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Role of the aprn


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Role of the aprn

  1. 1. The Role of the ARNP: What Does the Future Hold Julie Marfell, DNP, FNP, BC, FAANP
  2. 2. 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
  3. 3. Mary Breckinridge, Founder Frontier Nursing Service, 1925
  4. 4. Number of nurse practitioners National  158,000 Kentucky  2,339
  5. 5. 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.
  6. 6. 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
  7. 7. To improve access to care all barriers must be removed ARNP practice.
  8. 8. 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)
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  10. 10. 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)
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  12. 12. Barriers to Practice Reimbursement In Kentucky  Can be listed as a provider panels as a Primary Care Provider  Able to be reimbursed by 3rd party payers and HMO’s.  Any willing provider  85% reimbursement
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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 Licensureatlevelsofroleand populationfoci 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
  17. 17. 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.
  18. 18. 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.
  19. 19. LACE: Regulatory Model APRN regulation includes:  Licensure  The granting of authority to practice  Accreditation  Formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing related programs  Certification  The formal recognition of knowledge, skills and experience demonstrated by the achievement of standards identified by the profession  Education  The formal preparation of APRNs in graduate or post-graduate programs
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. Key Messages Nurse should practice to the full extent of their education and training
  29. 29. Key Messages (continued) Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
  30. 30. Key Messages (continued) Nurses should be full partners, with physician and other healthcare professional, in redesigning healthcare in the United States.
  31. 31. Key Messages (continued) Effective workforce planning and policy making require better data collection and improved information infrastructure.
  32. 32. 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.
  33. 33. Action steps (continued) Double the number of nurse with doctorates by 2020 Currently 10% of nurses hold doctorates
  34. 34. Action steps (continued) Address the faculty shortage by creating competitive salary and benefit packages Average academic salary: Average family nurse practitioner:
  35. 35. Action steps (continued) Encourage 10% of baccalaureate program graduates to enter master’s or doctoral programs within 5 years of graduation
  36. 36. Action steps (continued) 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 
  37. 37. Action steps (continued) Enhance new nurse retention by implementing transition into practice nurse residency programs
  38. 38. Action steps (continued) Embedding leadership development in to nursing education programs and increasing the emphasis on interdisciplinary education.
  39. 39. Action steps (continued) Ensuring nurses engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan.
  40. 40. 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.
  41. 41. Patient –Centered Medical Homes (continued) National Committee on Quality Assurance (NCQA) will recognize nurse-led primary care practices as patient centered medical homes.
  42. 42. Innovated Models of Care Programs that support preventative services Good care in modest cabins
  43. 43. Nurse practitioner owned health care practices Collaborative agreement is a barrier
  44. 44. 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.
  45. 45. 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
  46. 46. 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
  47. 47. 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.
  48. 48. Ride the wave
  49. 49. 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 Center for Workforce Studies Association of American Medical Colleges (2009) Recent Studies and Reports on Physician Shortages in the U.S. cestudiesnov09.pdf
  50. 50. 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. white_paper_9.20.10.pdf National Committee on Quality Assurance (2010) Recognizing Nurse Led Practices of Patient-Centered Medical Home.
  51. 51. References (continued) National Council of State Boards of Nursing (ND) Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, Education , int_Presentation.pdf Pearson, Linda (2010) The Pearson Report: A National Overview of Nurse practitioner Legislation and Healthcare Issues. Institute of Medicine(2010) The Future of Nursing: Leading Change, Advancing Health. Leading-Change-Advancing-Health.aspx
  52. 52. “... to reach wide neighborhoods of men.”
  53. 53. For More Information about the Frontier School of Midwifery & Family Nursing (606) 672-2312 P.O. Box 528, 195 School St. Hyden, KY 41749