Transcript Intro to the Professional Role of the Nurse Practitioner

870 Week 2
Spring 2016
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• On the web
PollEv.com/drhal<Your response>
• Florence Nightingale advocated for higher education for nurses
in the late 1800s
• Education began with diploma nurses – they were essentially
unpaid labor for hospitals, classes cancelled when work levels
high
• 1950s – Move toward 4 yr (BSN) degrees, but there was an
RN shortage, so the 2 year AD degree created.
• LPNs – evolved alongside – 1st formal program in 1892
• Also: nursing assistants, medical assistants, others (and everyone
dresses the same!)
Advanced Practice Nursing
• Origins in 1940s with Nurse anesthetists & nurse midwives
• 1954: Psychiatric Nursing
• 1960s: concept of APRN developed to cope with shortage of medical
doctors
• 1965: Henry Silver, MD and Loretta Ford, RN – began the first formal
training program for Nurse Practitioners
NP Process:
1. Graduate from an accredited program
2. Pass a National Board Exam
3. Apply to state BON for CRNP
28th Annual APRN
Legislative Update:
Advancements continue
for APRN practice
Phillips, Susanne J.
The Nurse Practitioner.
41(1):21-48, January 16,
2016.
doi:
10.1097/01.NPR.000047
5369.78429.54
Copyright © 2016 The Nurse Practitioner. Published by Lippincott Williams & Wilkins.
13
28th Annual APRN Legislative Update:
Advancements continue for APRN practice
Phillips, Susanne J.
The Nurse Practitioner. 41(1):21-48,
January 16, 2016.
doi:
10.1097/01.NPR.0000475369.78429.54
Figure. Summary of Practice Authority for
NPs*
Copyright © 2016 The Nurse Practitioner. Published by Lippincott Williams & Wilkins.
14
28th Annual APRN Legislative Update:
Advancements continue for APRN practice
Phillips, Susanne J.
The Nurse Practitioner. 41(1):21-48,
January 16, 2016.
doi:
10.1097/01.NPR.0000475369.78429.54
Table Total Number of Licensed/Certified
APRNs Reported by BONs and/or State
Nursing Associations in 2015
Copyright © 2016 The Nurse Practitioner. Published by Lippincott Williams & Wilkins.
15
Legal authority
Reimbursement
The Pennsylvania BON grants CRNPs and CNSs
authority to practice and regulates their practice.
APRN is not defined in statute or regulation. A
CRNP performs the expanded role in collaboration
with a physician, which is defined as a process in
which a CRNP works with one or more physicians
to deliver healthcare services within the scope of
the CRNP's expertise. The CRNP's SOP is defined
in statute and regulation. CRNPs are recognized
as PCPs by DPW and many insurance companies,
but there are some managed-care companies that
do not recognize CRNPs as PCPs. The Pennsylvania
Department of Health Regulations authorizes a
hospital's governing body to grant and define the
scope of clinical privileges to individuals with
advice of the medical staff. After February 5,
2005, CRNPs must have a master's degree and
pass a national certification exam. The BON does
not track, monitor, or license CRNAs; the BOM
licenses and regulates CNMs.
Third-party reimbursement is available for the
CRNP, CRNA, certified enterostomal therapy nurse,
certified community health nurse, certified
psychiatric/mental health nurse, and certified CNS,
provided the nurse is certified by a state or a
national nursing organization recognized by the
BON. Medicaid reimburses CRNPs and CNMs at
100% of the physician payment for certain
services. The State Department of Health allows
HMOs to recognize CRNPs as primary care
gatekeepers.
Prescriptive authority
The BON confers prescriptive authority, including Schedules II-V
controlled substances, to CRNPs with a collaborating physician.
Regulations allow a CRNP to prescribe and dispense drugs if the
CRNP has successfully completed a minimum of 45 hours of course
work specific to advanced pharmacology and if the prescribing
and dispensing is relevant to the CRNP's area of practice,
documented in a collaborative agreement, and not from a
prohibited drug category and conforms with regulations.
The CRNP may write a prescription for a Schedule II controlled
substance for up to a 30-day supply.
CRNPs may prescribe Schedules III-IV controlled substances for up
to a 90-day supply; Schedule V is not restricted. CRNPs are
authorized to request, receive, and dispense pharmaceutical
sample medications. Prescription blanks must include the name,
title, and Pennsylvania certification number of the CRNP. The
collaborative agreement is a signed, written agreement between
the CRNP and a collaborating physician in which they agree to
the details of their collaboration, including the elements in the
definition of collaboration.
• AANP strongly opposes this terminology
• “In 2010, the IOM developed a blueprint for the future of nursing. A key
recommendation of this report is that NPs should be full partners with
physicians and other health care professionals.1 Achieving this
recommendation requires the use of clear and accurate nomenclature of the
nursing profession.”
• “These inaccurate terms originated decades ago in bureaucracies and/or
organized medicine; they are not interchangeable with use of the NP title.
The terms fail to recognize the established national scope of practice for the
NP role and authority of NPs to practice according to the full extent of their
education.”
• “The term “mid-level provider” implies an inaccurate hierarchy within clinical
practice. Nurse practitioners practice at the highest level of professional
nursing practice. It is well established that patient outcomes for NPs are
comparable or better than that of physicians.2 NPs provide high-quality and
cost-effective care. “
(n.d.). Retrieved January 20, 2016, from
https://www.aanp.org/images/documents/publications/useofterms.pdf
https://www.youtube.com/watch?v=V_PnaXjVn2c
• Read it here!
https://iom.nationalacademies.org/~/media/Files/Report%20Files/2010/The-Future-of-
Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf
• Key Messages
• Nurses should practice to the full extent of their education and training.
• Nurses should achieve higher levels of education and training through an
improved education system that promotes seamless academic progression.
• Nurses should be full partners, with physicians and other health care
professionals, in redesigning health care in the United States.
• Effective workforce planning and policy making require better data
collection and an improved information infrastructure.
Recommendation 1:
Remove scope-of-practice barriers. Advanced practice registered nurses should be able to practice to the
full extent of their education and training. To achieve this goal, the committee recommends the following
actions.
•
•
For the Congress: • Expand the Medicare program to include coverage of advanced practice
registered nurse services that are within the scope of practice under applicable state law, just as
physician services are now covered. • Amend the Medicare program to authorize advanced practice
registered nurses to perform admission assessments, as well as certification of patients for home health
care services and for admission to hospice and skilled nursing facilities. • Extend the increase in
Medicaid reimbursement rates for primary care physicians included in the ACA to advanced practice
registered nurses providing similar primary care services. • Limit federal funding for nursing education
programs to only those programs in states that have adopted the National Council of State Boards of
Nursing Model Nursing Practice Act and Model Nursing Administrative Rules (Article XVIII, Chapter
18).
For state legislatures: • Reform scope-of-practice regulations to conform to the National Council of
State Boards of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules (Article
XVIII, Chapter 18). • Require third-party payers that participate in fee-for-service payment
arrangements to provide direct reimbursement to advanced practice registered nurses who are
practicing within their scope of practice under state law.