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

 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: cclinical nurse specialist, nnurse anesthetist, nnurse-midwife, or nnurse practitioner Minnesota statutes, section , subd 3

Definition Continued The practice includes functioning as a:  direct care provider,  case manager,  consultant,  educator, and  researcher. Minnesota statutes, section , subd. 13

Definition Continued The APRN must practice within a health care system that provides for:  consultation,  collaborative management, and  referral Minnesota statutes, section , 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 , 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 , 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

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 APRN Registry

Prescribing…  Delegated medical function (exception: CNMs)  Memorandum of Understanding  Created by MNA and MMA  Identifies elements required for written agreement Minnesota statutes, section

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 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: LLicensure The granting of authority to practice AAccreditation Formal review and approval by a recognized agency of certification agencies and APRN education programs CCertification The formal recognition of knowledge, skills and experience demonstrated by the achievement of standards identified by the profession EEducation The formal preparation of APRNs in graduate or post-graduate programs Implementation target date: 2015

APRN Regulatory Model Nurse Anesthetist Nurse Midwife Clinical Nurse Specialist Adult- Gerontology Women’s Health/ Gender Related Family/Individual Across lifespan NeonatalPediatrics Psych/Mental Health Licensure at levels of role and population foci POPULATION FOCI APRN ROLES APRN Specialties 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 Nurse Practitioner

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. IOM / RWJF Landmark Report

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   APRN Video:

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