Download HERE - Minnesota Nurse Practitioners

The State of APRN Practice 2011
Sue LaMotte, RN, CNM, MS
MN NP Group
April 30, 2011
Agenda
History
Current State
Statute Language
APRN Data
Future State
Consensus Model for APRN Regulation
IOM Report
APRN Coalition
APRN
Regulation
1983
Language defining
CNM and CRNA in
Health Insurance
Statutes (62A)
1988
Nurse Practice Act
(148.171 – 148.285)
added definition of
CNM and
prescribing
authority
NP and Psych/MH
CNS definition
added
to 62A.15
1990
NPA added 148.235
(prescribing section)
Added NP
definition and
prescribing
authority
1994
Psych/ MH CNS
added to 148.235
1999
Extensive revision
of NPA; all
definitions in law
now outlined
In NPA
Mission Statement
…to protect the public’s health and safety
by providing reasonable assurance that the
people who practice nursing are
competent, ethical practitioners with the
necessary skills appropriate to their title
and role
About the Board
 1907
 16 Board members
4 Public members
8 RNs (Bacc, AD,
LTC, APRN,
practice)
4 LPNs
 33 Staff
 Meet 6 times / year
Functions of the Board
 authorize individuals to practice nursing
 approve licensure-preparing nursing
education programs
 identify standards of nursing practice
 discipline individuals who do not meet the
standards
The Nurse Practice Act
 Authorizes APRN practice
Licensed as RN
Current certification on APRN Registry
 APRN is independently accountable for practice
 Language is very broadly written
Does not detail specifics of scope of practice
Look to professional bodies, certification
organizations, ANA Standards, etc
Definition
“Advanced practice registered nurse, abbreviated APRN, means an
individual licensed as a registered nurse by the board and certified
by a national nurse certification organization acceptable to
the board to practice as a:
clinical nurse specialist,
nurse anesthetist,
nurse-midwife, or
nurse practitioner
Minnesota statutes, section 148.171, subd 3
Definition
Continued
The practice includes functioning as a:
direct care provider,
case manager,
consultant,
educator, and
researcher.
Minnesota statutes, section 148.171, subd. 13
Definition
Continued
The APRN must practice within a health
care system that provides for:
consultation,
collaborative management, and
referral
Minnesota statutes, section 148.171, subd. 13
CNP Practice
…means, within the context of collaborative
management:
(1) diagnosing, directly managing, and preventing acute
and chronic illness and disease; and
(2) promoting wellness, including providing
nonpharmacologic treatment.
The NP is certified in a specific field of clinical
practice.
Minnesota statutes, section 148.171, subd. 11
Collaborative Management
…is a mutually agreed upon plan between an
APRN and one or more physicians… that
designates the scope of collaboration
necessary to manage the care of patients.
Minnesota statutes, sections 148.171, subd. 6
National Nurse Certification
Organizations
 American Academy of Nurse Practitioners
 American Association of Critical-Care Nurses
Certification Corporation
 American Nurses Credentialing Center
 American Midwifery Certification Board
 Pediatric Nursing Certification Board
 National Certification Corporation for Obstetric,
Gynecological, and Neonatal Nursing Specialties
 Council on Certification of Nurse Anesthetists
APRN Registry
Practicing without current certification or
failure to notify Board of current
certification is subject to payment of a
penalty fee:
$200 first month
$100 each subsequent month
Prescribing…
Delegated medical function (exception:
CNMs)
Memorandum of Understanding
Created by MNA and MMA
Identifies elements required for written
agreement
Minnesota statutes, section 148.235
Credentials
IDENTIFICATION
An advanced practice registered nurse …….. shall use
the appropriate designation:
 RN,CNS
 RN,CNM
 RN,CNP
 RN,CRNA
for personal identification and in documentation of services
provided. Identification of educational degrees and
specialty fields may be added.
Minnesota statutes, section 148.233 subd 2
Reasons for a
Future APRN Model
 Lack of common definitions related to APRN
roles
 Lack of standardization in programs leading
to APRN preparation
 Proliferation of specialties and subspecialties
 Lack of common legal recognition across
jurisdictions
Benefits of
APRN Consensus Model
Facilitates mobility
of APRNs
Ensures public safety
Increases access to health care
Advocates appropriate scope of
practice
Consensus Model for
APRN Regulation
APRN regulation includes:
 Licensure
• The granting of authority to practice
 Accreditation
• Formal review and approval by a recognized agency of
certification agencies and APRN education programs
 Certification
• The formal recognition of knowledge, skills and experience
demonstrated by the achievement of standards identified by the
profession
 Education
• The formal preparation of APRNs in graduate or post-graduate
programs
Implementation target date: 2015
APRN Regulatory Model
APRN Specialties
Licensure at levels of role and
population foci
Focus of Practice beyond role and population focus
Linked to health care needs
Examples include but are not limited to: Oncology, Older Adults,
Orthopedics, Nephrology, Palliative care, Critical Care
POPULATION FOCI
Family/Individual
Across lifespan
AdultGerontology
Women’s Health/
Gender Related
Neonatal
Pediatrics
Psych/Mental
Health
APRN ROLES
Nurse
Anesthetist
Nurse
Midwife
Clinical Nurse
Specialist
Nurse
Practitioner
IOM / RWJF Landmark Report
1)
Nurses should practice to the full
extent of their education and training.
2)
Nurses should achieve higher levels of
education and training through an
improved education system that
promotes seamless academic
progression.
3)
Nurses should be full partners, with
physicians and other health care
professionals, in redesigning health care
in the United States.
4)
Effective workforce planning and policy
making require better data collection and
an improved information infrastructure.
The Stars Align
 Synergy
 Affordable Healthcare Act
 Growing participation
 Birth of the Minnesota APRN Coalition
 IOM/RWJF Report: The Future of Nursing: Leading
Change, Advancing Health
Minnesota APRN Coalition
Vision Statement
The Minnesota APRN Coalition’s vision is that the people of Minnesota
have unrestricted access to APRNs who have statutory authority to
practice to the fullest extent of their education and training.
Mission Statement
The Minnesota APRN Coalition is dedicated to improving patient
access to and choice of safe, cost-effective healthcare providers by
removing statutory, regulatory and institutional barriers that prevent
APRNs from practicing at the highest level of their education and
training.
Minnesota APRN Coalition
ALL APRN “roles” are participating
Several active working groups
Participated in NCSBN APRN Summit
Bill authors recruited; Statute language
drafted
Strategy developing
Suggested Statute Changes
Eliminate written prescribing agreement
Second license
Delete “collaborative management”
language
Practice to fullest extent of education &
training
New credential designation
NCSBN
National Council of State Boards of Nursing
Excellent resource
APRN Summit in January
Toolkit for implementation of IOM / Consensus Model
recommendations
www.NCSBN.org
APRN Video:
http://www.youtube.com/watch?v=OmbfWqxc6PA
Technology
www.nursingboard.state.mn.us