Transcript Grassroots Advocacy Presented by Ann Sheehan, DNP, RN, CPNP

Advocacy is important to me,
personally
11%
Disagree
24%
Strongly
Agree
64%
Agree
Advocacy is important to me,
professionally
3%
Disagree
32%
Strongly
Agree
65%
Agree
Advocacy is important to the
continuation of my career
11%
Disagree
25%
Strongly
Agree
64%
Agree
Advocacy is my responsibility
8%
Disagree
24%
Strongly
Agree
68%
Agree
Advocacy is the responsibility of
my professional organization
4%
Disagree
42%
Strongly
Agree
54%
Agree
Have you ever been to your state or national capitol
to talk to legislators and/or their staff regarding an
issue related to health care or APRN practice?
71% No
29% Yes
How often do you contact your state
and/or national legislator(s)?
Monthly
25%
Annually
20%
Only when
prompted to
do so by my
professional
organization
83%
The Problem Defined
Taft, S. & Nanna, K. (2008)
“Policy is shaped by
how policy makers
learn about health
care issues and how
those issues are
defined as problems.”
Policy Facts
Legislation is
made by
personal stories
and anecdotes
Regulations are
made with facts
and figures
Michigan Legislation
Senate
Bill 2
SB 2
Define the Scope of APRN Practice
 Allow NPs to provide health care services
within their scope of practice
 Allow for prescriptive authority within the
APRNs scope of practice
 Requires APRNs to consult with other health
professionals and make referrals

SB 2 Defines APRN Scope of
Practice

APRN
 Nurse Practitioner
 Nurse Midwife
 Clinical Nurse Specialist
 Nurse Anesthetist (this group of APRNs are not
included in SB 2)

The definition WILL NOT expand the scope of
practice but WILL define the scope of
practice for APRNs in the state of Michigan
Education
Training
Certification
Defines
APRN
scope of
practice
How Nurse Practitioner Scope of
Practice Differs from Physician
Physician scope of practice, as defined by their education, training
and experience
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Nurse Practitioner scope of practice, as defined by their education, training and
experience
Consultation and Referrals
All health
care
providers
consult with
each other
No one
health care
provider is
an expert in
every field
SB 2 WILL NOT

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Require new or additional third party
reimbursement
Mandate workers compensation benefits
Mandate increased reimbursement rates for
health care services from health care insurers
Allow NPs to form PLLC or PC
Interfere with current or future health care
insurers requirements for direct reimbursement
Interfere with current or future practice
arrangements made with employers and
employees
SB 2 Facts
Update Michigan’s Public Health Code to
reflect what is currently going on in practice
 18 states and DC have defined scope of
practice with equal or better patient
outcomes than physicians
 Prescriptive authority and licensure allows
for better tracking of patient outcomes and
allows for improved transparency in billing
and accountability

SB 2 Facts
No data from states that impose greater
restrictions on APRN practice suggests safer or
better patient care or that the roll of the
physician has changed or deteriorated
 Trends show that APRNs are moving out of
states with restrictive practice acts decreasing
patient access to care in those states
 APRNs support the Patient Centered Teambased Model of Care that integrates
interprofessional patient care with the specific
needs of the patient at the forefront

SB 2 Actualizes the RWJ and IOM “The Future
of Nursing” Report AND Governor Snyder’s
Healthy Michigan Initiate




Nurses should practice to the full extent of their
education and training
Nurses should achieve higher levels of education
and training to promote health care and improve
patient outcomes
Nurses should be full partners with physicians in
providing health care
Effective planning and policy making requires better
data collection and improved infrastructure
Federal Trade Commission
The Federal Trade Commission supports
unrestricted APRN practice acts in every
state
 The Federal Trade Commission has sent
letters to state congressional leaders who
have failed to pass unrestricted APRN
practice acts sighting restraint of trade

SB 2 Bottom Line
APRNs in Michigan are already providing
health care to many patients
 20 years of research shows that APRNs

 Do not increase liability claims or costs
 Have equal or higher patient satisfaction
 Have equal or better patient outcomes

A recent study showed that underutilization
of APRNs costs our nation nearly $9 billion
annually
SB 2 on the Senate Floor
November 13, 2013
SB 2 Amendments
1. Prohibit
APRNs from
opening
independent
practices after
the bill
becomes law.
This does not
apply to nonprofits such as
NMHCs
2. Extends a
mentorship
agreement for
new APRN grad
from 2 years to
4 years. The
mentor can
either be a
physician or a
licensed APRN
3. Adds 2
physicians to
the newly
created APRN
taskforce (this
taskforce will
provide
disciplinary
action for
APRNs when
necessary)
4. Holds APRNs
that practice
independently
(without
supervision of a
physician) to
the same
standards as
physicians in
cases of
malpractice
On to the House of Representatives
House Health Policy Committee
Members



