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1 Advanced Nursing Practice: Past, Today and Tomorrow sj 1

2 Presented by 민설자 SUR JA MIN, MSN, RN, CNS, APRN Board of Director of Houston Korean Nurse Association Inc. 강선화 Sun Jones, DNP, RN, FNP- BC President of Arizona Korean Nurses Association University of Phoenix Faculty sj 2

3 민설자 SUR JA MIN, MSN, RN, CNS, APRN Early years First NP Training Program Documenting Nurse Practitioner value How I became a Nurse practitioner My Experiences as a Nurse Practitioner sj 3

4 sj 4

5 What is a Nurse Practitioner (NP)? sj 5

6 First NP Training Program Introduction of low cost primary care services Medicaid and Medicare Henry Silver (physician) and Loretta Ford (nurse) created the first training for NPs in 1965 University of Colorado sj 6

7 Historical Timeline In 1967, Boston College initiates one of the earliest master s program for NPs In 1968, Directed by a nurse and physician team, the Boston-based Hill/Massachusetts General Nurse Practitioner program. In 1973, More than 65 NP program in the US In 1974, The American Nurse Association (ANA) develops the Council of Primary Care Nurse Practitioners. In 1978, The association of Facilities and Pediatric Nurse Practitioners(AFPNP) is established sj 7

8 Historical Timeline con t In 1980, More than 200 NP programs or tracks are available to students and 15,000-20,000 NPs are practicing Nurse Practitioner Associate for Continue Education(NPACE) is established. In 1989, Ninety percent of NP programs are either master s degree granting programs or post-master s degree programs Publication of the Journal of the AANP begins In 1993, AANP forms Certification program as separately incorporated entity sj 8

9 Documenting Nurse Practitioner Value 1970s - Legitimization and clarification of the NP roles 1980s - NPs conducted scientific studies to show the value 1990s Medical Journals showed the services provided by NPs were not inferior to the services provided by medical doctors sj 9

10 sj 10

11 How I became as a Nurse Practitioner University of Texas School of Nursing at Houston Oncology Clinical Nurse Specialist (CNS) Changes in Medicaid and Medicare Health Care System sj 11

12 My experiences as a Nurse Practitioner Homeless Clinic General to complex conditions Substance abuses No resources available to provide for the pt s needs Patients had no resources Patients utilized County Hospital ER for minor to urgent care needs U.T. M.D. Anderson C.C. at Neuro-oncology sj 12

13 After retirement Working part time at a community clinic that serves those with low income or no health insurance with language disparities. Hope Clinic serving Koreans HKNA Yearly Health Fair in collaboration with Korean Medical Doctors sj 13

14 Nurse Practitioners Present and Future sj 14

15 sj 15

16 강선화 Sun Jones, DNP, RN, FNP-BC President of Arizona Korean Nurses Association University of Phoenix Faculty Desert Valley Family Medicine, P.C. East Valley Family Medical, P.C. Nursing Experiences Banner Good Samaritan Medical Center Phoenix Children s Hospital sj 16

17 NP Qualifications Education MS DNP Clinical experience Board certification ANCC AANP Licensure requirements Maintaining RN license Endorse of Licensure State variability Continuing Education sj 17

18 Need for Nurse Practitioners Patient Protection and Affordable Care Act (PPACA) Will increase the demand of Primary Care Provider to 22 percent. NP growth to 170,000 FTE in 2015 from 128,000 now. Increased programs available to graduate more NPs Increased number of NPs in primary care settings may add pressures on insurers and state government to loosen the scope of practice restrictions NPs role in the quality of care delivered. sj 18

19 Health Care Expenditures CMS (the Center for Medicare and Medicaid Services) estimate that American health spending will reach nearly $5 trillion, or 20 percent of GDP, by Health Professional Workforce Scope of Practice Restrictions Health Professional Workforce Shortages Increased number of physicians entering the specialties Lack of access to care sj 19

20 Primary Care Settings Private practice Pediatrics Internal medicine Women s health Midwives Mental health Public health Retail based clinics Occupational health sj 20

21 Acute Care Settings Acute care settings NICU ICU Bone Marrow Transplant Center Organ Transplant Center Wound Care Clinic - Out patient or Inpatient Hospitalists sj 21

22 Long term care settings Nursing Homes Rehab Centers Assisted Living Centers sj 22

23 Current Issues Scope of Practice State Requirements General Requirements Specialty Requirements Variability between States sj 23

24 Current Issues Prescription privileges DEA State Regulatory difference Relationships with specialists Hospitalists PCP Specialists (Oncology, GI.. etc.) sj 24

25 Nurse Practitioner Scope-of-Practice Authority, 2012 No physician involvement needed to diagnose, treat or prescribe Physician involvement needed to prescribe but not to diagnose or treat Physician involvement needed to prescribe, diagnose or treat Note: In Connecticut, Indiana, Minnesota and Pennsylvania, physician involvement is required to diagnose or treat, but written documentation of this is not required. In other states that require physician involvement to diagnose or treat, written documentation is also required. Source: Linda J. Pearson, The 2012 Pearson Report, American Journal for Nurse Practitioners. sj 25

26 sj 26

27 Current Issues Reimbursements Medicare - 85% discount rate Medicaid (State and federal coverage) Private insurances Malpractice Contractual Issues sj 27

28 Future Issues DNP requirements AMA resistance Health Care Reform Reimbursement issues for NPs sj 28

29 References American Association of Nurse Practitioners (N.D.). Historical Timeline: Retrieved from Auerbach, D. (2012). Will the NP Workforce Grow in the Future? New Forecasts and implications for healthcare delivery. Medical Care, 00 (00). APRN Consensus Work Group & the National Council of State board of Nursing APRN Advisory Committee (May, 2008). Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. Retrieved from Cassidy, A. (October 25, 2012). Health Policy Brief: Nurse Practitioners and Primary Care, Federal and state laws and other policies limit how these professionals can help meet the growing need for primary care. Health Affairs. sj 29

30 References Ewing, J. & Hinkley, K. (April 20, 2013). Meeting the Primary Care Needs of Rural America: Examining the Role of Non-Physician Providers. National Conference of State Legislatures. Fairman, J. (2008). Nursing history & Health Care (Penn Nursing Science- Nurse Practitioners: Shaping the Future of Health Care. Shiff, M. (December, 2012). The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care. National Governors Association. Bipartisan Policy Center. (September, 2012). What is Driving U.S. Health Care Spending? America s Unsustainable Health Care Cost Growth. sj 30

31 Questions? sj 31

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