Posted on

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!

 

 

 

Follow Carrie Sue on:    

Facebook        YouTube       Twitter

Posted on

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.

 

 

Follow Carrie Sue on:    

Facebook        YouTube       Twitter