Research Protocol for Nurse Practitioner Scope of Practice Laws. Prepared by the LawAtlas Legal Team

Transcription

1 Research Prtcl fr Nurse Practitiner Scpe f Practice Laws Prepared by the LawAtlas Legal Team May 2015

2 LawAtlas SM Plicy Surveillance Prtal 2 NURSE PRACTITIONER SCOPE OF PRACTICE May 2015 Research Prtcl I. Date f Prtcl: May 2, 2015 II. III. Scpe: Cmpile state statutes and regulatins authrizing and regulating the scpe f practice, specifically medical activities nurse practitiners may cnduct independently f a physician. Nurse practitiners (NPs) are ne f fur categries f advanced practice registered nurses (APRNs). This crss-sectinal dataset includes cding questins abut the medical activities NPs may perfrm withut entering an agreement with a supervising physician, the prescribing authrity f NPs, the delegatin authrity f nurses, and the settings in which NPs have an expanded scpe f practice. Primary Data Cllectin a) Prject Dates: Legal research was cnducted between January 15, 2015 and April 30, 2015 b) Dates Cvered in the Dataset: The research identified laws in frce as f May 1, c) Data Cllectin Methds: The LawAtlas Legal Team (hereafter, team ) building this dataset cnsisted f tw legal researchers ( Researcher #1 and Researcher #2 r Researchers ) and ne Supervisr. The team researched scpe f practice laws fr nurses, fcusing n Nurse Practitiners ( NPs ). d) Databases Used: Searches were cnducted using WestlawNext and statespecific legislature websites. Full text versins f the laws were cllected and pulled frm state legislature websites. e) Search Terms: The fllwing searches were used in the current (Multistate Legislative Service - (LEGIS-ALL)) bill libraries f Westlaw: adv: advanced practice nurs! adv: " nurse practitiner!" adv: nurse practitiner!" /p scpe adv: nurse! /p scpe adv.: nurse! /p delegate "retail clinic" /p nurse! cmmunity /p health /p nurse! /p center OR clinic OR facility ambulatry p/treatment /p center /p nurse! OR facility rural /p health /p clinic /p nurse! OR center OR facility

3 LawAtlas SM Plicy Surveillance Prtal 3 "Urgent Care" /p center /p nurse! OR clinic OR facility emergency care /p center /p nurse! OR clinic OR facility The Researchers supplemented key wrd searches by reviewing the table f cntents chapters n nurse practice acts. All chapters were examined in their entirety fr relevant law. Discrepancies were reviewed by a supervising researcher and reslved by further research. f) Initial Returns and Additinal Inclusin r Exclusin Criteria: Included laws pertaining t the general scpe f NP practice in the state, specific medical activities that NPs culd perfrm, prescriptive authrity f NPs, delegatin authrity f nurses t ther medical prfessinals, and settings in which NPs may have an expanded scpe f practice. Excluded areas f law, include: Scpe f practice f ther types f Advanced Practice Registered Nurses (APRNs) than NPs, unless the state des nt differentiate between APRN types within its laws and/r des nt have laws specific t NPs. In such states, laws abut APRNs generally were cllected and cded. Licensing, educatin and training requirements t btain an NP license r certificatin. Scpe f practice fr Licensed Practical Nurses (LPNs). LPN s are nly referenced t in the dataset when selected as a medical prfessinals Registered Nurses (hereafter, RNs ) and/r NPs can delegate t. Any laws related t the distributin f cntrlled substances. The team decided t scpe these law ut because the prvisins fr cntrlled substance regulatin varied significantly frm standard laws n NP s ability t prescribe, dispense and administer general prescriptin legend drugs. A separate dataset wuld be needed t adequately capture the variatin in these laws. Laws related t the prnuncement f death and rdering f medical equipment were scped ut because f incnsistencies and vagueness in the law. The inclusin f these activities within NPs scpe f practice was ften implied in the law already, making their inclusin in this dataset as specific medical activities ptentially misleading. IV. Cding a) Develpment f Cding Scheme: The team wrked in cllabratin with Sibhan M. Gilchrist, JD, MPH, a Health Plicy Analyst fr the United States Center fr Disease Cntrl, t determine the fcus f the research and the key questins t be cded. The Researchers cnceptualized cding

4 LawAtlas SM Plicy Surveillance Prtal 4 questins, then circulated them fr review by the Supervisr. The Supervisr cnsulted with Sibhan Gilchrist after reviewing the questins t identify which questins were mst valuable. When the questins were finalized, the researchers entered the questins int the LawAtlas Wrkbench. b) Cding Methds: The team frequently met as a grup t narrw the scpe f the dataset t direct indicatrs f NPs scpe f practice. As necessary, the cding scheme was altered t accmmdate newly identified features f the data, and cmpleted states were recded. Belw are specific rules used when cding certain questins and answer chices in the dataset: Questin: What medical activities can nurse practitiners perfrm independently? Respnses were nly selected where the state explicitly indicated an NP culd cnduct the activity independently r where the law included n language restricting the perfrmance f activities t thse under a practice agreement. The respnses were cnceptualized and/r cnslidated as fllws: Manage a patient s treatment includes explicit use f, including with any tenses (ing, ate, ent), fr manage, administer, prvide, crdinate and deliver treatment as well as any ther language shwing the direct ability t prvide treatment. Initiate apprpriate treatment includes explicit use f, including with any tenses (ing, ate, ent), fr intiate, begin, develp prescribe and cmmence as well any language demnstrating an NP can begin a new frm f treatment fr a patient. Perfrm medical diagnsis includes explicit use f perfrm, cnduct and prvide medical diagnsis. This des nt include the rdering f medical r diagnstic tests r the review f patient medical infrmatin f which separate answer chices were develped t cde these activities. Make referrals t specialists indicates the ability t refer patients t ther medical prfessinals. Als cded where the law explicitly stated NP s may cnduct referrals bradly. This respnse was nt selected when the law nly indicated NP s culd refer patients t general health r cmmunity resurces. Nurse Practitiners are explicitly prvided the brad authrity t practice independently was selected nly where 1) a state s law explicitly stated NPs culd practice independently f a physician; and 2) n type f practice

