Role of the aprn

The Role of the ARNP: What Does the Future Hold Julie Marfell, DNP, FNP, BC, FAANP

Introduction
Objectives:
Analysis the role of the ARNP in improving access to primary care
Discuss the how health care reform will effect the role of the ARNP
Discuss how ARNP’s can be utilized in a public health setting
www. frontierschool.edu

Mary Breckinridge, Founder Frontier Nursing Service, 1925

Number of nurse practitioners
National
158,000
Kentucky
2,339

Provider shortage
Predicted shortage of physicians in 2015 of 63,000. ( Association of American Medical Colleges)
Health care reform will bring in approximately 32 million Americans to health insurance rolls.

Provider shortage (continued)
108% increase in the number of nurse practitioners from 2000-2009.
Kentucky 55 out of 120 counties HPSA
NP practice in 114 of our 120 counties
43% of population live in rural areas
28% of physician live in rural areas
27% shortage of Family Practice Physicians

To improve access to care all barriers must be removed ARNP practice. www. frontierschool.edu

Barriers to Practice
Prescribing barriers
36 states require written documentation of physician involvement to prescribe (gold)
15 states and the District of Columbia have no requirement for any physician involvement (green)

Some states still have a requirement for physician involvement for diagnosing and treating aspects of NP practice
23 states have no requirement for physician involvement (green)
4 states have a requirement but do not require written documentation (blue)
24 states require written documentation (gold)

Barriers to Practice
Reimbursement
In Kentucky
Can be listed as a provider panels as a Primary Care Provider
Able to be reimbursed by 3 rd party payers and HMO’s.
Any willing provider
85% reimbursement

Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education
2008 National Council of the State Boards of Nursing
46 Nursing organizations endorsed the Consensus Model
Addressed the fact that there is no uniform model for regulation of APRN across the states

Consensus Model
APRN are unable to move easily from state to state due to each state having different criteria for licensure, this decreases access to care

Consensus Model
Defines APRN practice
Describes a regulatory model
Indentifies titles to by use
Defines specialties
Describes the emergence of new roles and population foci
Provides strategies for implementation

APRN Regulatory Model Nurse Anesthetist Nurse Midwife Clinical Nurse Specialist Adult- Gerontology Women’s Health/ Gender Related Family/Individual Across lifespan Neonatal Pediatrics 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

APRN Titling
The title of Advanced Practice Registered Nurse (APRN) is the licensing title to be used for the subset of nurses prepared with advanced, graduate-level nursing knowledge to provide direct patient care in one of the four roles.
Licensure is based on graduate education in one of the four roles and population foci.
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APRN Titling (continued)
Verification of licensure will indicate the role and population focus for which the APRN has been licensed.
The nurse must legally represent themselves, including in a legal signature, as an APRN and by role (e.g. APRN-CNP)
The title of APRN and role titles are legally protected titles and may not be used by any individual who does not hold the proper credentials.

LACE: Regulatory Model
APRN regulation includes:
L icensure
The granting of authority to practice
A ccreditation
Formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing related programs
C ertification
The formal recognition of knowledge, skills and experience demonstrated by the achievement of standards identified by the profession
E ducation
The formal preparation of APRNs in graduate or post-graduate programs

Foundational Requirements for Licensure
The Boards of Nursing (Licensure) will
License APRNs in one of four roles with a population focus
Be solely responsible for licensing (exception for states where boards of midwifery regulate nurse-midwives and midwives)
Only license graduates of accredited graduate programs
Require successful completion of a national certification examination that assesses APRN core, role and population competencies.
Only license an APRN when education and certification are congruent
Not issue a temporary license

Foundational Requirements for Licensure (cont.)
The Boards of Nursing will:
License APRNs as independent practitioners with no regulatory requirements for collaboration, direction or supervision
Have at least one APRN representative position on the board and utilize an APRN advisory committee that includes representatives of all four APRN roles
Institute a grandfathering clause that will exempt those APRNs already practicing in the state from new eligibility requirements
Have the option for mutual recognition of advanced practice nursing through the APRN Compact

Foundational Requirements for Accreditation of Education Programs
Accreditors will:
Evaluate APRN graduate degree and post-graduate certification programs
Through their established accreditation standards and process, assess APRN education programs in light of the APRN core, role core and population core competencies
Assess developing APRN education programs and tracks by reviewing them using established accreditation standards and granting pre-approval, pre-accreditation or accreditation prior to student enrollment
Include an APRN in the visiting team when reviewing an APRN program
Monitor the APRN education programs throughout the accreditation period

Foundational Requirements for Certification
Certification programs providing APRN certification used for licensure will :
Follow established certification testing and psychometrically sound, legally defensible standards for APRN examinations for licensure
Assess the APRN core and role competencies across at least one population focus of practice
Assess specialty competencies separately from the APRN core, role and population focused competencies.
Be accredited by a national certification accreditation body

Foundational Requirements for Certification (cont.)
Certification programs providing APRN certification used for licensure will :
Enforce congruence between the education program and the type of certification examination
Provide a mechanism to ensure ongoing competence and maintenance of certification
Participate in ongoing relationship which make their processes transparent to BON
Participate in a mutually agreeable mechanism to ensure communication with the BON