Currently sitting in
the House Health
Policy Committee
 Still called SB 2

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Gail Haines (Chair) 43rd District
Mike Calton (Maj. Vice-Chair) 87th District
Hugh Crawford, 38th District
Bob Genetski, 80th District
Mike Shirkey, 65th District
Thomas Hooker, 77th District
Ken Yonker, 72nd District
Dale Zorn, 56th Disctrict
Joseph Graves, 51st District
Klint Kesto, 39th District
George Darany, (Min Vice-Chair), 15th
District
David Knezek, 11th District
Kate Segal, 62nd District
Thomas Stallworth, 8th District
Winnie Brinks, 76th District
Phil Cavanagh, 10th District
1. Voted out of
House HP
Committee
5. Goes to the
Governors
desk for
signature
All of this has to
be accomplished
by December 31,
2014 or this bill
dies and the
process starts all
over again
4 .Committee
to reach a
consensus
2. Vote on the
House Floor
3. Must come
out of the
House the
same as it
came out of
the Senate
MSMS Propaganda
http://www.youtube.com/watch?v=qDotJFkPw6Y
MSMS Propaganda

Under SB 2, "Nursing care provided by a CNP includes
ordering, performing, supervising, and interpreting laboratory
and imaging studies." This is effectively the definition of a
pathologist and a radiologist. These specialties generally
require between 8-10 years of specialized training and often
perform extremely complicated genetic and molecular tests.

Under SB 2, Advance Practice Nursing includes, "diagnosing,
treating, and managing patients with acute and chronic
illnesses and diseases." This definition is extremely broad and
could potentially encompass any patient that would walk into
my office or through the hospital doors.

Under SB 2 , Certified Nurse Midwives could offer "treatment of
male partners for sexually transmitted infection, and
reproductive health." Reproductive health is extremely broad,
and could include extremely invasive procedures.
MSMS Propaganda

Are you willing to put Michigan citizens at risk?

Together, physicians and nurses work for the
general welfare of patients in Michigan, and
their partnership fosters the development of
groundbreaking advances in medicine.

It's a partnership focused patient care. It's a
partnership that's working. It's a partnership
worth preserving
Michigan Legislation

Senate Bill 568
SB 568

Introduced by Senator Marleau as a counter
to SB 2
 Introduced in October 2013
Senator Marleau is the Chair of the Senate
Health Policy Committee
 Supported by physician groups
 Bill currently sits in the Senate Health Policy
Committee

 It has not had a first reading in this committee yet
SB 568 Will
Replace the regulatory boards and
disciplinary subcommittees with separate
task forces for allopathic physicians,
osteopathic physicians, PAs and APRNs
 Allow health professional licensees to form a
patient care team and require the team to
have a practice agreement
 Create the Michigan Patient Care Board and
require it to establish a model practice
agreement for the patient care teams
 Require a PA or APRN to be a care team
member in order to practice

SB 568 Will
Eliminate references to CNM and CNP specialty
fields and provide for the licensure of CNMs,
CNPs, and CNSs as APRNs
 Extend to APRNs certain provisions that apply to
PAs
 Include a PA and an APRN in the definition of
“prescriber” in the Pharmacy Practice and Drug
Control Act
 If a licensee organized as a PC or PLLC with
other licensees, each stakeholder of the
corporation or member of the company must
comply with all applicable requirements to
engage in his/her health profession

SB 568 and Michigan Business
Includes APRN and nurse anesthetist in the
definition of professional services
 Authorizes a physician to organize a PC or
PLLC with any other licensed individuals

 Expands this option to more than just PAs
Allows a licensed physician to organize a
PLLC with one or more CRNA
 Eliminates ban on PAs from forming PCs or
PLLCs without other professionals

SB 568 and Patient Care

Creates a Michigan Patient Care Board with the
Department of Licensing and Regulatory Affairs
(LARA)
 3 allopathic physicians
 3 osteopathic physicians
 3 PAs
 3 APRNs
 7 public members

Board would establish a model practice
agreement for use by physicians and PAs and
APRNs who organize a patient care team
SB 568 and Patient Care Task Force



Patient Care Taskforce designed to regulate various
health professions
Make recommendations to the Patient Care Board
regarding improvements for patient care
Create separate Regulatory and Disciplinary Task
Forces for each health profession
 Sets forth rules for implementation of its power and duties
 Sets forth rules to establish the requirements for
education, training and/or experience of a health
profession for licensure in MI
 Establishes criteria for the evaluation of programs for
educating and training the individual health professions to
determine whether grads of programs have the knowledge
and skills necessary for practice
SB 568 and Patient Care Teams
Licensees can form patient care teams to
collaboratively provide patient care in the
best interest of the patient’s health
 Patient Care Team is made up of at least 2
licensed health professionals, including at
least 1 physician
 The team’s practice agreement has to be
available to the Board at any time

