1. Private Practice CRNP owned NURS 7226 Beth Anne Kelley Lindsey Saunders Lauren Studdard

2. History NP Role: Rooted in primary care and patient-centered The 1960’s President Kennedy’s assassination, President Johnson’s “War on Poverty”, and the women’s movement The 1970’s Rapid influx of Health Maintenance Organizations (HMOs) Emphasized primary care and lower hospitalization rates First Primary Care NP Role: care of children Other roles have emerged over 4 decades Families, Adults, Older Adults, and Women Variety of practice settings Private Practice More broad-based venues for practice

3. Requirements Licensure -active unencumbered Alabama RN license Education -Masters or higher degree in advanced practice nursing from an accredited program Certification -certified by a board- recognized certifying body

4. NP-Physician Collaboration CRNP is the BOSS The collaborating physician must be readily available when needed The same 10% requirement is mandatory for NPs who own their own business 10% of NP scheduled hours 10% of MD chart review Team Approach Restrictions on NP Practice Effective collaboration = Comprehensive, patient-focused care Professional Ethic Complex needs of primary care

5. More on collaboration Collaborative model should include: Stress shared goals Responsibility Accountability Practice philosophy Independent and cooperative decision-making Allow for differences in opinions and approaches Security of one’s own unique professional identity Approval for referral

6. Prescriptive Privileges Approved formulary for legend drugs of any classification Standard family is non-controlled legend drugs Controlled substances or restricted classes are on the specialty formulary (prescribed by physicians or NPs who have a DEA license)

7. Preparing for this role Licensing, Tax, and Insurance Regulations State Nursing License Advanced Practice License and Certification Collaboration Agreement State and Federal Narcotics License Medicaid and Medicare Provider Number and Managed Care License National Provider Number (NPI) Clinical Laboratory License Employee ID Number (tax ID number) Professional Liability and Malpractice Insurance Conventional Commercial Insurance

8. Preparing for this role Develop a Business Strategy, Plan and Time-line Determine Business Structure Business Name and Location Financing Fees, Reimbursements and Billing Hire Staff and Management Personnel Purchase Equipment Develop Human Resource Management Strategy Quality Assurance Policies and Procedures Marketing Strategies

9. Salary Mean Income of Nurse Practitioners in 2013 United States: $95,070 Alabama: $88,320 Montgomery, Al: $90,070 Income of NPs who own the practice is dependent upon number of patients, type of practice and services available. Practice growth and expansion of services will increase revenue.

10. QUESTIONS/COMMENTS

11. References Alabama Board of Nursing. (2003). Advanced practice requirements. Retrieved from http://www.abn.alabama.gov/Content.aspx?id=623 Alabama Board of Nursing. (2003). Alabama administrative code. Retrieved from http://www.abn.alabama.gov/Content.aspx?id=123 American Nurses Association. (2013). Frequently asked questions about prescribing controlled substances. Retrieved from http://www.nursingworld.org/documentvault/aprn- resource-section/faq-about-prescribing-controlled-substances.pdf Bush, N., & Watters, T. (2001). The emerging role of the oncology nurse practitioner: A collaborative model within the private practice setting. Oncology Nursing Forum, 28(9), 1425-1431. Retrieved from http://eds.a.ebscohost.com. spot.lib.auburn.edu/ehost/detail?sid=f3faa200-7b2c-412f-b35a- abe217e317f6%40sessionmgr4005&vi d=6&hid=4203&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=952 2538 Hamric, A.B., Hanson, C.M., Tracy, M.F., & O’Grady, E.T. (2014). Advance practice nursing: An integrative approach (5th ed.). St. Louis: Elsevier. Barberio, J, (2010, July). Establishing an independent nurse practitioner practice. Advanced Healthcare Network for NPs & Pas. Retrieved from http://nurse-practitioners- -and-physician- assistants.advanceweb.com /features/ articles/establishing-an-independent-nurse- practitioner-practice.aspx United States Department of Labor, Bureau of Labor Statistics (2013). Occupational employment and wages: Nurse practitioners (Publication No. 29-1171). Retrieved from http://www.bls.gov/oes/current/oes291171.htm