Advance Practice Nurses in Maine

1. Advance Practice Nurses in Maine Independent practice

2. APRN Scope of Practice • Assessing clients • Synthesizing & analyzing data, understanding &applying nursing principles at an advanced level • Providing expert teaching & guidance • Working effectively with clients, families, health care team • Managing clients’ physical &psycho-social health-illness • Utilizing research skills • Analyzing multiple sources of data, differential diagnosis, selecting appropriate treatment • Independent decisions in solving complex client care problems • Diagnosing, prescribing, administering & dispensing therapeutic measures • Recognizing limits of knowledge &experience, planning for situations beyond expertise, consulting with or referring to other health care providers as appropriate

3. NP History in Maine • NPs earned the right to practice independent of physicians in ME in the mid-1990s • NP must complete at least 24 months of supervised work • NPs can now be credentialed as participating providers • NPs can be primary care providers in managed care organizations • A new grad can be supervised by another NP who is independently licensed.

5. Physician supervision required Physician supervision not required

6. APRNs in Maine • 1088 NPs in ME in 2011 • Most are independently licensed • Fewer than 50 practice independently

7. Where are the APRNs? • Distribution of NPs and primary care similar • Majority of NPs in ME in Primary Care • From the ME NP Association web site: • Overall 25% of NPs in rural areas of ME • In primary care about 40% rural (most in FM) • Rural distribution of NPs almost identical to FPs • NPs, PAs and Physicians are all leaving primary care at about the same rate (AHRQ and Robert Graham Center data)