The state’s legislature are considering granting full practice authority to nurse practitioners who receive additional training and certification to work independently of doctors in an effort to offset the shortage of primary care physicians. With the additional authority, nurse practitioners would be able to treat patients without a “practice agreement” from a supervising physician.
Concerned Californians are supporting the passing of legislature to allow nurse practitioners full practice authority. More than a third of California residents believe there aren’t enough primary care providers and specialists in their communities according to a poll by the California Health Care Foundation. However, California’s doctors’ lobbies have fought the idea for legislature allowing full practice authority, arguing that it would dilute the quality of medical care that patients receive.
Nurse practitioners hold a master’s degree or doctorate in nursing practice, and the majority of nurse practitioners work in primary care. Full practice authority allows nurse practitioners to evaluate patients independently, order diagnostic tests, manage treatments, and prescribe medication.
If California passes new legislature to allow full practice authority for nurse practitioners, it would join 22 other states and the Veterans Administration in doing so. Researchers from the Bay Area Council Economic Institute also believe that it would save the state millions of dollars a year.
To learn more about California’s
efforts to pass legislation granting full practice authority to nurse
practitioners in an effort to offset doctor shortages, visit here.
Our Nurse of the Week is Becky Zimmerman, a nurse in the Neonatal Intensive Care Unit (NICU) at a Wisconsin hospital who was recently nominated for a DAISY Award by one of the families she cared for. Her patient, Whitney Driver, went into labor at 26 weeks, almost three months before her due date, and gave birth to twin boys who weighed just under two pounds.
Zimmerman was assigned as the primary care nurse for the twins, named Hudson and Hayden. Zimmerman and Driver both report growing close during the Driver twins’ 89 day stay in the NICU, but the family truly formed a connection after they lost one of their sons, Hayden, at just 17 days old.
Driver was overcome by postpartum depression and grief
from losing her son, but knew she needed to find a way to be there for her
other son. Zimmerman became a huge part of helping Driver manage her emotions
and get the help she needed.
Zimmerman tells nbc15.com, “I’ve taken care of a lot of babies. But this story is the kind of one that really clenched my heart.”
The Driver family eventually nominated Zimmerman for a
DAISY Award, a program that honors exceptional nurses. To learn more about Becky
Zimmerman, a NICU nurse from Wisconsin who was recently nominated for a DAISY Award
by one of the families she cared for, visit here.
A 2018 study by the American Enterprise Institute (AEI) called “Nurse Practitioners: A Solution to America’s Primary Care Crisis,” by Peter Buerhaus, suggested that NPs can help with the problems of not having enough primary care physicians in particular areas of the United States.
David Hebert, JD, Chief Executive Officer of the American Association of Nurse Practitioners (AANP), recently explained how NPs can make a difference and what can stand in their way.
What follows is an edited version of the interview.
How many states restrict NPs scope-of-practice? What are the limits—what are they not allowed to do in these states that other states allow them to do? If they are allowed their total scope-of-practice, are they able to do everything that a primary care doctor can do?
Currently, 28 states don’t allow NPs to practice to the fullest extent of their training and licensure. Twelve of these—including California, Texas, and Florida—are “restricted practice” states, where the law restricts NPs ability to provide care without a formal contract with a physician. Sixteen other states, including Pennsylvania, Ohio, and Kentucky, are “reduced practice” states, where state regulations limit NPs’ ability to treat patients in certain care settings.
In 22 states, the District of Columbia, and Guam, NPs have full practice authority. This means NPs evaluate patients, diagnose, order and interpret diagnostic tests, as well as initiate and manage treatments under the exclusive licensure authority of the state board of nursing.
NPs and physicians both have the skill set to provide the full range of primary care services to patients. It’s not really about the provider—it’s about giving patients a choice of provider and ensuring them access to high-quality health care. NPs are a critical component of care teams. We work with all kinds of providers in every care setting to make sure patients get the best possible care. When it comes to scope-of-practice laws, we want NPs to be allowed to practice to the fullest extent of their training and licensure.
With the lack of primary care physicians, especially in rural and medically underserved areas, what can the NP bring to the community?
NPs ensure patients in rural communities have greater health care access, especially in primary care. The AEI report confirmed that while the NP workforce is growing significantly, the physician workforce is growing at a much slower rate. The study also concluded what we’ve seen in our own work: primary care NPs (PCNPs) are more likely to practice in rural areas, where the need for primary care is greatest.
It’s important to remember that primary care can prevent additional health complications for patients, making NPs a vital resource for rural communities. People living in states with laws that reduce or restrict NPs’ scope-of-practice have significantly less access to PCNPs. This finding indicates that such state regulations have played a role in impeding access to primary care. This alone should be cause for concern among policymakers seeking to improve public health.
When NPs have moved into areas and had the complete ability to practice, what have been some of the results?
