driving aprn policy: a legislative success
DESCRIPTION
Driving APRN Policy: A Legislative Success James LaVelle Dickens, DNP, FNP-C, FAANP Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013TRANSCRIPT
James LaVelle Dickens, DNP, FNP-C, FAANP
Texas ranks 47th in the country in the supply of primary care physicians
Out of the 254 counties in Texas, 185 are designated as medically underserved
Historically, policies limited APRNs scope of practice and restricted APRNs ability to address the primary care shortage
Primary care shortages will continue and the aging population is on the rise
The number of primary care providers per 100,000 rural population is significantly less than in metropolitan areas
0
2000
4000
6000
8000
10000
12000
2001 2011
Number of APRNs
Senate Bill 406 “Texas Team”
Action Coalition
The Future of
Nursing: Leading
Change,
Advancing Health
June 14, 2013 Senate Bill (SB) 406 was signed into law by Governor Rick Perry
SB 406 - first piece of legislation in over a decade that significantly broadens APRN scope of practice
October 2010 - Institute of Medicine (IOM) report released, The Future of Nursing: Leading Change, Advancing Health
IOM Recommendation – remove barriers that prevent APRNs from practicing to the fullest extent of their education and experience
The Future of Nursing: Campaign for Action was created under the Robert Wood Johnston Foundation
Texas based action coalition was “born” and named “The Texas Team; Advancing Health through Nursing”
The Texas Team worked to increase access to care for Texans through expanded scope of practice for Advanced Practice Registered Nurses (APRNs)
And employed specific strategies to achieve a successful inter-professional collaboration.
November 2011, “The Texas Team” convened the APRN Roundtable
Texas Nurses Association, Coalition for Nurses in Advanced Practice, APRN specialty organizations were represented at the roundtable
APRN Roundtable - strategies were identified by the groups to achieve consensus on scope of practice expansion
May 2012 – APRN groups testified to legislative committee
Intent to move forward with legislative change in Prescriptive Authority model
Dr. Ray Perryman issued report regarding the economic benefit in greater utilization of APRNs
Senator Jane Nelson, Chair of Senate Health and Human Services Committee
Representative Lois Kolkhorst, Chair of the Public Health Committee
Legislators encouraged collaboration between nursing and medicine
Negotiations began on new model Texas Nurses Association
Coalition for Nurses in Advanced Practice
Texas Nurse Practitioners
Texas Medical Association
Texas Academy of Family Physicians
Texas Academy of Physician Assistants
Senator Jane Nelson and staff
Representative Lois Kolkhorst and staff
SB 406 was filed on February 26, 2013
Signed by Governor on June 14, 2013
Effective November 1, 2013
Eliminates the requirement for onsite physician supervision
Allows physicians to delegate drug and durable medical devise prescribing authority to an APRN or PA
Increases the number of APRNs or PAs to whom a physician can delegate prescriptive authority from 4 to 7
Improved coordination between the Texas Medical Board and the Board of Nursing
Allows physicians to delegate prescribing authority to APRNs and PAs for Schedule II controlled substances in hospital and hospice settings
Outcomes
Lessons learned
Moving Forward
Peck, J. L., Addressing the Texas Health Care Crisis: Effective Use of Advanced Practice Registered Nurses. The Journal for Nurse Practitioners. 2013; 9 (2):116-120.
Tovar, S. APRNs Achieve First Expansion of Prescriptive Authority in a Decade. Texas Nurses Association. The Nursing Voice. July 2013