what nurses did or failed to do Silva (1999) What are traditional APRN roles? Clinician Educator Administrator Researcher Change Agent Academic Nursing Practice defined: it is the intentional integration of research, education, and clinical care in an academic setting for the purposes of advancing the science and shaping the structure and quality of health care. Lang, Evans, Swan (2002) POSITIONING APRNs FOR HEALTH CARE REFORM: CONSENSUS ON APRN REGULATION Scope of practice is governed by the BON Codes Rules List rules for announcement of advanced practices Rules of limited prescriptive authority APRN scope CAN-MAY-PAY 2

3 APRN scope- CAN--MAY CAN----- Training National Certification educational program- standard MAY--- Law and rule Licensed by state board as a nurse Announce advanced practices File for prescriptive authority NEW- will have a separate license Hospital credentials-may Maybe more restrictive But add liability to hospital or MD Cosign Do not violate restriction of trade laws Practice standards for specialty through certifications and practices JACHO 10 practices supervised Hospital credentialed PAY-----Billing Membership Organization- WVNA/ ANA & AANP Insurance Private- must be enrolled as provider PAYMENT MAYBE LOWER Medicare- 85% Reform law 100% CNM State Medicaid WV 100% APN Must bill under APN # legally WVNA nurses ONLY political voice of all nurses- lobbyist The only association that represent ALL nurses at the state level VOICE ANA WVNA-State Wide Professional Policy Nurse Leaders Staff Lobbyist Board members- volunteers nurses leaders Legislative leaders- Nurse liaisons to legislatures Districts -nurse members and local leaders Associates/ congresses WVNA-Association Federal ANA/ AANP State Congresses are Branches of specialty APN, Midwives, CRNA, LPN, Student, school nurses, and legislative Local Districts- 12 3

4 WVNA/ ANA Health Care Reform Safe Staffing National PAC WVNA No Union representations WVNA Congresses APN- NP & CNM- CRNA Staff School nurses Nurse executives LPN Student Health Policy and Legislation Statements WVN PAC Support Guides WVNA in legislative policies Up dated annually HP&L committee- mostly teleconference WVNA supports PAC efforts Interview WV candidates Endorse WV candidates Identify nursing stake holders Hold a meet and greet reception during legislative session American Association of Nurse Practitioners State Representative to AANP- National representation for APNs Parent organization for the WVNA APN Congress (Discount/But No Joint membership) Together work for national nursing policy and support state APRN initiatives WVNA State Lobbyist Many special nursing groups now have private lobbyist- CRNA s, school nurses, SANE Team with WVNA lobbyist Angy Nixon & Lori McComas Stakeholders group- Hospital association, BON, Center for Nursing 4

5 From: The US Public's Health Care Agenda for 2013 CNN updated 3:53 PM EST, Fri March 1, 2013 JAMA. 2013;309(8): doi: /jama Figure Legend: Copyright 2012 American Medical Association. All rights reserved. With no deal done, deep spending cuts are set to take effect Medicare Pay to Shrink 2% as Sequester Looms on Friday Robert Lowes Feb 27, 2013 Unless a Congressional miracle occurs, Medicare reimbursement for physicians will decrease by 2% as $85 billion worth of automatic, across-the-board budget cuts called sequestration take effect on March 1 for the current fiscal year. Organized medicine is complaining not only about reduced pay, which could push struggling medical practices further into a hole, but also about the deleterious effect of even larger budget cuts in store for federal agencies such as the Centers for Disease Control and Prevention, the US Food and Drug Administration, and the National Institutes of Health. APRN Priorities? Promote a rigorous practice environment responsive to the diverse needs of the communities we serve. Develop and lead innovative research and scholarship that informs practice. Deliver excellent patient-centered care that reflects the full extent of professional nursing education and scope of practice. Improve health through service and leadership. Create dynamic, affirmative organizational cultures that support all aspects of nursing. APRN to do list Interprofessional education & practice Leadership prime Evidenced based practice Health outcomes Intersection of ERA Education Regulation Association From: Ruth Blevins [ruth@wvnurses.org] Sent: Friday, March 01, :47 PM To: Cotton, Sandra Subject: Bill & Conference call We have a bill number!!! SB 379 I ve attached it so you can refer to it. Conference call Tuesday night march5 7:00pm Xxx-xxx-xxxx Code Senate Bill No. 379 (By Senators Beach, Kessler (Mr. President), Blair, Boley, D. Hall, Miller, Fitzsimmons, Laird and Sypolt) [Introduced February 27, 2013; referred to the Committee on Health and Human Resources; and then to the Committee on Government Organization.] A BILL to amend and reenact a, b and c of the Code of West Virginia, 1931, as amended; and to amend and reenact , a, b and c of said code, all relating to expanding prescriptive authority of advanced nurse practitioners and certified nurse-midwives; and removing the requirement for collaborative relationships with physicians. 5

6 APRN to do list Interprofessional education & practice Leadership prime Evidenced based practice Health outcomes Intersection of ERA Education Regulation Association The Challenge 26 Million Veterans Only 8 Million in VAHC Joining Forces Hemmingway was right when he said, Life breaks all of us, but some grow stronger at the broken places. Santo Thomas and Los Banos are the engines under the hood of my life. It is so obvious what war takes away and very little, if anything, is said about what it gives Letter from Diane Cantrel (2000) WWII concentration camp childhood survivor to retired Army Nurse, Major Ruby Bradley The Challenge 18 M veterans receiving care in civilian sector Most veterans do not self identify Military status unknown to healthcare providers Many women vets do not identify themselves as veterans Do not know they are eligible for VA services Lack of knowledge regarding military and military culture Lack of knowledge regarding services available to community vets Effects of military service impact: Mental health Physical health 3 Questions you need to ask: 1. Have you ever served in the military? 2. Have you been deployed? 3. Have you served in harms way? Joining Forces Resources available to support education programs (community provider toolkit, PTSD 101 Course) (Behavioral Health Certificate, continuing education) Jonas Foundation 6