The document includes:

• Overview
• Map of State Progress in Removing Barriers to Practice and Care
• Recent Publications in Support of Removing Barriers

Let us know if you have anything to add by emailing Winifred Quinn at wquinn@aarp.org

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The four types of advanced practice registered nurses:

• nurse practitioners
• clinical nurse specialists
• certified registered nurse anesthetists
• certified nurse-midwives

APRNs are registered nurses with advanced degrees who have passed national certification exams. Learn who APRNs are.

Twenty-seven states and the District of Columbia allow nurse practitioners to practice without restriction. See other states’ efforts  to update their laws.

Studies show that better laws mean more Americans enjoy greater access to high-quality health care at a lower cost:

Access

In 2012, the National Governors Association produced a paper supporting its premise that the best way “states could increase access to primary care for their residents is to consider easing their scope of practice restrictions.”

Quality

A review of published literature over 18 years on care provided by APRNs shows “APRNs provide effective and high-quality patient care, have an important role in improving the quality of patient care in the United States.”

Cost

Separate studies in multiple states show the economic benefits of removing barriers to practice and care; scholars and think tanks make the same case in articles. A Federal Trade Commission report states that “expanded APRN scope of practice is good for competition and American consumers.”

Two webinars, “The Evidence Shows: Better Laws Mean Better, More Accessible Care” and “Progress on the Institute of Medicine Recommendations: More Evidence” provide data showing that the  nation benefits when nurses can practice to the full extent of their education and training.

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State

California: Bay Area Council Economic Institute Analysis Finds Granting Full Practice Authority for Nurse Practitioners Increases Access and Controls Costs

Florida: Expanding Scope of Practice for Advanced Registered Nurses, Physician Assistants, Optometrists, and Dental Hygienists

Kentucky: Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost

Massachusetts: Controlling Health Spending in Massachusetts

Minnesota: Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost

New Jersey: Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost

North Carolina: Economic benefits of less restrictive regulation of advanced practice nurses in North Carolina.

Ohio: The Impact of Full Practice Authority for Nurse Practitioners and Other Advanced Practice Registered Nurses in Ohio

Pennsylvania: The Value of Full Practice Authority for Pennsylvania’s Nurse Practitioners

Texas: The Economic Benefits of More Fully Utilizing Advanced Practice Registered Nurses in the Provision of Health Care in Texas: An Analysis of Local and Statewide Effects on Business Activity

National

 Medicare and Medicaid: Impact of Nurse Practitioners on Health Outcomes of Medicare and Medicaid Patients

Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians

Anesthesia: Cost Effectiveness Analysis of Anesthesia Providers

Maternity care: Potential Medicaid Cost Savings from Maternity Care Based at a Freestanding Birth Center

Neonatal: Collaboration, Not Competition

Long term care: Onsite Nurse Practitioners at Skilled Nursing Facilities Prevent Avoidable Hospitalizations

Retail clinics: Scope-of-Practice Laws for nurse Practitioners Limit Cost Savings That Can Be Achieved in Retail Clinics

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Legislative and institutional barriers prevent Advanced Practice Registered Nurses (APRNs), including Certified Nurse Midwives, Nurse Practitioners, Psychiatric Clinical Nurse Specialists and Certified Registered Nurse Anesthetists, from practicing to the full extent of their education and training.  These restrictions limit patients’ access to high-quality, cost effective health care across a variety of specialties including primary care, internal medicine, and pediatrics where patient care needs exceed physician supply.

These findings, along with regional comparisons and a gap analysis, which assessed the Massachusetts Nurse Practice Act against the National Council of the State Boards of Nursing’s Consensus Model for APRN Regulation, are detailed in the MA Action Coalition Report on The Advanced Practice Nurse in Massachusetts. 

The post MA Action Coalition Report: The Advanced Practice Nurse in Massachusetts appeared first on Campaign for Action.

California ranks 23rd among states in the number of primary care physicians per 100,000 residents. With 2.5 million previously uninsured Californians expected to gain coverage by next year, according to the California Healthcare Foundation, the demand for primary healthcare services will only grow. The white paper—Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost—finds that allowing nurse practitioners to practice to the full extent of their education and training could save the state $1.8 billion on preventative care visits alone over 10 years while increasing the number of preventative care visits by 2 million per year.

“Access to primary care is critical for properly managing and preventing chronic conditions,” said Sean Randolph, President and CEO of the Bay Area Council Economic Institute. “The prevalence and mismanagement of chronic conditions is one of the biggest drivers of healthcare cost increases. Allowing nurse practitioners to deliver primary care services with full practice authority is an important reform that will benefit consumers, businesses, and healthcare purchasers across the board.”

The scope of activities a nurse practitioner (NP) can perform—regulated by the state in which they are licensed—is often widely debated by the medical community, patients, and policy makers. When this report was written, 17 states and the District of Columbia permitted NPs to diagnose, treat and prescribe medications without physician oversight. Eight states allowed them to diagnose and treat, but required physician supervision for the prescribing of medications. In the state of California, NPs cannot diagnose, treat patients or prescribe medications without a signed collaborative practice agreement and Standardized Procedures.

“Our analysis makes a strong argument for allowing nurse practitioners to provide the healthcare services they were trained and licensed for,” said Micah Weinberg, PhD, Senior Fellow with the Bay Area Council Economic Institute. “While no single policy change will be a panacea for the critical cost and access issues facing California, this reform could be an important first step to bring down some of the barriers that are keeping healthcare costs artificially high.”

The white paper was funded by a research grant from the Robert Wood Johnson Foundation and AARP.

Read the Spotlight paper.

Read the Technical Appendix.

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In December 2012, the National Governors Association (NGA) published The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care.  The report offers a positive perspective on nurse practitioners; both Nebraska and West Virginia entered its findings into testimony in their successful efforts to improve their states’ laws.

The report can be sent to your state’s governor to help educate her or him on the benefits of removing barriers to APRN practice and care. It is also a wonderful opportunity to introduce the governor to the state’s Action Coalition.

Below is a letter that you can tailor and send to your governor. Fill in the blanks, enclose the NGA report (see view button, to the right), and send it off! In addition, modifying the language to give it a personal touch can, of course, make it more effective. If someone in your Action Coalition or workgroup has a personal connection to the governor’s senior staff, ask him or her to send it–that would increase the likelihood of a key stakeholder’s being made aware of this important report.

(Remember: This letter is about what nurses can do for the state and what your Action Coalition can do for the governor, not the other way around. Ask not what your governor can do for you, but what you can do for your governor.)

Finally, follow up with the governor’s office after sending the letter. The best way to ensure it gets read is to follow through with a phone call.

In summary, here are the steps you should take:

1. Read the NGA report
2. Read the letter
3. Decide who should sign and send the letter
4. Fill in the blanks
5. Add a personal touch
6. Send the letter with the NGA report enclosed
7. Follow up with a phone call

We hope this helps.

Review the letter.

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