 Make physician continuously available to other
members of the team
Patient Care Teams and APRNs
In order to engage in practice, a PA or
APRN would have to enter into a practice
agreement as a member of a patient care
team
 Bill would require referral to a PA or APRN
in his/her capacity as a patient care team
member, rather than a person performing a
delegated task under a physicians
supervision

Other revisions and SB 568
Defines a prescriber as a licensed dentist,
podiatrist, optometrist, veterinarian, or other
licensed health professional acting under the
delegation and using, recording, or otherwise
indicating the name of the delegating
physician
 Refer to APRNs rather than CNMs and CNP

SB 568 Facts

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Michigan Patient Care Board is physician
dominated
Patient is defined as an individual who is under
the care of a physician or a patient care team
Definition of APRN does not include CRNA
Only APRNs and PAs are required to be part of
a patient care team
RNs and CRNAs would continue to be regulated
under the BON while CNS, CNPs, and CNMs
would be regulated under the new Patient Care
Board and new APRN taskforce and the BON for
the RN license
SB 568 Facts
Definition of collaboration means that
communication and decision making process
occurs among members of a patient care
team
 Definition of patient care team means a team
of 2 or more licensed health professionals
including at least 1 physician
 Physicians are not required to practice in a
team, while APRNs and PAs are subject to
practice in collaboration with a physician in a
patient care team

SB 568 Facts
Allows for a 19 member patient care board to
establish a model practice agreement
 Patient care teams must have a practice
agreement in place as previously described
 APRNs and PAs must enter into a practice
agreement as a member of a patient care
team
 APRNs and PAs can ONLY provide medical
care services as a member of a patient care
team

SB 568 Facts
APRNS and PAs may make calls or go on
rounds, in collaboration with a physician
 APRNs and PAs may prescribe drugs if they
are a member of a patient care team

Each APN needs to

Talk to YOUR House Member
 Especially if your member sits on the House HP Committee
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Create Talking Points
Create an Elevator Speech
Repeat your talking points and elevator speech to
everyone so it rolls off your tongue when you are asked
about NPs and legislation related to NPs
Stick to your points, don’t get caught up in arguments
that don’t have merit or evidence
Ask for evidence when you are presented with
challenges
Collect Personal Stories
Join a Professional Organization
Creating Michigan’s APRN Future
A change in
health care
delivery will not
be realized until
APRNs become
comfortable
advocating for
themselves and
their profession
The days of
silently standing
by as other
professions
prescribe
nursing’s fate
should be long
gone
Need to create
opportunities for
nurses to
participate in
advocacy
activities with or
without a mentor
Opportunities
Stay
Informed
Mentorship
Empowered Advocates
Preparation for a Legislator Visit

Review your talking points/the points you want
to make
 Create a leave behind one-pager

Research the legislators voting record and know
what committees he/she sits on
 Thank him/her for support on legislation you are
interested in
Bring examples that demonstrate how your
APRN role is a critical part of the health care for
your legislator’s constituents
 Be prepared to tell personal stories to illustrate
your points

During your Legislator Visit


Introduce yourself, where you work and where you
live
Ask if the legislator has knowledge or personal
experience with an APRN (or more specific: NP,
NMW, CNS)
 What does he/she know about NPs?
 Does he/she know any NPs?


Briefly describe your practice and what a typical
work day is like for you, the type of activities you do
in assessing and managing your patient’s care
Ask what the legislator’s main priorities and/or
concerns are for his/her constituents related to
health care, then start your conversation there
Building Legislative Relationships
Rule of 5’s

Attend a “meet the candidate” or “open house” event
 Organize an event with several APRNs for your legislator

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Donate time and/or money to support a candidate
that is running for office
Write a note of congratulations to the candidate that
wins and remind them that you can be a consultant
on health issues or other expertise you have
Send a thank you note when he/she does
something good that has nothing to do with health
care
Copy news articles that might be of interest related
to a bill you are for or against
The Last Words
Educate, Educate, Educate
Many Legislators don’t know the difference
between an LPN and an NP
 What will happen if you ignore or don’t
participate in this discussion?

 You could be educated for a career that does not exist
any longer in Michigan

It took DOs 100 years to get their scope of
practice issues worked out
 The NP profession is 49
 We are about half way there!

Participate in this health care reform TODAY
It is a long
walk to the
Capitol by
yourself!