History of NPs. Goals of the First Program. First FNP in the Country. Where We Were 3/20/2013

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1 History of NPs First nurse Practitioner Program developed at the University of Colorado School of Nursing in 1965 Carolyn Montoya MSN, CPNP, Doctoral Candidate College of Nursing, University of New Mexico NMNPC April 11, 2013 Collaborative effort Dr. Loretta C. Ford and Dr. Henry K. Silver Goals of the First Program To test the expansion of the scope of practice of nurses for well child care in community-based settings If successful have the findings integrated into collegiate nursing curricula First program in the country? First FNP in the Country JAMA Article 1969 New Mexico Hamlet Avoids Medical Isolation with Family Nurse Practitioner First Family Nurse Practitioner Martha Schwebach Hope Medical Center, Estancia, NM (pop.900) Dr. Robert Oseashohn Chairman of the UNM, SOM Department of Community Medicine and Epidemiology Where We Were Twenty-four years ago Linda Pearson published the first annual update on state scope of practice for advance nursing practice in the Nurse Practitioner Journal (known as the blue journal) NPs had legislative authority to prescribe in 28 states NPs in NM Practice defined in the nurse practice act for more than 10 years. Prescriptive privileges were under our own signature with written protocols & physician supervision. Pearson,

2 Where We Were Twenty-two years ago in NM 1991 Revision to the nurse practice act defined advanced practice as being in collaboration with a physician NPs needed to submit proof of national certification; completion of an approved program; and letter of collaboration with a physician NPs could prescribe non-controlled substances with supervision of a physician Rx pad needed to have both the NP and the physician names preprinted on Rx. Where We Were 1993 Twenty Years ago in NM Independent Practice! Pearson, 1993 How Did We Get There? United nursing community Political strength Supporting data State needs Cost savings Formation of Coalitions Nursing Non- Nursing Birkholz & Walker, 1994 Where Are We As a Profession of NPs? Number of NPs in the US and states varies according to sources Current estimate of NPs in the US Estimate of 180, 233 NPs in NM 1,167 State with the largest number of NPs? State with the fewest number of NPs? Kaiser Family Foundation, 2011, Where Are We As a Profession of NPs? Where is NP Education? United States All programs were originally certificate granting programs. New Mexico Certificate granting program out of the School of Medicine in the 1970 s. Master s Program at the College of Nursing started in originally only accepted 8 students. More than 200 students have completed FNP concentration 2

3 Where is NP Education? Current NP concentrations in NM UNM - Albuquerque FNP ACNP/Gero PNP (only offered ~ every 3 years) NMSU Las Cruces Psych/Mental Health Nurse Practitioner Offered as a DNP program University of St. Francis - Albuquerque FNP Where is NP Education? DNP Clinical/Practice Degree Expectation that this be the standard degree for NPs as of 2015 NMSU BSN to DNP & Post MSN to DNP UNM Post MSN to DNP for NEOL Summer 2013 Future plans for Post MSN to DNP for FNP & ACNP/Gero Tentatively Summer 2015 PhD Research Degree Both UNM and NMSU have on-line Nursing PhD programs Continued resistance by outside forces to limit NP Scope of Practice (SOP) American Academy of Family Physicians White paper September 18, 2012 Primary Care for the 21 st Century Ensuring a Quality, Physician-led Team for Every Patient Failed state regulatory reforms Iowa Failed to pass an update to Nurse Practice Act which included Board of Nursing (BON) ability to define SOP. Kentucky Failed at collaborative practice agreement for nonscheduled drugs. Missouri Failed to pass a bill authorizing independent practice of APRNs. Continued threat of Medical Boards or Medical Societies introducing restrictive regulations Oklahoma Failure of regulations to require supervising physician to spend ½ day/week in APRN s office. Washington state Failure of a bill to require all healthcare professionals holding a doctorate degree to identify their type of license, registration, or certification in all advertisements which contain their name. Continued threat of state laws becoming more restrictive Kentucky Eliminated APRNs from owning pain management clinics. Missouri Limited certain specific procedures to physicians (e.g. placement of intrathecal infusion pumps; or spinal cord stimulators outside of a surgical, obstetrical, or post-op course of care). 3

4 Virginia HB requirement that NPs practice as part of a patient care team led by a physician. Increase number of NPs a physician can enter into a collaborative agreement. What are our Strengths? Research Mundinger, et al., 2000 study published in JAMA! Comparable outcomes NPs & physicians Newhouse, et al., 2011, Nursing Economics Systematic Review of APRN outcomes Similar outcomes when compared to physicians. Institute of Medicine Report Future of Nursing, 2010 What are Our Strengths? Supporters of NPs National Governor s Association - White Paper, 2012 NPs well qualified to deliver primary care Recommendation for states to change scope of practice & assure reimbursement Robert Wood Johnson Foundation & AARP Future of Nursing Campaign for Action Low rates of malpractice cases Public Approval Where are We with HealthCare? United States US ranks at or near bottom on almost all indicators of mortality, survival, and life expectancy among highincome countries Mortality rates children 1-19 years higher in US than peer countries except Portugal (n = 17) Americans live shorter lives; experience more injuries & illness than individuals in other high-income countries. Where are We with Health Care? New Mexico National Research Council and Institute of Medicine. (2013). U.S. Health in International Perspective: Shorter Lives, Poorer Health. 4

5 Where are We with Health Care? New Mexico Video What will the Future Look Like? What will the Future Look Like? What Should NPs Do? LEANING IN or LEANING BACK What Should NPs Do? 5

6 References Birkholz, G., & Walker, D. (1994). Strategies for state statutory language. Changes granting fully independent nurse practitioner practice. Nurse Practitioner, 19(1), Mundinger, M.O., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians. A randomized trial. Journal of the American Medical Association, 283(1), National Governor s Association. (2012). The role of nurse practitioners in meeting increasing demand for primary care. Retrieved from: References National Research Council and Institute of Medicine. (2013).U.S. Health in International Perspective: Shorter Lives, Poorer Health. New Mexico Hamlet Avoids Medical Isolation (1969). Journal of the American Medical Association, 207(10), Newhouse, R.P. (2011). Advanced practice outcomes : A systematic review. Nursing Economics, 29(5), Pearson, L. J. (1989). How each state stands on legislative issues affecting advanced nursing practice. Nurse Practitioner, 14(1), References Pearson, L. J. (1993). How each state stands on legislative issues affecting advanced nursing practice. Nurse Practitioner, 18(1), Phillips, S. (2013). Evidence-based practice reforms improve access to APRN care. Nurse Practitioner, 38(1),