Increasing Health Care Access by Removing Barriers: APRN Model Act

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Increasing Health Care Access by Removing
Barriers APRN ModelAct Rules

• Mary Zaccagnini, DNP, RN, ACNS-BC
• Treasurer
• MN APRN Coalition
• Mary Chesney, PhD, RN, CNP
• President Chair
• MN APRN Coalition

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History of APRN Legislation

• 1999 Nurse Practice Act opened
• Definition of collaborative practice added
• CNS added to prescriptive language
• 2009
• Attempt to move independent practice language
  failed
• Formed the APRN Coalition
• 2012
• Applied for 501c6 status
• Working on new legislation based on the APRN
  Consensus Model
• Mary Chesney presented on behalf of the coalition
  to the Governors Task Force on Health Care
  Reform Workgroup
• The Workgroup included our recommendations in the
  overall list

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MN APRN Coalitions 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.

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AARP (2011) http//championnursing.org/category/to
pics/22/overview
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Difference between restrictive v. non-restrictive
APRN practice states

• No appreciable difference between practice safety
  (based on National Practitioner Data Bank 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)

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Propose Legislation to 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
  masters 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

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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

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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.

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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

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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
  doesnt exist in practice

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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.

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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 APRNs
  expertise, and includes accepting referrals from,
  consulting with, cooperating with, or referring
  to all other types of health care providers.

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Key Issues

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

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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

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MN APRN Coalitions Next Steps

• Raise funds to hire lobbyist
• Increase membership
• Increase membership donations
• Solicit outside donations
• Work hard on regional and MN senate district
  grassroots politics
• Reassess post-election and develop strategic plan
• Continue to get our message out (meetings, phone
  calls, emails, Facebook, Twitter)

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Current Financial Status

• October 1, 2012 balance
• 16,000
• Additional match up to 28,000 awarded by the
  Minnesota Association of Nurse Anesthetists
  
• Based on coalition membership and donations
  received after June 1 (date of award decision by
  committee)
• June 1 October 1 approximately 8,000 in new
  memberships and donation
• Approximately 40,000 - 60,000 will be required
  to pay lobbyist for amount of time needed to move
  legislation forward

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3 Key Messages for Media Work (recommended by Sue
Stout)

• APNs are trusted professionals who are well
  tested in the community with a long track record
  of quality safety.
• When APNs are allowed to practice fully, they
  can provide care that is more economical and
  better than our current health care system allows
  and this savings can be passed on to the state
  and to consumers.
• Government is in the way, and the legislature
  needs to act to remove regulatory barriers which
  prevent APNs from fully practicing to meet the
  needs of the public.

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Contact, Join, Donate, and Follow the Coalition

• http//www.mnaprnc.org/membership/
• https//www.facebook.com/MinnesotaAPRNCoalition