role of the aprn
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The Role of the ARNP: What Does the Future
HoldJulie Marfell, DNP, FNP,
BC, FAANP
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Introduction
Objectives:Analysis the role of the ARNP in improving
access to primary careDiscuss the how health care reform will
effect the role of the ARNPDiscuss how ARNP’s can be utilized in a
public health setting
Mary Breckinridge, FounderFrontier Nursing Service, 1925
Number of nurse practitioners
National 158,000
Kentucky 2,339
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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.
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Provider shortage (continued)
108% increase in the number of nurse practitioners from 2000-2009.
Kentucky 55 out of 120 counties HPSANP practice in 114 of our 120 counties
43% of population live in rural areas28% of physician live in rural areas
27% shortage of Family Practice Physicians
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To improve access to care all barriers must be removed ARNP practice.
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Barriers to Practice
Prescribing barriers36 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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Some states still have a requirement for physician involvement for diagnosing and treating aspects of NP practice23 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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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 provider85% reimbursement
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Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and
Education2008 National Council of the State Boards of Nursing46 Nursing organizations endorsed the
Consensus ModelAddressed the fact that there is no uniform
model for regulation of APRN across the states
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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
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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
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APRN Regulatory Model
NurseAnesthetist
NurseMidwife
Clinical NurseSpecialist
Adult-Gerontology
Women’s Health/Gender Related
Family/IndividualAcross lifespan
Neonatal PediatricsPsych/Mental
Health
Lic
ensu
re a
t le
vels
of
role
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p
opu
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oci
POPULATION FOCI
APRN ROLES
APRN SpecialtiesFocus of Practice beyond role and population focus
Linked to health care needsExamples 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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Key Messages
Nurse should practice to the full extent of their education and training
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Key Messages (continued)
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
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Key Messages (continued)
Nurses should be full partners, with physician and other healthcare professional, in redesigning healthcare in the United States.
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Key Messages (continued)
Effective workforce planning and policy making require better data collection and improved information infrastructure.
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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.
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Action steps (continued)
Double the number of nurse with doctorates by 2020Currently 10% of nurses hold doctorates
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Action steps (continued)
Address the faculty shortage by creating competitive salary and benefit packagesAverage academic salary:Average family nurse practitioner:
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Action steps (continued)
Encourage 10% of baccalaureate program graduates to enter master’s or doctoral programs within 5 years of graduation
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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 rolesKentucky Coalition of Nurse Practitioners
and Nurse Midwiveshttp://www.kcnpnm.org/
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Action steps (continued)
Enhance new nurse retention by implementing transition into practice nurse residency programs
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Action steps (continued)
Embedding leadership development in to nursing education programs and increasing the emphasis on interdisciplinary education.
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Action steps (continued)
Ensuring nurses engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan.
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Innovated models of care
Patient –Centered Medical HomesPrimary 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.
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Patient –Centered Medical Homes (continued)
National Committee on Quality Assurance (NCQA) will recognize nurse-led primary care practices as patient centered medical homes.
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Innovated Models of Care
Programs that support preventative servicesGood care in modest cabins
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Nurse practitioner owned health care practices
Collaborative agreement is a barrier
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Doctor of Nursing Practice
Currently there are 37 programs nationwide offering the DNP.92 more lined up for accreditationUnsure if 2015 will be actualized, possible
2020.
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Quality of Nurse Practitioner Care
National Provider Data BankMalpractice 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
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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
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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.
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Ride the wave
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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
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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/
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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
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