Unleashing the Potential of CA APRNs: A View from ANA

1. Unleashing the Potential of CA APRNs: A View from ANA

2. __________________________________ Lisa Summers, CNM, DrPH Senior Policy Fellow, Department of Nursing Practice & Policy April 30, 2011 APRN Summit San Pedro, CA

3. Overview ANA Advocacy on APRN Issues (a national - or perhaps “inside the beltway” - perspective) Four Thoughts to Offer (as a supportive “outsider” Discussion

4. ANA Advocacy on APRN Issues With limited seating at many policy tables, ANA is often in a position to be the sole voice of nursing. This position has become increasingly crucial, yet sensitive, with the growth of nursing specialties and the increasing importance of varied nursing roles. As a historical convener of the larger nursing community, ANA seeks to fully and accurately represent the nursing community. Each of the following is prefaced with “work with other organizations representing APRNs and key stakeholders to ….”

5. ANA Advocacy on APRN Issues • Ensure the ability of APRNs to practice to the full extent of their education and training. • ANA’s “Regulatory Rapid Response Team” is being vigilant with regard to the implementation of the Affordable Care Act, including a host of issues that impact APRNs. • Hot topic: 475 pages of regulatory language on implementation of the provision establishing Accountable Care Organization

6. ANA Advocacy on APRN Issues • Embed IOM definition of primary care in all legal and regulatory work on health system reform, particularly the medical (or primary care) home. • Lots of recent activity on Joint Commission Primary Care Home Standards and EPs • Facilitate a widespread understanding of and acceptance for the Consensus Model for APRN Regulation and work to implement the model.

7. ANA Advocacy on APRN Issues • Advocate for increased funding for advanced practice nursing education, including expansion of recently enacted graduate nurse education (GNE) demonstration project • Achieve equitable reimbursement for APRNs • Provide a legal challenge to arbitrary practice restrictions • Facilitate the ability of APRNs to be privileged as LIPs in institutions.

8. ANA Advocacy on APRN Issues • Ensure that nurses are involved in the design, development and implementation of HIT systems, and that APRNs are eligible for funding to enhance adoption of HIT. • Ensure that ANA’s expansive work in the national quality enterprise is in concert with APRNs efforts to be included in national performance measurement programs currently designed for physicians. • Gather and disseminate workforce and payment data

9. Kudos to CA APRNS Goal: create a strong coalition to address barriers to APRN practice in CA White paper: to create a unified message for CA legislators about how APRNs can help fill healthcare needs in CA

10. Four Thoughts Carpe diem! Continued coalition building is key Carefully consider the role of the white paper Be forward looking

11. Carpe diem Unique moment in time…open door…tipping point …harmonic convergence Consensus Model for APRN Regulation – solutions to long-standing problems; everyone gave a little Healthcare reform – unity in the Nursing Community was fruitful; can be leveraged despite a legislators view of ACA IOM report: Future of Nursing – potential impact of Flexner Report? Unprecedented consumer engagement

12. Coalition building • “Usual” challenges of APRN coalition building • 4 unique professional roles • multiple organizations • Unique challenges of coalition building in CA: • Geography • Statutory language • Somewhat rocky history and interorganizational relationships; “fragmented” • Board of Nursing in the headlines

13. Coalition building • A coalition is an alliance of organizations that come together to address a specific problem and reach common goals. • Within a coalition, groups attain • Strength in numbers • Increased credibility • Professional networking opportunities • Increased knowledge-sharing • Better media reach • Better access to legislators and regulators

14. Coalition building • A state coalition – particularly one that is broad-based (beyond nursing) provides a unique platform to be heard • Helps audiences understand that it’s not just individual professions fighting for turf... • it’s a bigger access issue.

15. Building partnerships beyond nursing • The Coalition for Patient’s Rights – formed to counter the AMA Scope of Practice Partnership • www.patientsrightscoalition.org • AARP – 2010 policy statement • http://championnursing.org/resources/aarp-2010-policy-supplement-scope-practice-advanced-practice-registered-nurses • Citizen Advocacy Center – Reforming Scope of Practice Toolkit • www.cacenter.org/cac/SOP

16. The white paper

17. The white paper • Recall that it was part of an overall strategy. • It is a means to an end, not an end in itself. • Don’t be burdened by it. • Don’t let the perfect be the enemy of the good. • The process has been important and valuable. • Remember the ultimate audience, as you appreciate what it has done for you internally.

18. The white paper – key messages • From the legislators perspective • Californians need health care • It’s expensive • They have to balance the budget • Lobbyists and $$ fuel the process, but • They have a broad constituency in the voters • Scope of practice: it’s not a doctor-nurse turf war; it’s about responding to the need for increasing access and controlling costs

19. Be forward looking • It’s all about the relationships (positive and negative) • Let go of hard feelings and ancient past; focus on the future • Each of the 4 APRN roles faces unique problems and opportunities, • as does each of the 4 LACE entities. • ANA seeks to represent the interests of the entire nursing profession, including the each of the 4 APRN roles.

20. The coalition looking forward • Narrowing the focus, defining the mission • Know your allies/opponents • “Step 1: What needs changing? • There are a host of complex rules and regulations that need to be carefully analyzed to determine what needs changing. • The answer to this key question will not always be the same for each the 4 APRN roles – again, effective coalition building in the states will be key!” ANA’s February Consensus Model Update for our state associations

21. The coalition looking forward • Devise a strategy for action • Very difficult to do without talented lobbyists who collaborate and facilitate communication • “The hesitancy in some states/organizations to ‘implement the Consensus Model’ is a result of a well-founded concern that we ‘first, do no harm.’” • For those reluctant to “open the practice act,” remember that whenever the legislature is in session, anyone can introduce legislation to change your practice

22. The coalition looking forward • 5 Golden Rules of a Coalition Coalition for Patients Rights State Based Coalition Building Program • Be inclusive not exclusive • All members must be treated as equals • Participation is required, not always agreement • Diplomacy always wins • Communicate often and be transparent Understand the differences; act on the commonalities.

23. Thank you! Questions? Discussion Lisa Summers, CNM, DrPH Senior Policy Fellow, Department of Nursing Practice & Policy Lisa.Summers@ana.org 301-628-5058