“What Policymakers Ask About Advanced Practice Registered Nurses” The National Forum of State Nursing Workforce Centers 2017 Annual Conference June 9, 2017 Andrea Brassard, PhD, FNP-BC, FAANP Senior Strategic Policy Adviser Center to Champion Nursing in America

What Policymakers Ask About APRNs Learner Objectives: Identify questions posed by policymakers and the public about the APRN workforce. Identify challenges and opportunities in existing and future APRN workforce data sources. 2

What Policymakers Ask About APRNs 3

What Policymakers Ask About APRNs Has removing legislative barriers in other states increased the supply of nurse practitioners (NPs) and other APRNs? In primary care? Do NPs (and other APRNs) practice in rural areas? Do NPs (and other APRNs) practice in underserved areas? What are the impacts or outcomes of APRN care? Oklahoma email “As you might know, Oklahoma is working on a bill for full practice authority. One of the arguments we’ve heard is that, even if the bill passes, there’s no guarantee that nurse practitioners will set up shop in rural areas and improve access. I’ve been searching for some sort of study or statistic that shows that rural health care access improved in a state after it allowed full practice authority. I’ve haven’t had much luck. Is there any research out there that you could share with me or point me to?” North Carolina email “Do y’all have any data on the positive effects modernizing rules has had in other states? Hopefully red states.” 4

The Case for Removing Barriers to APRN Practice 5

Campaign for Action.org Resources Issues: Improving Access to Care “Improving Access to Care: What You Need to Know” https://campaignforaction.org/resource/improving-access-care-need-know/ Webinars “The Evidence Shows: Better Laws Mean Better, More Accessible Care” https://campaignforaction.org/resource/evidence-shows-better-laws-mean-better-accessible-care/ “Lessons Learned: Gaining Full Practice Authority in Nebraska https://campaignforaction.org/resource/lessons-learned-gaining-full-practice-authority-nebraska/ 6

Sources of APRN Workforce Data Professional Organizations Federal Government Nursing Workforce Centers Boards of Nursing 7

Professional Organizations AANP National NP Sample Survey National NP Practice Site Census AANA Membership survey ACNM NACNS CNS census AMA AMA Health Workforce Mapper Uses AMA Master File and NPPES/NPI (CMS) file 8

HRSA – Bureau of Health Workforce Federal Government HRSA – Bureau of Health Workforce National Center for Health Workforce Analysis National Sample Survey of Nurse Practitioners 2012 National Sample Survey of Registered Nurses 2008 National and State Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025 Federal Office of Rural Health Policy Census – American Community Survey Bureau of Labor Statistics Estimates 150,230 NPs AANP estimate 222,000 NPs CMS - NPPES/NPI Update from George Zangaro – National Sample Survey of Registered Nurses is underway. NCSBN is helping with sampling frame. Going out in January 2018. Will over sample NPs. Will be a paper format but could respond on mobile device or PC. 9

Workforce Data Improving workforce data collection is a goal I know we all share. Almost half of the Campaign’s Action Coalitions have made workforce data their main focus. And more than 70 percent of State Nursing Workforce Centers are partners with Action Coalitions in their states—a step toward creating a comprehensive collection of workforce data that integrates the diverse sources of statistics. 10

Workforce Data Target Target 1: Increase by three the number of nursing education, supply, or demand data elements collected by states. As we look forward, working in collaboration with you we are aiming to increase the number of nursing education, supply, or demand data elements collected by the states by three. Source: National Forum of State Nursing Workforce Centers 11

State APRN Workforce Reports California’s Primary Care Workforce: Current Supply, Characteristics, and Pipeline of Trainees Colorado’s Future Healthcare Workforce and the Role of Advanced Practice Registered Nurses Georgia Distribution of Nurse Practitioners According to Region and County 2015 Hawai’i Workforce: APRN Infographic Illinois Healthcare Action Coalition Advanced Practice Nursing Workforce Survey 2014 Data Report 2015 Indiana Nursing Licensure Survey 12