5 LawAtlas SM Plicy Surveillance Prtal 5 agreement was required. 1 This answer chice was added t capture thse states where NPs have the ability t independently cnduct a brad range f medical activities even if each activity is nt explicitly delineated in the law. Nurse practitiners cannt perfrm medical activities withut physician supervisin was selected whenever 1) an NP must enter a cllabrative practice agreement with a supervising physician in rder t cnduct any medical activity; r 1) where sme type f practice agreement was required; and 2) the law was unclear as t whether every activity an NP cnducted must be authrized pursuant t a practice agreement. Researchers frequently fund laws authrizing RNs as a whle t cnduct different medical activities. Mst f these laws were scped ut t keep the fcus f the dataset n NPs. When laws specific t Advanced Practice Registered Nurses and NP s indicated that RN s scpe f practice was als authrized under their scpe f practice, RN s activities were still nt cded t avid incnsistencies acrss jurisdictins. 2 Questin: T which medical prfessinals, if any, can nurse practitiners explicitly delegate medical activities? When researchers fund laws explicitly identifying APRNs r NPs as a prfessinal nurse r RN, any medical prfessinals RN s r prfessinal nurses culd delegate t were als cded fr NPs. 3 The Supervisr decided t remve anther questin asking which medical prfessinals RNs culd delegate t t keep the fcus n NPs. Fr mre infrmatin n RN s scpe f practice, please see the LawAtlas RN Scpe f Practice dataset, which is scheduled fr release in summer 2015 Fr the delegatin questins abve, certain medical prfessinals were cnslidated int the fllwing respnse categries: 1 In West Virginia and Texas, Nurse Practitiners are explicitly prvided the brad authrity t practice independently was cded. In these states, the law explicitly indicated that NPs culd practice independently and nly required an agreement fr prescribing medicatin. These are the nly tw states with this exceptin. 2 An exceptin was made fr the scping ut f RNs fr nurse delegatin, reasning fr this decisin is discussed fllwing the questin belw. Des the law allw nurses t delegate medical activities t ther medical prfessinals? 3 Researchers did nt assume NPs were autmatically RNs as a type f advanced registered practice nurse. As indicated, medical prfessinals RNs culd delegate t where nly cded fr NPs where NPs r APRN were explicitly identified as an RN r prfessinal nurse.

6 LawAtlas SM Plicy Surveillance Prtal 6 Medical Technicians: Includes any type f technicians 4 whether a prir certificatin is needed r nt. 5 Nurse Aide: Includes Nurses assistant Certified Nurses Assistant Certified Nurses Aide Medicatin Aide: Includes Medicatin assistants Certified Medicatin Aide Certified Medicatin assistants Medicatin Technician Any qualified individuals: Cded wherever law explicitly stated an RN r NP culd delegate t any qualified, capable, and/ r ther individual pssessing the skills, knwledge and qualificatins needed t cnduct the delegated medical activity. Als includes Unlicensed assistive persnal and Unlicensed persnal. Finally, after cnsultatin with Gilchrist, the Supervisr added tw final questins explring whether a jurisdictin recgnized specific settings where NP s received an expanded scpe f practice. These questins were added t identify when states had taken steps t increase the availability f medical services in high need areas r newly develping medical care settings. Questin: In what settings d nurse practitiners have an expanded scpe f practice? These settings were cded when the law authrized any additinal autnmy r activity, and nt nly where cmplete independence was prvided cmparatively. The settings listed were cnceptualized and/r cnslidated as fllws: Remte Health Settings: Includes Remte Practice Site. Refers t thse medical treatment sites which are the principal r main practice site f the NP s supervising physician. V. Quality Cntrl Quality cntrl cnsisted f the Supervisr exprting the data int a Micrsft Excel dcument each day the Researchers cded t examine the data fr any missing entries, citatins and cautin ntes. 59% f the recrds were redundantly cded thrughut the life f the prject (30 f 51). The Supervisr assigned 100% redundant cding f the first 10 4 Includes any type f technician ther than medicine technician, cded as medicatin aide. 5 Researchers fund that sme states required medical prfessinals t be certified befre they culd be delegated t, such as a Certified Nurse Aide. The Supervisr excluded certificatin requirements because f variatin and incnsistencies acrss states. Researchers cded the identificatin f any certified medical prfessinal int the mst clsely related existing categry ( Certified Nurse Aide = Nurse Aide ).

7 LawAtlas SM Plicy Surveillance Prtal 7 jurisdictins. The rate f divergence was 43%. The supervisr assigned the next 10 jurisdictins fr redundant cding and the rate f divergence fell t 16% n April 20, The Supervisr assigned the next 10 jurisdictins fr redundant cding and the rate f divergence again fell t 8% n April 27, The team discussed all divergences thrughut the prcess and re-cded as necessary. A naïve cder was brught n t cde 20% f the ttal number f recrds (11 f 51). The rate f divergence was at 15%. The supervisr cnducted a cding review n April 27, Re-cding was cmpleted and the final rate f divergence was 0%. Prir t publicatin, the Supervisr dwnladed all cding data int Micrsft Excel t d a final review f cding answers, statutry and regulatry citatins, and cautin ntes. All unnecessary cautin ntes were deleted, and all necessary cautin ntes were edited fr publicatin.