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DiversityNursing Blog

Guest column: Nurses can ease crisis

Posted by Alycia Sullivan

Mon, Aug 05, 2013 @ 01:07 PM

Consider how long you may be in the waiting room for a visit for your child and consider how long it will take to get an appointment. The average wait time in an emergency room in 2011 was 64.3 minutes. Some experts expect that to double soon, especially in rural areas. Why? Because folks who cannot access primary care use the emergency room for primary care.

We are in a state of crisis. We need to serve more people with fewer physicians. The American Medical Colleges Center for Workforce states that there will be a national shortage of about 63,000 primary care physicians by 2015. South Carolina already ranks 33rd for lowest ratio of those physicians.

According to a 2012 article in Medical Care magazine, the number of nurse practitioners in the U.S. will increase by 94 percent by 2015. We have 2,592 Advanced Practice Registered Nurses (APRNs) already in South Carolina. Among these APRNs are Nurse Practitioners (NPs) and Certified Nurse Midwives (CNMs), who hold at least a master’s degree in nursing with advanced education and clinical training to assess, diagnose and manage a patient’s health care at the primary care entry while working collaboratively in teams for the optimal patient outcome. Allowing a patient the option to select an APRN as their primary provider could give people access to over 3,000 additional primary care providers when this crisis hits.

The problem deepens for the patients who will desperately need access to care. Currently, the barriers to practice for these advanced level nurses include: the inability for APRNs to order handicapped placards, the inability to order durable medical equipment, inability to refer patients for diagnostic care, limitations on prescribing certain medications for pain and more. An APRN cannot provide care for a patient or prescribe any medication for them unless they have permission and the “supervision” of a physician within a 45 mile radius. This archaic constraint means that patients struggle to get the care they need in a timely and safe manner.

In a rural setting, accessing care is even more burdensome for patients because of fewer providers and transportation options and higher unemployment, affecting health insurance eligibility. Accessing care is difficult and barriers exist everywhere.

The Institute of Medicine in their 2010 report, “The Future of Nursing,” calls for the removal of barriers for APRNs so access to primary care is improved. According to the Washington Post, about 6,000 APRNs have already opened independent practices. Nineteen states have already removed barriers and now allow APRNs to practice to the fullest extent of their education and training. There is no longer an excuse for South Carolina to have an “F” in the healthcare rankings.

We hope our policy leaders will take action and allow our qualified APRNs to provide the care that so many South Carolinians need before the burden on our healthcare system becomes even greater. Research shows that APRNs deliver safe, cost-effective, high quality autonomous care to manage a patient or population’s health, while working collaboratively in teams for the optimal outcome.

Source: Greenville Online

Topics: APRN, lacking, nurse practitioner, care, reform

Comprehensive Review Of Laws And Regulations Affecting Advanced Nursing Practice In Every State

Posted by Alycia Sullivan

Tue, Feb 05, 2013 @ 02:03 PM

The most comprehensive review of new legal and regulatory issues affecting advanced nursing practice across the United States is now available in the "25th Annual Legislative Update," presented exclusively by The Nurse Practitioner: The American Journal of Primary Healthcare.The Nurse Practitioner is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. 

Compiled by Susanne J. Phillips, MSN, FNP-BC, the annual supplement presents a comprehensive review of the legislative proceedings, bills, and laws pertaining to advanced practice registered nursing (APRN) practice in every state. The 25th Annual Legislative Update is now freely available on the journal website. 

Progress in Evidence-Based Reforms Improving Access to APRN Care 

The 25th Annual Legislative Update incorporates current information provided by state nursing boards and APRN associations about the "hot topics" affecting APRN practice in their states. "Despite attempts by medical boards to limit current practice authority, APRNs succeeded in improving access to APRN care in several states," writes Phillips. 

The special edition provides an essential update on recent legislative and regulatory activity promoting access to APRN care, prompted by decades of peer-reviewed research demonstrating the quality and safety of APRN practice. Efforts are ongoing to standardize laws and regulations governing APRN practice across states, and to establish effective consumer protections. 

Yet legislation continues to be "vehemently opposed" in many states, according to Phillips. She discusses steps APRNs can take to "empower legislators to move beyond the outdated, evidence-lacking arguments that APRNs are not educated enough, safe enough, or credentialed enough to care for the nation's residents." 

This year's update presents a rundown of the latest developments in the areas of legal authority, reimbursement, and prescriptive authority for all 50 states. It also includes a table summarizing practice authority for nurse practitioners in every state and the District of Columbia, along with updated statistics and the total number of APRNs reported by state boards of nursing. 

Nurses Encouraged to Work Together to Meet Challenges 

The past year has seen several important improvements in legal authorization of APRN practice, including passage of legislation and promulgation of regulations in 17 states. In addition, eight states reported statutory or regulatory activity leading to improvements in prescriptive authority. 

But challenges remain, including reports of defeated bills and unsuccessful regulatory reform efforts in five states. In addition, two states - Kentucky and Missouri - passed legislation limiting APRN practice in specific ways. Phillips urges APRNs and others interested in ensuring access to evidence-based healthcare to support state APRN organizations. 

Nurses are also encouraged to check out the Future of Nursing Campaign for Action, supported by the Robert Wood Johnson Foundation and AARP, to see what steps are being taken and participate in efforts to improve nursing practice. Phillips adds, "This is a great way for all of the APRN organizations to work together to implement the recommendations and improve practice in your state."

Article adapted by Medical News Today from original press release.

Topics: laws, United States, challenges, regulations, APRN care, reform

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