Increasing Health Care Access by Removing Barriers: APRN Model Act & Rules

1. 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

2. 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 Governor’s Task Force on Health Care Reform Workgroup • The Workgroup included our recommendations in the overall list Zaccagnini 10/12

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) http://championnursing.org/category/topics/22/overview

5. 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) Chesney_3-1-12 – Zaccagnini 10/12

6. 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 licensureto 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 Chesney_3-1-12 Zaccagnini 10/12

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 Chesney_3-1-12 Zaccagnini 10/12

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. Chesney_3-1-12 Zaccagnini 10/12

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 Chesney_3-1-12 Zaccagnini 10/12

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 Chesney_3-1-12 Zaccagnini 10/12

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. Chesney_3-1-12 Zaccagnini 10/12

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. Chesney_3-1-12 Zaccagnini 10/12

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 Chesney_3-1-12 Zaccagnini 10/12

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 Chesney_3-1-12 Zaccagnini 10/12

15. MN APRN Coalition’s 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) Chesney_3-1-12 Zaccagnini 10/12

16. 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 Zaccagnini 10/12

17. 3 Key Messages for Media Work (recommended by Sue Stout) • APN’s are trusted professionals who are well tested in the community with a long track record of quality & safety. • When APN’s 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 APN’s from fully practicing to meet the needs of the public.

18. Contact, Join, Donate, and Follow the Coalition • http://www.mnaprnc.org/membership/ • https://www.facebook.com/MinnesotaAPRNCoalition Zaccagnini 10/12