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If there are any silver linings to the towering black cloud that is the COVID-19 pandemic, one of them is the relaxation of restrictions on advanced practice registered nurses (APRNs) to allow these practitioners to deliver care during this health crisis. This summer, a national study is documenting those changes to APRN practice and may provide evidence to policymakers about relaxing restrictions on APRNs permanently.

Starting June 1, nurse leaders from three nursing schools in Tennessee have been conducting the National APRN Practice and Pandemic Survey to measure the impact of decisions by state leaders to waive physician oversight of APRNs during the pandemic. Ultimately, investigators hope to have data to be able to introduce in those states that still have practice restrictions evidence to “change some of those practice acts to allow APRNS to practice to the full extent of their education and licensure,” says Ruth Kleinpell, PhD, RN, FAAN, FAANP, FCCM, Independence Foundation professor of nursing education, assistant dean for clinical scholarship, professor of nursing at Vanderbilt University School of Nursing. Kleinpell is one of the principal investigators for the study.

Other principal investigators are Wendy Likes, PhD, DNSc, APRN-BC, FANNP, dean and professor of the University of Tennessee Health Science Center College of Nursing; Carole R. Myers, PhD, RN, FAAN, professor at the University of Tennessee, Knoxville; and Mavis Schorn, PhD, CNM, FACNM, FAAN, FNAP, senior associate dean for academics at Vanderbilt University School of Nursing.

The National APRN Practice and Pandemic Survey runs through the end of August.

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So far, over 9,000 APRNs have responded from all 50 states, notes Kleinpell. Of those, 60% to 70% of the respondents report that they have provided care to COVID-19 patients. Some 86% of respondents are nurse practitioners; nurse-anesthetists, nurse-midwives and clinical nurse specialists also have responded.

From State to National

Initial discussions for the survey began when the governor of Tennessee issued an executive order that released some practice restrictions on APRNs, such as a collaborating physician not having to conduct an on-site visit, says Kleinpell. This led to interest in conducting a survey in Tennessee. After further discussions with various organizations, including advanced practice nurse societies, the survey expanded to a national scope.

Practice Restrictions

Across the country, you’ll find a patchwork of suspended and waived regulatory restrictions on APRN practice, detailed in a map from the American Association of Nurse Practitioners. In five states, notes Kleinpell, executive orders temporarily suspended practice requirements; in 16 states, select practice agreement requirements were waived. Some 22 states have adopted full practice authority licensure laws for nurse practitioners.

The study will look at the impact of these changes during the COVID-19 pandemic, says Kleinpell. It will compare states that have full practice to states that have restricted or reduced practice to see what practitioners are reporting not only with respect to the impact on the pandemic but also impact on practice in general, she notes.

When the results are available, the investigators plan to publish their findings and provide state-based summaries. Those results could be available in September or October.

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Broadening Patient Access

“Ultimately we would like to have data to be able to substantiate some policy changes at the state level, particularly in those states that continue to have restrictive practices or practices that are burdensome to APRNs,” says Kleinpell. In states that don’t have restrictions, “the APRNs are able to practice based on their licensure and education, which is really how it should be in all fifty states. We’re seeing undue burden not only on the practitioner but on the ability for patients to have care access.”

Louis Pilla
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