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It’s 2016 and APRNs are still not recognized in all of the United States.  

In 2010, the Institute of Medicine released the report, The Future of Nursing, which outlined the need for advanced practice nurses (APRNs) to gain full practice authority in the United States.  This document, a collaboration of the Committee on the Robert Wood Johnson Initiative, set the policy agenda for APRNs to be given full practice authority in the majority of states that did not already have the legislation to support that practice. Full practice authority in every state is necessary to provide consistency in APRN practice, to provide access to healthcare for patients in greater numbers, to reduce healthcare costs and improve preventative health practices.  The IOM points out the disparities and waste in our current system, such as the ability of an APRN to have full practice authority in one state and go to a neighboring state and be unable to prescribe as much as a Tylenol without a physician’s oversight.  The Consensus Model for APRN Regulation, Licensure, Accreditation, Certification and Education set forth the structure in which states could base legislation of APRNs in the hopes to standardize practice.

 

The goal was to implement the model by 2015.Stethoscope-2

As of 2016, twelve states have fully implemented the full Consensus Model through legislation.  Many are close, but some are far from reaching full practice authority for APRNs.  I moved from Oregon, which has full practice authority, to Texas which limits APRN practice and requires burdensome physician oversight.  Instead of serving patients in my rural community, which suffers from disparities in healthcare services, I work in a nursing leader position, with a BSN requirement.   I am working with the state APRNs to advance legislation that will remove barriers to practice, but there is a lot of opposition from another special interest group, physicians.  Some physicians view APRNs as competitors, instead of partners in expanding healthcare services.

Political victories are happening.

West Virginia is on the cusp of expanding APRN practice authority and are waiting for their governor to sign the bill into legislation. Amy Summers, a member of the West Virginia legislature, was the lead sponsor of HB 4334 which expanded APRN authority to practice independently and to expand prescriptive authority.

Summers stated in defense of the bill, “This is not a new idea, this isn’t something that needs studied further. Iowa has allowed full practice authority for 33 years, Alaska 28 years, New Mexico 20 years.  No state has ever repealed full practice authority once it was given.”

I hope that Texas, and the many states that have yet to adopt the Consensus Model, will move towards joining forward thinking states.  States like Oregon, Idaho, Iowa, Utah, Montana, Maine, Nevada, New Mexico, North Dakota, Vermont, Colorado and Hawaii, all of which have given full practice authority to all APRNs.

How does your state measure up? Click here to find out!

 

 

 

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Why Mid-Level is a Dirty Word

A colleague of mine recently described herself as a “mid-level provider.”thumbs-down1

I cringed.

There is nothing mid-level about her.  She has spent over six years in a university and hundreds of clinical hours learning to become a Nurse Practitioner, not half of a physician.  She spent years as a bedside nurse prior to advancing her education to become a NP.  Physicians and nurses have two separate career paths in which they collaborate to care for men, women, and children.

When I first heard the term “midlevel” I wondered if the Advanced Practice Nurse (APRN) is in the middle, who is above and below?  If APRNs are viewed as below physicians, does that make her above registered nurses?  An APRN has advanced assessment skill and practice authority, but she is still a nurse.  She always maintains her registered nurse license.  An APRN does not graduate from or stop being a nurse when she becomes an advanced practice nurse!

Words mean things. Why would anyone want to go see someone for their healthcare needs that is described as “mid-level?”  APRNs produce the same good outcomes as other primary care providers.  Their outcomes are not mid-level, their care is not mid-level, and their experience is not mid-level.

The use of “mid-level” comes from the U.S. government.  They use the terms mid-level and non-physician practitioner to describe APRNS and Physicians Assistants (PA).  The APRN Consensus Model encourages the use of the term Advanced Practice Nurse (APRN) to describe Nurse Midwives, Clinical Nurse Specialists, Nurse Anesthetists, and Nurse Practitioners.    With the implementation of the APRN Consensus Model, throughout the majority of the United States, the use of APRN is increasing. It is being used more in legislative language too.  Despit this progress, the use of “mid-level” is still rampant. We need to encourage the use of APRN in our professional circles.

 

 

Standing together, as healthcare professionals, we can promote the good work of APRNs by using an accurate descriptor.  Our patients are listening.

 

 

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Joy Who?

The internet was in an uproar. Miss Colorado, Kelley Johnson, delivered a monologue about her experience of being “just a nurse” for the talent portion of the Miss America pageant. I watched it on YouTube the night of the contest. Like many nurses, I felt all the warm, fuzzy, nurse feelings and even got a little misty eyed. By Tuesday morning, the news reached my Facebook nursing groups. Joy Behar and Michelle Collins had mocked Miss Colorado on The View. Ms. Collins thought it would be a good laugh to poke fun at the heartfelt monologue delivered by Nurse Kelley. Ms Behar chimed in with the question, “why does she have a doctor’s stethoscope around her neck?”

A doctor’s stethoscope! Behar poked a sleeping bear with those words. Nurses roared into action as the disparaging remarks reached nurses across the globe. Hashtags like #nursesshareyourstethoscopes, #nursesrock, #nursesmatter, #notacostume, #mytalentisnursing, #nursesunite and #notjustanurse began trending on social media. I wish that Ms. Behar and Ms. Collins had supported Nurse Kelley, not only as a healthcare professional, but as a woman. It was disturbing to watch an all-woman-panel mock another woman for sharing her talent, the art of nursing.

The backlash from three million nurses was swift and strong. Pictures of nurses wearing stethoscopes flooded my news feeds. I spent time retweeting every one of my fellow nurses posts about the scandal. I was caught up in the collective outrage and for a few days I felt united with my sister and brother nurses.

