Download Acute care vs primary care

ACUTE CARE VS PRIMARY CARE, THE
PEARSON REPORT, IOM REPORT,
OAAPN
The distinctions and overlap in practice by acute
and primary care NPs.
Shonda Perry, Brian Vereb
NATIONAL ORGANIZATION OF
NURSE PRACTITIONER FACULTIES
The National Organization of Nurse Practitioner
Faculties (NONPF) is the only organization
specifically devoted to promoting quality nurse
practitioner (NP) education at the national and
international levels.
 Consensus Model for APRN Regulation, patient
safety is a key uniting link among the
components of advanced practice registered
nursing (APRN) regulation – licensure,
accreditation, certification, and education
(LACE).

SCOPE OF PRACTICE

Scope of practice is the “definition of the rules,
the regulations, and the boundaries within which
a fully qualified practitioner with substantial and
appropriate training, knowledge, and experience
may practice.
NONPF STATEMENT ON ACUTE CARE AND
PRIMARY CARE NURSE PRACTITIONER
PRACTICE 2011
A fundamental premise of the Consensus Model is that
NP competencies are not setting specific. Historically,
the acute care NP (ACNP) practiced predominantly in
the hospital and the primary care NP (PCNP) practiced
within a community setting.
 These setting boundaries often overlap.


Example - An ACNP may practice in both hospital and
home settings. The PCNP who practices predominantly in a
community-based setting might also work within a hospital
setting, e.g. in a diabetes clinic within the hospital.
KEY POINTS
The key issue is that scope of practice should be
linked to educational preparation and
corresponding NP certification.
 NPs should be regulated according to the services
they perform and population served and not
where they provide services.

KEY POINTS

The main emphasis of PCNP educational
preparation is on comprehensive, chronic,
continuous care characterized by a long term
relationship between the patient and PCNP.


The PCNP provides care for most health needs and
coordinates additional health care services that
would be beyond the PCNP’s area of expertise.
The ACNP educational preparation focuses on
restorative care that is characterized by rapidly
changing clinical conditions.

The ACNP provides care for unstable chronic
conditions, complex acute illnesses, and critical
illnesses.
KEY POINTS
Scope of practice must be tied to formal APRN
education and not pre-APRN education or
on-the-job training.
 Certification must match educational
preparation. Certification eligibility should be
linked to the educational preparation, and
similarly a NP graduate should sit only for
certification that corresponds with the population
focus of his/her educational preparation.

KEY POINTS

Both the PCNP and the ACNP
might evaluate an acutely ill patient, but the severity of
the symptoms would determine which provider is most
appropriate and best matched to the patient’s acuity level.
The PCNP does not have the educational preparation to
care for the complex acute or critical patient but does have
preparation to manage the simple acute patient. Likewise,
the ACNP does not have the educational preparation to
provide comprehensive, continuous care but does have the
preparation to provide preventive services within the
context of restorative care.
 can serve as the point of entry to health care and they also
collaborate with each other when managing patients.
 may engage in specialty practice, but this specialization
occurs as supplemental to the formal NP education and
national certification.

EXAMPLE
T.O. is an 82 year-old male who presents for a routine primary care visit
for management of chronic hypertension, osteoarthritis, and sinus
bradycardia. On his previous EKGs, there was no evidence of heart
block or ischemia. T.O. is taking daily hydrochlorothiazide for his
hypertension. He feels well and has no symptoms. His blood pressure is
108/70 and his pulse is 42. His EKG shows sinus bradycardia with
second degree heart block.
The PCNP admits T.O. to
interventional cardiology.
The ACNP manages T.O. in the
interventional cardiology unit.
Post-hospitalization, T.O. is followed up by the ACNP for pacemaker
management and the PCNP for hypertension and arthritis.
ACNP: 12 lead ECG interpretation, life- threatening dysrythmias management,
including pharmacological and interventional management of hypertensive
crisis,
pacemaker indications and placement.
PCNP: chronic hypertension management, osteoarthritis management
IOM REPORT
The Future of Nursing: Leading Change,
Advancing Health (2011). Institute of Medicine
 Available free at:
http://books.nap.edu/openbook.php?record_id=12
956&page=17
 In 2008, the RWJF and the IOM launched a twoyear initiative to respond to the need to assess
and transform the nursing profession.
 Goal: action-oriented blueprint for the future of
nursing

