Download MN APRN Coalition

Mary Zaccagnini, DNP, RN, ACNS-BC
Treasurer
MN APRN Coalition
Mary Chesney, PhD, RN, CNP
President & Chair
MN APRN Coalition
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
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.
AARP (2011) http://championnursing.org/category/topics/22/overview
Difference between restrictive v. nonrestrictive 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
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 licensure to 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
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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
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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
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
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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
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.
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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
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
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
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)
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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
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.
Contact, Join, Donate, and
Follow the Coalition
 http://www.mnaprnc.org/membership/
 https://www.facebook.com/MinnesotaAPRNCoalition
Zaccagnini 10/12