Mary Chesney, PhD, RN, CNP President & Chair MN APRN Coalition

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1 Mary Chesney, PhD, RN, CNP President & Chair MN APRN Coalition Clinical Assistant Professor Director, Doctor of Nursing Practice Program University of Minnesota School of Nursing or

2 Overview of Proposal Sector Addresses primary care workforce & consumer access to care Regulatory issue Outcomes Increased consumer access to care and choice Allows APRNs to practice to fullest extent of education & training Recruitment strategy v. brain-drain Controversy likely supporters, opponents

3 MN APRN Coalition s Mission The MN APRN Coalition is dedicated to improving patient access and choice to safe, cost-effective health care by removing statutory, regulatory, and institutional barriers that prevent APRNs from practicing to the fullest extent of their education and training.

4 AARP (2011)

5 Difference between restrictive v. nonrestrictive APRN practice states No statistical difference between practice safety (based on NPDB data of substantiated malpractice or negligence reports Restrictive states - legislative inertia or aversion to tackle scope of practice legislative issues Restrictive states increased strength of funding & lobbying efforts by national medical organizations & their state affiliates (Safreit, 2010)

6 Proposal Enact the APRN Model Act & Rules in Minnesota Based on APRN Consensus Model of LACE Provides for public safety by requiring: APRN licensure to specific role and population focus Graduation from an nationally accredited ARPN master s or doctoral program Successful completion of at least one national certifying exam and attainment of ongoing recertification Graduation from an educational program that provides basic, standardized core courses as well as specific role/population-focused courses

7 Overview of APRN Statutes in U.S. 17 states & D.C. have full statutory authority for APRN practice (Alaska, Arizona, Colorado, District of Columbia, Hawaii, Idaho, Iowa, Maryland, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Utah, Vermont, Washington, Wyoming) IOM Report on the Future of Nursing: Leading Change, Advancing Health Practice to fullest extent of education and training Substantiated decades of evidence that APRNs are safe, deliver high quality care, and are cost-effectiveness States should remove barriers pass the APRN Model Act & Rules

8 Current MN Statutory Language The advanced practice registered nurse must practice within a health care system that provides for consultation, collaborative management, and referral as indicated by the health status of the patient. Collaborative management is defined as a mutually agreed-upon plan between an advanced practice registered nurse and one or more physicians or surgeons licensed under chapter 147 that designates the scope of collaboration necessary to manage the care of patients. The advanced practice registered nurse and one or more physicians must have experience in providing care with the same or similar medical problems, except that certified registered nurse anesthetists may continue to provide anesthesia in collaboration with physicians, including surgeons, podiatrists licensed under chapter 153, and dentists licensed under chapter 150A. Certified registered nurse anesthetists must provide anesthesia services at the same hospital, clinic, or health care setting as the physician, surgeon, podiatrist, or dentists.

9 Current Statutory Language A (CNS, NP, NA) who has a written agreement with a physician based on standards established by the Minnesota Nurses Association and the Minnesota Medical Association that defines the delegated responsibilities related to the prescription of drugs and therapeutic devices, may prescribe and administer drugs and therapeutic devices within the scope of the written agreement and within the practice as a (NP, CNS, NA). MD and APRN agreement (MMA & MNA Memorandum): Signed by both parties once per year Lists categories of drugs APRN may prescribe MD and APRN are required to keep a copy on file at their worksite. MD & APRN to review prescriptive practice annually

10 Why is this a problem? Creates unnecessary barriers to APRN practice Numerous cases of Psych MH CNS/NPs having to pay physician for collaboration/prescriptive agreement Increasingly, malpractice insurers are recommending that physicians not enter into these agreements Prohibits effective models of care that have been highly successful elsewhere in increasing access to care for vulnerable, underserved populations & saving health care expenditures Provides a false sense of supervision that doesn t exist in practice

11 APRN Model Statutory Language Practice of advanced practice registered nursing. The "practice of advanced practice registered nursing" means the performance of an expanded scope of nursing in a role and population focus. The scope of an advanced practice registered nurse includes, but is not limited to, performing acts of advanced assessment, diagnosing, prescribing and ordering. The practice includes functioning as a primary care provider, direct care provider, case manager, consultant, educator, and researcher.

12 APRN Model Statutory Language Advanced practice registered nursing practice requires the advanced practice registered nurse to be accountable to patients for the quality of advanced nursing care rendered; for recognizing limits of knowledge and experience, planning for the management of situations beyond the APRN s expertise, and includes accepting referrals from, consulting with, cooperating with, or referring to all other types of health care providers.

13 Key Issues Proposed statutory language would Remove collaborative management language Remove the written prescriptive agreement requirement and establish prescribing as appropriate for APRN s role (e.g. CNP, CNM, CNS, CRNA) & population focus Would grant APRNs statutory authority as L.I.P.s

14 Benefits of APRNs Model Act & Rule Protects public by ensuring standards (L.A.C.E.) APRNs have long, established track record of SAFETY & QUALITY APRNs are experts in advancing holistic health Health promotion & prevention Increasing consumers capacity for self-care/activation/lifestyle management of chronic disease New law would remove legislative barriers that prevent citizen access to care New law would allow APRNs to practice their full scope without restraint of trade by another profession

15 For more information contact: Mary Chesney, PhD, RN, CNP President & Chair of MN APRN Coalition