IOM REPORT-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

PRACTICE TO FULLEST EXTENT OF
EDUCATION
More than 3 million RNs, more than 250,000
APRNs
 Because licensing and practice rules vary across
states, the regulations regarding scope of practice
have varying effects. The tasks nurse
practitioners are allowed to perform are
determined not by their education and training
but by the unique state laws under which they
work.
 The report offers recommendations for a variety
of stakeholders—from state legislators to the
Centers for Medicare & Medicaid Services to the
Congress—to ensure that nurses can practice to
the full extent of their education and training

PEARSON REPORT



By Linda J. Pearson, DNSc, FPMHNP-BC,
FAANP
It is a comprehensive nationwide legislative and
healthcare issue summary for NPs
Published in The American Journal for Nurse
Practitioners on an annual basis.

AJNP (includes The Pearson Report) - $25.00
PEARSON REPORT




Number of NPs in state? 4876
Physician involvement required for any aspect of
practice? Yes
Additional limitations/prohibitions to NP practice?
No.
 CNPs may give orders for PT, may supervise services
provided by a home health agency if included in the
standard care arrangement, and may legally sign to
issue handicap placards and plates for qualified
patients.
 NPs may dispense an expanded list of stock medications
in federally supported free clinics, including drugs and
devices to treat asthma, diabetes, hypertension, and
high cholesterol.
NP/physician prescriptive agreement required? Yes.
 NPs must enter into a standard care arrangement with
a physician to collaborate
PEARSON REPORT

NP authorized to Rx controlled substances?

NP name required on Rx pad? Yes


Yes. Schedules II-V. Legislation is pending the Governors
approval to allow NPs to prescribe Schedule II drugs.
Number of medical malpractice reports from the
National Practitioner Data Bank (NPDB) filings
(9/90-9/09):
• NP ratio - 1:166
• DOs/Interns/Residents - ratio 1:4
• MDs/Interns/Residents - 1:4 ratio
2007 Consumer Choice ranking of state’s NP
regulation (100 is ideal): 71 (NY 85, Michigan 57,
Iowa 86, Indiana 65, PA 78, Washington 98)
OAAPN
Ohio Association of Advanced Practice Nurses
(1996)
 Formerly the Ohio Coalition of Nurses with the
Specialty Certification (OCNSC) (1990)
 1996- SB 154- Title Recognition
 1999- HB 241- Prescriptive Authority

MEMBER BENEFITS
Quarterly newsletter
 Fee reduction for annual meeting and conference
 Seven local regional meeting locations
 E-mail alerts concerning important practice,
legislative, and reimbursement information
 Online access to a message board for sharing
your experiences and knowledge with fellow
colleagues
 Online job board postings

COMMITTEES
Communication
 Education
 Finance
 Legislative
 Reimbursement

Local: Cleveland Region, Sandusky Chapter,
Mansfield Chapter, Canton Chapter
USEFUL INFORMATION
Quick links to formulary, current legislation
 Updates on legislation, action needed
 Information on meetings, upcoming conferences
and Rallies
 Assistance with reimbursement issues
 CEU/ Conferences
 Current Job postings
 Can purchase SCA template ($35.00)
 Some information outdated

REFRENCES
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APRN Consensus Group Work Group & NCSBN APRN Advisory
Committee. (2008). Consensus model for APRN regulation:
Licensure, accreditation, certification, and education, retrieved
March 6, 2012 from
http://www.nonpf.org/associations/10789/files/APRNConsensusMo
delFinal09.pdf
Dumas, M.A., Finnegan, L., Kapustin, J., Melander, S., 2011,
National Organization Of Nurse Practitioner Faculties Statement
On Acute Care And Primary Care Nurse Practitioner Practice
2011, retrieved March 6, 2012 from
http://www.nonpf.org/associations/10789/files/ACPCStatementFin
alNov2011.pdf
Ohio Association of Advanced Practice Nurses (2012). Retrieved
March 6, 2012 from http://www.oaapn.org/index.php/about-oaapn
Institute of Medicine. (2011). The Future of Nursing: Leading
Change, Advancing Health Retrieved March 5, 2012 from
http://books.nap.edu/openbook.php?record_id=12956&page=17