NP & PA GATHERING MORNING LEGISLATIVE BRIEF FOR ADVANCED PRACTICE PROVIDERS

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1 NP & PA GATHERING MORNING LEGISLATIVE BRIEF FOR ADVANCED PRACTICE PROVIDERS Gina Dennik-Champion, MSN, RN, MSHA Executive Director & Lobbyist, Wisconsin Nurses Association Medical College of Wisconsin The 46th Annual Winter Refresher Course for Family Medicine February 4, 2016

2 Drivers for Increase Utilization of APPs Increase in chronic diseases Healthcare provider shortages percent vacancy rate for APNs (WHA Personnel Survey 2014) Affordable Care Act enrollment Focus on prevention and primary care Focus on patient-centered team-based care

3 Drivers for Increase Utilization of APPs Growth in Medicare Businesses demand Federal Trade Commission (FTC) Outcomes of care-health care systems data Provider dissatisfaction

4 National Nursing s Response 2010 Institute of Medicine Report entitled, The Future of Nursing Leading Change, Advancing Health.. Nurses should practice to the full extent of their education and training Source: Institute of Medicine,

5 Issues for Wisconsin APNs Wisconsin s Nurse Practice Act 441. Wisconsin s Administrative Code Chapter N 8 Title Protection

6 Wisconsin Incongruities with other States Wisconsin APNs do not have a separate license. The title of APN is outdated compared to title Advanced Practice Registered Nurse Title protection for three of the four types of APNs, e.g. Nurse Practitioner, Nurse Anesthetist and Clinical Nurse Specialist, is lacking. Collaboration agreement is required between a physician and advanced practice nurse in order to prescribe one directional collaboration

7 Wisconsin Response Address issues and move toward national model for congruency APRN Coalition Wisconsin Association of Clinical Nurse Specialists Wisconsin Association of Nurse Anesthetists Wisconsin Affiliate of American College of Nurse Midwives Wisconsin Nurses Association Wisconsin Nurses Association Advanced Practice Registered Nurse Forum

8 Wisconsin Response 2013 APRN Uniformity Act Title protection Non-discrimination Patient compensation fund 2015 APRN Title Protection Act Goal is to amend Wisconsin State Statute Chapter 441(Wisconsin Nurse Practice Act) to create uniformity with other states by: Separate licensure for Advanced Practice Registered Nurses APRN-CNM, APRN-CRNA, APRN-CNS and APRN-NP Define APRN Repeal Certified Nurse Midwife

9 Administrative Rules Proposed changes to Nursing Administrative Code N8 Acknowledges advanced education credential DNP Clarification APNP must currently have national certifying body certification Criteria for application as APNP evidence of 45 hours of P&T within 5 years CEU 16 hours per biennium

10 Administrative Rules Proposed changes to Nursing Administrative Code N8 Language upgrade Prescribe for ADHD vs. Hyperkinesia DEA number as means of prescribing Care Management replaces Case Better states APNP ability to order treatment, therapeutics and testing as part of care management

11 Administrative Rules Board of Nursing approved on November 12, 2016 N8.10 (7) When needed, advanced practice nurse prescribers shall work in collaboration with a physician or other health care professional. The need for collaboration shall be based on the advanced practice nurse prescriber s training, education and experience. The advanced practice nurse prescriber shall document this relationship collaboration. (e.g. patients medical record)

12 Administrative Rules Board of Nursing voted on January 14, 2016 to return to the original N8.10(7) with one modification Advanced practice nurse prescribers shall work in a collaborative relationship with a physician. The collaborative relationship is a process in which an advanced practice nurse prescriber is working with a physician, in each other s presence when necessary, to deliver health care services within the scope of the practitioner s education, training and experience. professional expertise. The advanced practice nurse prescriber and the physician must document this relationship.

13 Administrative Rules 2014 Changes to MEB 8 for Physician Assistants Supervising physician to PA ratio went from 2 to 4 concurrently and PA can be supervised by more than one physician Supervising physician must be readily identifiable by the PA Physician review of PA s prescriptive practices simplified through streamlining the frequency of the required periodic reviews and how they should be documented (initially and then annually)

14 Administrative Code for Telemedicine Proposed by the Medical Examining Board MEB 24 Concerns identified Describes telemedicine needing a different set of practice standards rather than a tool providing access to care Narrow definition causes unintentional consequences for other health care providers WNA recommends that Wisconsin health care providers work together on development of telehealth standards and expectations.

15 Other Legislation Authorizes APNPs and PAs to provide the information required by DNR to determine if a person s disability qualifies him or her for such a permit. Authorizes APNPs and PAs to prescribe an epinephrine auto-injector in the name of any entity or organization (beyond the school setting) Further authorizes an APNP and PA to issue a standing order to one or more persons authorizing the dispensing of an opioid antagonist, and authorizes a pharmacist to deliver an opioid antagonist to an individual in accordance with a standing order.

16 For more information go to WNA website or