1. Our APRN State of Consensus 48 endorsing nursing organizations 55 states and jurisdictions 252,000 APRNs

2. The Campaign for APRN Consensus is 71% of the way towards our goal!

3. The education and oversight of APRNs Materials that assist in evaluating an individual’s care Individual training and preparation Case logs/Practice Profiles/Peer Review Graduate education in a role and population Performance Indicators/quality measures National advanced certification in a role and population NPDB Specialty training and certification State Prescription database Maintenance of certifications Patient Satisfaction Professional development & FPPE/OPPE [TJC] Continuing education Incident reports Professional Societies Complaints /claims Evidence based care Awards Outcomes analysis Board oversight Professional Portfolio Performance Review Public Regulation, Public Protection Access Licensure Accreditation Certification Education CNP CNS CNM CRNA

4. Not all APRNs are regulated by Boards of Nursing Nebraska has an APRN Board Boards of Nursing may be under umbrella Boards Some BONs are under a Board of Health or Board of Medicine or some APRN roles are regulated or co-regulated by a BOH or BOME

5. APRN Major Elements of Consensus by 2015 All four roles…

6. APRN Major Elements of Consensus by 2015 Points for any role…

7. Title: APRN Clinical nurse specialist Certified nurse practitioner Certified nurse midwife Certified registered nurse anesthetist

8. What is in a name?

9. APRN Title

10. New Map Points in Areas other than Practice and Prescribing Autonomy Who needs to get this done? Title AL, AK, AS, CO, DE,FL, IL, IN, IA,MI, NH (CNS), NJ, NY, NC, OR, PA, SD, TN, VA, WA, WI Roles AS (CNS), FL (CNS), IN (CRNA), MS (CNS), NH (CNS), NY (CRNA), PA (CNM, CRNA), VA (CNS), WA (CNS) Education CA (CRNA), IN (CNP), NH (CNS), NY (CRNA, CNS), PA (CRNA, CNM), SD (CRNA), WA (CNS) Certification CA (CNS, CNM, CNP), IN (CNP, CNS), KS, MS (CNS), NH (CNS), NY (CRNA, CNS, CNP), PA (CNM, CRNA), WA (CNS), Licensure AL, AK, AZ, CA, CO, DC, FL, GA, IN, MD, MA, MI, MS, MO, NH (CNS), NJ, NY (CRNA,CNS), NC, OH, PA, TN, VA (CNS), WA (CNS), WY

11. APRN Roles: Clinical nurse specialist Certified nurse practitioner Certified nurse midwife Certified registered nurse anesthetist

12. Roles Recognition 1

13. License RN + APRN Levels of regulatory status Certification Recognition Licensure

14. 2 nd License RN + APRN License

15. Education Completion of graduate level or post graduate level education in an APRN role

16. Education

17. Certification National, advanced certification in a role and population that includes wellness content and embeds gerontology content in the adult roles

18. Points for Role Certification 2 1

19. Let’s talk for just a moment about the concept of ‘grandfathering’ Two categories have to be thought about: – Those who are presently licensed in the state – Those who may wish to endorse into a new state.

20. Autonomous Practice No written requirement for supervision or collaboration or other encumbrance

21. Points for Autonomous Practice 6

22. Points for Independent Prescribing 2 3

23. IOM FTC AMAAMA AAFP ASAASA Medical societies CMS NGA AARP RWJ Economists APRN MGMA

24. The American Academy of Family Physicians

25. The 2014 Legislative Season The focus of APRN supportive bills; Licensure, Title Independent practice Independent prescribing Expanded functionality in roles Reimbursement

26. The 2014 Legislative Season Federal bills that may pertain to APRNs VA APRN Military Homecare/primary care Tele-health and tele-med Other provider autonomy

27. New Map Points 2011201220132014 Title KS, OK ID, KY, TN, WVAR, AZ, MI, RIIA, KS, PA, FL Roles IN, OK, VTMD, SC, WVIN, MI, MS, NY, OH, RI AK**, KS, MN, NY, WA Education VTWVIDMN, PA, WV Certification KS, NV, OK, VTWVID, MN, NYKS, MN, NY, PA Licensure KS, OKIA, ID, MO, WVHI, MI. MN, MO HI, IA, KS, MS, NY, SD Practice autonomy FL, IA, ILCA, KY, IA, LA, MA, WA AR, CA, CT, FL, IL, MD, MI, MN, MO, MS,NE, NJ, NV, NY, OH, OR, RI, TX, WV CT, FL, KS, MA, MI, MN, MO, MS, NE, NY, PA Prescriptive authority FL, HI, IL, MA, ND, WA AL, FL, ID, KY, MA, MO, ND, OH AL,* AR, CT. IL. KY. MI, MN, MO, MS, NE, NJ, NV, NY, OR, TX, WV CT, FL, KS, KY, MN, MO, NE, NJ, NY, OK, PA, UT, WI

28. New Map Points in Areas other than Practice and Prescribing Autonomy Who needs to get this done? Title AL, AK, AS, CO, DE,FL, IL, IN, IA,MI, NH (CNS), NJ, NY, NC, OR, PA, SD, TN, VA, WA, WI Roles AK (CNS), AS (CNS), FL (CNS), IN (CRNA), MS (CNS), NH (CNS), NY (CRNA), PA (CNM, CRNA), VA (CNS), WA (CNS) Education AK (CNS), CA (CRNA), IN (CNP), NH (CNS), NY (CRNA, CNS), PA (CRNA, CNM), SD (CRNA), WA (CNS) Certification AK (CNS), CA (CNS, CNM, CNP), IN (CNP, CNS), KS, MS (CNS), NH (CNS), NY (CRNA, CNS, CNP), PA (CNM, CRNA), WA (CNS), Licensure AL, AK, AZ, CA, CO, DC, FL, GA, IN, MD, MA, MI, MS, MO, NH (CNS), NJ, NY (CRNA,CNS), NC, OH, PA, TN, VA (CNS), WA (CNS), WY

29. APRN Legislative Efforts What haven’t we attempted that maybe we should?

30. “The future is going to be different in healthcare. But how soon is that future going to get here? That is the only question” Mark McClellan, to RWJ/AARP September 17, 2014