Weeks later, the nurse hashtags have stopped trending and the conversation has changed to other hot topics. All of the nurse empowerment energy has evaporated.

Have we once again become stethescope#justnurses?

Joy Behar’s comment was careless. It was a throw away thing to say to fill up space and to seem like she had something intelligent to add to the conversation. I don’t believe that she meant it maliciously, she was being thoughtless. Her thoughtlessness united nurses in a way that I have not seen since nurses jumped on planes and busses to help in the aftermath of Hurricane Katrina. The energy on social media was exciting. It was gratifying to read supportive comments and see nurses being given positive attention. I loved seeing all the stethoscopes and reading nursing stories about where those stethoscopes have been. For a few days it has felt like nurses were united and a part of a large community. United in their outrage of being publicly mocked.
It is now clear that nurses have the ability to direct national conversations. Where have all the hashtags gone? Why aren’t there trending hashtags like #endhealthdisparity, #decreasepatientratios, #stoplateralviolence, #nurseautonomy, or #APRNsIncreaseAccessToHealthcare? Healthcare policy and laws are influenced by a handful of lobbyists and legislators. These lobbyists and legislators number far fewer than three million nurses, but their decisions affect the entire nation. Can you envision a healthcare system being directed by our modern day Florence Nightingales and Clara Bartons, with the support of the national nursing community?
The best thing that could result from this stethoscope spectacle would be for nurses to finally find their voice.

We have power to influence, educate and advocate for the healthcare changes that we know we need. We can command a national stage whenever we choose to unite behind a cause. Its time to come together to influence issues that affect our friends, neighbors and families. Nurses are never just nurses, it is time to prove it.

To take action start here: American Nurses Association

 

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Giving Thanks for Advanced Practice Nurses


     I am thankful for advanced practice nurses (APRN) A Nurse Practitioner (NP) is one type of advanced practice nurse and one that probably comes most readily to the mind of the public. Certified Nurse Midwives (CNM), Certified Nurses Anesthetists (CRNA), and Clinical Nurse Specialists (CNS) are also APRNs and fill similar, but diverse roles. I have been fortunate to have been cared for and mentored by many APRNs throughout my life and career. This November I wanted to share how APRNs have touched my life and express my gratitude.

1.As a young child, my family accessed healthcare through the county public health system. Thanks to public health nurses, and the APRNs that led them, I was vaccinated against diseases and screened for health problems. I grew up healthy despite my parents’ lack of healthcare insurance and money.

2. As a teenager, living in a rural community, my primary healthcare provider was a Nurse Practitioner. She practiced in a small healthcare clinic a few minutes from my house. At that time I was covered by insurance, but she had low rates for self-pay patients. I loved the way that she took time to listen to my teenage complaints and helped me navigate my own health for the first time.

3. Then next time I came across an APRN I was a service member’s wife, struggling to raise a growing family during wartime. A Nurse Practitioner screened me for depression and referred me to a support group. That support group helped me to survive and thrive through each of my husband’s deployments.

4. In nursing school a Nurse Practitioner faculty member candidly shared the practice struggles facing APRNs. She mayNurse-Heart have thought she was dissuading me from entering the struggle, but she inspired me to eventually join the cause.

5. I learned about the true mission of public health at the side of a CNM. Her job was to make prenatal and postpartum home visits. She taught me how to meet people wherever they are in life. I can still picture her on a dozen different sofas, rattling off nursing advice in both Spanish and English.

6. My leadership preceptor in nursing school was also a CNM. She was the director at a community hospital labor and delivery department. She ran around that unit with a mug of tea she would intermittently reheat, but never finish. She taught me what is meant to be a visible leader.

7. When my career turned from adult medicine to perinatal nursing, I learned how to be fully present and care for a woman in labor thanks to a group of CNMs. They taught me how to seamlessly involve the partner and other present family members. I can’t express how much of the nurse I am today is directly due to the hours I spent in the sacred spaces that those women created for our patients.

8. When I decided to become an APRN, I was mentored by two amazing CNSs and a wonderful NP. The lessons they taught went far beyond how to dictate a note or prescribe a medication. I am truly grateful for their time and advice. I owe them much of my career success. The greatest gift they gave me was belief in my own ability. They drilled in me to not sell myself short, to not settle and to unabashedly pursue my goals as an equal player in the healthcare arena.

9. The darkest year of my life was attended by another APRN. A CNM helped me through back-to-back perinatal losses. She was the first primary care provider to truly listen to my health complaints and she diagnosed me with hypothyroidism. The diagnosis came too late to affect my pregnancy, but she helped me on the road to health, both physically and mentally.

10. I don’t want to leave out CRNAs! I work with brilliant, funny and energetic CRNAs. They are an important part of the perinatal team. I am thankful that when we are running to the same emergency together, I know our patient can be in the OR within minutes receiving lifesaving care from our team.

      I would not be the person I am today without APRNs. It’s possible I may not even be here without some of them. APRNs fill an increasingly important role in our healthcare system. Despite the amazing, holistic and safe care that APRNs provide patients, they experience many barriers to practice. Our nation continues to face a crisis in healthcare that could be greatly reduced by allowing all APRNs to practice to their full scope, in every state. Currently APRNs are lobbying for independent practice in many states and nationally. Independent practice is evidence based and a safe policy. We need public support to help pass legislation to allow more APRNs to care for patients. To learn more about the APRN regulations in your state and pending legislation click here. If you are grateful for an APRN, please share your story in the comments.

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at http://yourahi.org/blog.

If you are interested in participating find out more details and sign up.

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