State APRN Workforce Reports Advanced Practice Registered Nurses in Louisiana According to Role 2014 Oklahoma Health Workforce Data Book 2014-2015 South Dakota Center for Nursing Workforce: Nursing Workforce Supply & Employment Characteristics 2017 2015 Nursing Workforce in Texas: Demographics and Trends Utah’s Advanced Practice Registered Nurse Workforce: 2013 2015 Washington State Advanced Registered Nurse Practitioner Survey Data Report 13

Rural Jakobs & Bigbee (2016) “The Distribution of Advanced Practice Nurses and Population Health in US Frontier Counties” Online Journal of Rural Nursing and Health Care Lower premature deaths and teen births in frontier counties where APRNs or physicians are present Grow-your-own recruitment and retention Xue, Ye, Brewer & Spetz (2016) “Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review” Nursing Outlook States granting NPs greater SOP authority tend to exhibit an increase in the number and growth of NPs…especially among rural and vulnerable populations Spetz, Skillman & Andrilla (2017) “Nurse Practitioner Autonomy and Satisfaction in Rural Settings” Medical Care Research and Review Rural analysis of NSSNP found rural NPs provide primary care, very satisfied, and plan to stay 14

State Data Post-Modernization Lessons Learned: Gaining Full Practice Authority in Nebraska https://campaignforaction.org/resource/lessons-learned-gaining-full-practice-authority-nebraska Minnesota Licensed APRN Growth https://campaignforaction.org/wp-content/uploads/2016/07/Minnesota-Growth-Update.pdf Nevada Growth Update: Changes after Implementation of Full Practice Authority https://campaignforaction.org/wp-content/uploads/2016/07/Nevada-Growth-Update.pdf 15

Colorado APRN Workforce/License Information: 1996 to 2016

Colorado APRN Workforce/License Information: 1996 to 2016 17

2017 Louisiana MSN Survey The work group created by House Resolution 199 of the 2014 Legislature is charged with developing a study to demonstrate nurse practitioners’ ability to increase access by healthcare consumers to high-quality, safe, and affordable care in medically underserved areas of the state. The work group also proposes surveying future APRNs to learn their willingness and ability to practice in underserved areas. Method The work group would like to work with Louisiana colleges and universities with masters and doctorates in nursing programs to administer a Survey Monkey to collect responses from graduate students. Intent of survey To learn the willingness of graduate students enrolled in masters and doctorates in nursing programs in Louisiana to practice in medically underserved areas of Louisiana; and To learn the barriers that exist in nurse practice. Contact: DBottcher@aarp.org 18

Nurse practitioners make most of the nation’s house calls. “The Evidence Shows” August 2, 2017 Webinar Nurse practitioners make most of the nation’s house calls. NP care in health centers is comparable to physician care. NP care does not vary by states SOP laws. Medicare payments for beneficiaries managed by NPs costs less than care for similar beneficiaries managed by MDs. Yao et al (2016) Increasing Role of Nurse Practitioners in House Call Programs JAGS NPs are now the largest type of provider delivering residence-based care and NPs provide care over the largest geographical service area. Kurtzman et al (2017) Does the Regulatory Environment Affect Nurse Practitioners‘ Patterns of Practice or Quality of Care in Health Centers? Health Services Research Perloff, DesRoches, Buerhaus (2015) Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians Health Services Research 19

Master file of APRN data Wish List Master file of APRN data Home address Employment address Employer specifics State BON data addresses labelled home or business Research to examine how inter-state regulatory differences affect APRN workforce distribution, practice patterns, consumer access to healthcare, and clinical and economic outcomes End “incident-to” billing 20

Q&A

Contact Information Andrea Brassard, PhD, FNP-BC, FAANP Senior Strategic Policy Adviser Center to Champion Nursing in America abrassard@aarp.org