Assessing Progress on the Institute of Medicine Report The Future of Nursing (2016) / Chapter Skim
Currently Skimming:
2 Removing Barriers to Practice and Care
2 Removing Barriers to Practice and Care
Pages 39-56
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From page 39... ...
. It suggests that advanced practice registered nurses (APRNs)
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• Amend the Medicare program to authorize advanced practice regis tered nurses to perform admission assessments, as well as certification of patients for home health care services and for admission to hospice and skilled nursing facilities. • Extend the increase in Medicaid reimbursement rates for primary care physicians included in the ACA to APRNs providing similar primary care services.
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From page 41... ...
For the Office of Personnel Management: • Require insurers participating in the Federal Employees Health Benefits Program to include coverage of those services of advanced practice registered nurses that are within their scope of practice under appli cable state law. For the Federal Trade Commission and the Antitrust Division of the Department of Justice: • Review existing and proposed state regulations concerning advanced practice registered nurses to identify those that have anticompetitive effects without contributing to the health and safety of the public.
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SOURCE: AANP, 2015. Reprinted, with permission, from the American Association of Nurse Practitioners.
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. Despite this rule, medical staff membership and hospital privileges remain subject to existing state law and business preferences.
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The Supreme Court ruling denied state-action immunity from federal trade laws to professional boards representing a majority of the regulated profession unless they are actively supervised by the state itself. The American Association of Nurse Anesthetists, American Nurses Association, AANP, American College of Nurse Midwives, National Association of Clinical Nurse Specialists, and Citizen Advocacy Center -- understanding the potential implications of the case for nurse scope-of-practice regulation -- filed an amicus brief in the case in support of the FTC.6 In March 2014, the FTC released a paper stating that "physician supervision requirements may raise competition concerns because they effectively give one group of health care professionals the ability to restrict access to the market by another, competing group of health care professionals, thereby denying health care consumers the benefits of greater competition" (FTC, 2014b, pp.
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. The CMA argued that, if passed, the bill would mean that "nurse practitioners will no longer need to work pursuant to standardized protocols and procedures or any supervising physician and would basically give them a plenary license to practice medicine" (California Medical Association, 2013)
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In 2008, scope-of-practice restrictions were loosened slightly when legislation 10 was passed permitting APRNs to sign birth and death certificates, advance directives, and applications for handicapped license tags. In 2010, restrictions were further reduced when a decades-old collaborative agreement between the Boards of Nursing and Physicians was replaced by an attestation statement.11 Finally, in 2015, the Certified Nurse Practitioners -- Authority to Practice bill 12 was signed into law, removing the attestation requirement and giving NPs full practice authority.
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A recent qualitative study conducted in Massachusetts, a restricted practice state, found that despite the state's scope-of-practice restrictions, some NPs described having a scope of practice similar to that of their physician colleagues, and the "supervision"
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It does recommend that "advanced practice registered nurses should be able to practice to the full extent of their education and training" (IOM, 2011, p.
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While The Future of Nursing places a strong emphasis on the importance of building the APRN workforce to meet the growing demands for primary care in a time of insurance expansion and shortages of primary care physicians, the 2012 HRSA National Sample Survey of Nurse Practitioners found that only 39.2 percent of all licensed NPs were working in primary care; the proportion was higher (47.4 percent) when calculated as the percentage of NPs who were currently employed in patient care roles (HRSA, 2014a)
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. Burnout among health care providers is associated with lower patient satisfaction and worse patient outcomes, including higher mortality rates (Aiken et al., 2002; Leiter et al., 1998; Poghosyan et al., 2010; Shanafelt et al., 2012; Stimpfel et al., 2012; Vahey et al., 2004)
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Evidence demonstrates that expanded team scope and roles as well as high-functioning teams enhance satisfaction among health care providers. Provider burnout is associated with lower patient satisfaction and worse patient outcomes, including higher mortality rates.
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2: The number of nurse practitioners and physician assistants practicing primary care in the United States. http://www.ahrq.gov/sites/default/files/publications/files/pcwork2.pdf (accessed November 7, 2015)
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2012a. FTC staff comment before the Louisiana House of Representatives on the likely com petitive impact of Louisiana House Bill 951 concerning advanced practice registered nurses ("APRNs")
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2015a. FTC staff comment to representative Jeanne Kirkton, Missouri House of Representatives, regarding the competitive impact of Missouri House Bill 633 on collaborative practice arrange ments between physicians and advance practice registered nurses (April 21, 2015)
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2009. NCSBN Model Nursing Practice Act and Model Nursing Administrative Rules.
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sacbee.com/news/politics-government/capitol-alert/article25872118.html (accessed September 23, 2015)
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