Mary Zaccagnini, DNP, RN, ACNS-BCTreasurer

MN APRN Coalition

Mary Chesney, PhD, RN, CNPPresident & Chair

MN APRN Coalition

History of APRN Legislation1999 – Nurse Practice Act opened

Definition of collaborative practice addedCNS added to prescriptive language

2009 Attempt to move independent practice language failedFormed the APRN Coalition

2012Applied for 501c6 statusWorking on new legislation based on the APRN Consensus ModelMary Chesney presented on behalf of the coalition to the

Governor’s Task Force on Health Care Reform WorkgroupThe Workgroup included our recommendations in the overall list

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MN APRN Coalition’s Mission

The MN APRN Coalition is dedicated to improving patient access and choice to safe,

cost-effective health care by removing statutory, regulatory, and institutional barriers that

prevent APRNs from practicing to the fullest extent of their education and training.

AARP (2011) http://championnursing.org/category/topics/22/overview

Difference between restrictive v. non-restrictive APRN practice statesNo appreciable difference between practice

safety (based on National Practitioner Data Bank data of substantiated malpractice or negligence reports)

Restrictive states - legislative inertia or aversion to tackle scope of practice legislative issues

Restrictive states – increased strength of funding & lobbying efforts by national medical organizations & their state affiliates (Safreit, 2010)

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Propose Legislation to Enact the APRN Model Act & Rules in MinnesotaBased on APRN Consensus Model of LACEProvides for public safety by requiring:

APRN licensure to specific role and population focusGraduation from an nationally accredited ARPN

master’s or doctoral programSuccessful completion of at least one national

certifying exam and attainment of ongoing recertification

Graduation from an educational program that provides basic, standardized core courses as well as specific role/population-focused courses

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Overview of APRN Statutes in U.S.17 states & D.C. have full statutory authority for APRN

practice (Alaska, Arizona, Colorado, District of Columbia, Hawaii, Idaho, Iowa, Maryland, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Utah, Vermont, Washington, Wyoming)

IOM Report on the Future of Nursing: Leading Change, Advancing Health Practice to fullest extent of education and trainingSubstantiated decades of evidence that APRNs are safe, deliver

high quality care, and are cost-effectivenessStates should remove barriers – pass the APRN Model Act &

Rules

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Current MN Statutory Language“The advanced practice registered nurse must practice within a

health care system that provides for consultation, collaborative management, and referral as indicated by the health status of the patient.

Collaborative management is defined as “…a mutually agreed-upon plan between an advanced practice registered nurse and one or more physicians or surgeons licensed under chapter 147 that designates the scope of collaboration necessary to manage the care of patients. The advanced practice registered nurse and one or more physicians must have experience in providing care with the same or similar medical problems, except that certified registered nurse anesthetists may continue to provide anesthesia in collaboration with physicians, including surgeons, podiatrists licensed under chapter 153, and dentists licensed under chapter 150A. Certified registered nurse anesthetists must provide anesthesia services at the same hospital, clinic, or health care setting as the physician, surgeon, podiatrist, or dentists.

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Current Statutory LanguageA (CNS, NP, NA)… “who has a written agreement with a physician based on standards established by the Minnesota Nurses Association and the Minnesota Medical Association that defines the delegated responsibilities related to the prescription of drugs and therapeutic devices, may prescribe and administer drugs and therapeutic devices within the scope of the written agreement and within the practice as a” (NP, CNS, NA).

MD and APRN agreement (MMA & MNA Memorandum): Signed by both parties once per yearLists categories of drugs APRN may prescribeMD and APRN are required to keep a copy on file at

their worksite. MD & APRN to review prescriptive practice annually

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Why is this a problem?Creates unnecessary barriers to APRN practiceNumerous cases of Psych MH CNS/NPs’ having to

pay physician for collaboration/prescriptive agreement

Increasingly, malpractice insurers are recommending that physicians not enter into these agreements

Prohibits effective models of care that have been highly successful elsewhere in increasing access to care for vulnerable, underserved populations & saving health care expenditures

Provides a false sense of supervision that doesn’t exist in practice

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APRN Model Statutory LanguagePractice of advanced practice registered

nursing.The "practice of advanced practice registered

nursing" means the performance of an expanded scope of nursing in a role and population focus. The scope of an advanced practice registered nurse includes, but is not limited to, performing acts of advanced assessment, diagnosing, prescribing and ordering. The practice includes functioning as a primary care provider, direct care provider, case manager, consultant, educator, and researcher.

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APRN Model Statutory LanguageAdvanced practice registered nursing

practice requires the advanced practice registered nurse to be accountable to patients for the quality of advanced nursing care rendered; for recognizing limits of knowledge and experience, planning for the management of situations beyond the APRN’s expertise, and includes accepting referrals from, consulting with, cooperating with, or referring to all other types of health care providers.

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Key IssuesProposed statutory language would

Remove collaborative management language

Remove the written prescriptive agreement requirement and establish prescribing as appropriate for APRN’s role (e.g. CNP, CNM, CNS, CRNA) & population focus

Would grant APRNs statutory authority as L.I.P.s

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Benefits of APRNs Model Act & Rule Protects public by ensuring standards (L.A.C.E.)

APRNs have long, established track record of SAFETY & QUALITY

APRNs are experts in advancing holistic health Health promotion & prevention Increasing consumers’ capacity for

self-care/activation/lifestyle management of chronic disease

New law would remove legislative barriers that prevent citizen access to care

New law would allow APRNs to practice their full scope without restraint of trade by another profession

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MN APRN Coalition’s Next StepsRaise funds to hire lobbyist

Increase membershipIncrease membership donationsSolicit outside donations

Work hard on regional and MN senate district grassroots politics

Reassess post-election and develop strategic plan

Continue to get our message out (meetings, phone calls, emails, Facebook, Twitter)

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Current Financial StatusOctober 1, 2012 balance

$16,000Additional match up to $28,000 awarded by the

Minnesota Association of Nurse Anesthetists Based on coalition membership and donations

received after June 1 (date of award decision by committee)

June 1 – October 1 = approximately $8,000 in new memberships and donation

Approximately $40,000 - $60,000 will be required to pay lobbyist for amount of time needed to move legislation forward

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3 Key Messages for Media Work (recommended by Sue Stout)APN’s are trusted professionals who are well

tested in the community with a long track record of quality & safety.

When APN’s are allowed to practice fully, they can provide care that is more economical and better than our current health care system allows and this savings can be passed on to the state and to consumers.

Government is in the way, and the legislature needs to act to remove regulatory barriers which prevent APN’s from fully practicing to meet the needs of the public.

Contact, Join, Donate, and Follow the Coalitionhttp://www.mnaprnc.org/membership/

https://www.facebook.com/MinnesotaAPRNCoalition

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