Foundational Requirements for Education
APRN educational programs/tracks leading to eligibility for a APRN license will:
Follow established educational standards and ensure attainment of the APRN core, role core and population core competencies
Be accredited by a nursing accrediting organization that is recognized by the U.S. Department of Education and/or the Council for Higher Education Accreditation
Be pre-approved, pre-accredited, or accredited prior to the acceptance of students, including all developing APRN education programs and tracks
Ensure that graduates of the program are eligible for national certification and state licensure
Ensure that official documentation (e.g. transcripts) specifies the role and population focus of the graduate

Future of Nursing: Leading Change, Advancing Health
Report done by the Institute of Medicine (IOM) and Robert Wood Johnson Foundation (RWJ)
Published in October, 2010

Recommendations
Remove regulatory barriers to nursing practice
Raise the education level of the nursing workforce
Enhance nursing’s leadership role in health care redesign
Strengthen data collection efforts

Key Messages
Nurse should practice to the full extent of their education and training

Key Messages (continued)
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 physician and other healthcare professional, in redesigning healthcare in the United States.

Effective workforce planning and policy making require better data collection and improved information infrastructure.

Action steps
Increase the number of nurses with baccalaureate degrees from 50% to 80% by 2020.
Encourage nurses with associate degrees and diplomas to enter baccalaureate programs within five years of graduation.

Action steps (continued)
Double the number of nurse with doctorates by 2020
Currently 10% of nurses hold doctorates

Address the faculty shortage by creating competitive salary and benefit packages
Average academic salary:
Average family nurse practitioner:

Encourage 10% of baccalaureate program graduates to enter master’s or doctoral programs within 5 years of graduation

Remove practice barriers that inhibit APRN from practicing to the full extent of their education and training and serving in primary care roles
Kentucky Coalition of Nurse Practitioners and Nurse Midwives
http://www.kcnpnm.org/

Enhance new nurse retention by implementing transition into practice nurse residency programs

Embedding leadership development in to nursing education programs and increasing the emphasis on interdisciplinary education.

Ensuring nurses engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan.

Innovated models of care
Patient –Centered Medical Homes
Primary care that is focused on providing customized services for each patient that reflects individual preferences.
Information is provided at the point of care and focus is changed from visits to care over time.

Patient –Centered Medical Homes (continued)
National Committee on Quality Assurance (NCQA) will recognize nurse-led primary care practices as patient centered medical homes.

Innovated Models of Care
Programs that support preventative services
Good care in modest cabins

Nurse practitioner owned health care practices
Collaborative agreement is a barrier

Doctor of Nursing Practice
Currently there are 37 programs nationwide offering the DNP.
92 more lined up for accreditation
Unsure if 2015 will be actualized, possible 2020.

Quality of Nurse Practitioner Care
National Provider Data Bank
Malpractice reports (1999-2009)
National data
NP 1:166 reports
DO 1:4
MD 1:4
Kentucky
NP 1:213 reports
DO 1:8
MD 1:4

Quality of Nurse Practitioner Care (continued)
Health Care Integrity and Protection Databank
Accumulated adverse reactions (1999-2009)
National data
NP 1:215 reports
DO 1:14
MD 1:20
Kentucky data
NP 1:234 reports
DO 1:10
MD 1:14

Conclusions
Nurse practitioners are increasing access to primary care
Nurse practitioners are provide safe health care.
Nursing and nurse practitioners are poised to be one of the solutions to our healthcare crisis.

Ride the wave www. frontierschool.edu

References
APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee (2008) Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education http://www.aacn.nche.edu/education/pdf/APRNReport.pdf
Center for Workforce Studies Association of American Medical Colleges (2009) Recent Studies and Reports on Physician Shortages in the U.S. http://www.aamc.org/workforce/stateandspecialty/recentworkforcestudiesnov09.pdf

References (continued)
Kentucky Coalition of Nurse Practitioners and Nurse-Midwives (2009) Nurse Practitioners and Nurse Midwives Provide Quality, Cost Effective Care but Barriers to their Practice Decrease Patient Access to Care. http://www.kcnpnm.org/resource/resmgr/white_papers/kcnpnm_white_paper_9.20.10.pdf
National Committee on Quality Assurance (2010) Recognizing Nurse Led Practices of Patient-Centered Medical Home. http://www.ncqa.org/

References (continued)
National Council of State Boards of Nursing (ND) Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, Education , https://www.ncsbn.org/APRN_Consensus_Model_PowerPoint_Presentation.pdf
Pearson, Linda (2010) The Pearson Report: A National Overview of Nurse practitioner Legislation and Healthcare Issues. http://www.pearsonreport.com/
Institute of Medicine(2010) The Future of Nursing: Leading Change, Advancing Health. http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

www. frontierschool.edu “ ... to reach wide neighborhoods of men.”

For More Information about the Frontier School of Midwifery & Family Nursing
www.frontierschool.edu
(606) 672-2312
P.O. Box 528, 195 School St. Hyden, KY 41749

Role of the aprn

by Julie Marfell

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Role of the aprn Presentation Transcript