In U.S. News & World Report’s 2018 Best State Rankings, nine of the top ten states for best health care allow patients full and direct access to NP care. According to Buerhaus, author of AEI’s report, people living in states that do not restrict NP scope-of-practice have significantly greater geographic access to primary care. More and more people are choosing NPs because the quality is high and accessible as well as because NPs take into account the needs of the whole patient, which resonates with today’s families.
What would you say to patients who might be afraid that they are getting lesser care in being treated by an NP as opposed to a doctor? How can NPs and other health care providers help patients to understand the benefits?
It’s important for patients to feel comfortable in their selection of a health care provider. Research shows that NPs achieve health outcomes for their patients equal to—and in some cases—greater than their physician counterparts. We encourage patients to consider an NP, take time to learn more about the care NPs provide at www.WeChooseNPs.org, and if it’s the right choice for them, to visit NPfinder.org, where they can find an NP in their area.
We’ve launched a nationwide campaign called We Choose NPs that showcase patients who choose NPs as their primary care providers. We believe it’s important for patients to have access to high-quality primary care and to have the information available to make the right health care choice for their family.
NPs are strengthening health care in a variety of important ways. Recently, Congress passed comprehensive opioid legislation that makes permanent the temporary authorization granted nurse practitioners (NPs) and PAs to provide lifesaving medication assisted treatments (MATs) for patients battling addiction. After conducting a billion patient visits last year alone, we’re very excited about the future and the opportunity to help patients nationwide.
Healthcare workforce gains seen with Medicare-funded test program
An increase in government funding for clinical training opportunities for advanced practice registered nursing (APRN) is a feasible and affordable way to grow the primary care workforce, according to a Report to Congress on the Centers for Medicare and Medicaid Services (CMS) Graduate Nurse Education Demonstration.
The $200 million initiative was started in 2012 to determine if Medicare funding for graduate clinical education for APRNs, similar to residency training for physicians, could help meet meet the health needs of the U.S. population.
CMS awarded funding for clinical training programs to five hospitals, which then partnered with accredited schools of nursing and non-hospital community-based care settings to deliver primary, preventive, and transitional care to Medicare beneficiaries.
The five hospitals are Duke University Hospital in Durham, North Carolina; Hospital of the University of Pennsylvania, Memorial Hermann-Texas Medical Center in Houston, Rush University Medical Center in Chicago, and HonorHealth Scottsdale Osborn Medical Center in Arizona.
Lori Hull-Grommesh, director of demonstration at Memorial Hermann-Texas Medical Center, commented on program results in the Texas Gulf Coast area, noting that 95% of APRN graduates are employed in the community setting and are helping meet critical access needs. She said she believes that national funding would allow these results to be replicated in other states.
The report stated that demonstration schools had significantly greater APRN enrollment and graduation growth than comparison schools. It also touched on financial incentives: clinical training for an APRN came to a total of $30,000 compared with $150,000 for just 1 year of community-based residency training for primary care physicians.
Although the GNE demonstration is slated to conclude at the end of June 2018, the five hospitals are currently collaborating with major national stakeholders in order to promote permanent funding to roll out the program nationally.
Aiken noted that various types of healthcare organizations, including physician practices and retail clinics, are hiring nurse practitioners in larger numbers and supporting efforts like the demonstration to increase the supply for advanced practice nurses. Also, healthcare settings are working to recruit more advanced practice nurses, especially for their valuable role in ending the opioid epidemic and addressing unmet mental healthcare needs, she pointed out.
The NHSC Scholarship program will receive $47.1 million to disburse as 229 awards to students pursuing primary care training to earn degrees in medicine, dentistry, nurse-midwifery, physician assistant, or nurse practitioner who will bring their skills to a high-need region after graduating. The Nurse Corps scholarship program will receive $25.1 million to give 219 awards to nursing students in exchange for a two-year work commitment in facilities with critical shortages. The National Health Service Corps Students to Service Loan Repayment Program will receive $19.3 million to provide 162 new awards to medical and dental students who choose primary care as their specialty and agree to work in rural or urban areas with high need.
HRSA Administrator George Sigounas tells HealthcareFinanceNews.com, “These programs connect primary care providers with the rural, urban, and tribal communities across the country that need them most. In addition to providing essential medical and dental care, these clinicians are on the front lines helping to fight pressing public health issues, like the growing opioid epidemic.”
Over 12,500 NHSC and Nurse Corps clinicians are currently providing care to about 13 million patients and another 1,725 primary care students are in school or residency preparing for future service with the Nurse Corps. The NHSC and Nurse Corps programs provide scholarships and loan repayment to healthcare providers in exchange for working in areas of the US with limited access to care, improving the health and wellness of those regions.
To learn more about the US Department of Health and Human Services’ $293 million in grant donations to help boost primary care in high need areas, visit here.
