You Can Do It!
Representative Melvin Neufeld
Kansas
Look to the Future
• What will the Healthcare System look
like?
– Shortage of primary care providers
– Shortage of dental primary care
– Increased demand in geriatrics
• Where do APRN’s fit?
Where are you now?
• From the “Overview” of AMA Scope of
Practice Data Series: Nurse Practitioners,
fighting words…
“It is the AMA’s intention that these
Scope of Practice Data Series modules
provide the background information
necessary to challenge the state and
national advocacy campaigns of limited
licensure health providers who seek
unwarranted scope-of-practice
expansions that may endanger the health
and safety of patients.”
-Standards of State’s vary greatly
How do you get there?
• In December of 2009, the American
Nurses Association and other nursing
organizations responded to the AMA
report with a strongly worded letter
characterizing the report as misleading.
• In January of 2010, the Engleberg
Center for Health Care Reform, part of
the Brookings Institution, issued a
report encouraging states to increase
the use of nurse practitioners and other
health professionals to improve access
and to reduce costs.
• On November 17, 2010, the Institute of
Medicine (IOM) released its report, “The
Future of Nursing: Leading Change,
Advancing Health.
• The report calls for:
– Increasing the use of nurse practitioners;
– Improving and increasing educational
opportunities for nurse practitioners; and
– Increasing the number of nurse
practitioners.
• Nurses should:
– practice to the full extent of their education
and training.
– achieve higher levels of education and training
through an improved education system that
promotes seamless academic progression.
– be full partners, with physicians and other
health professionals, in redesigning health care
in the U.S.
• Effective workforce planning and policy
making require better data collection and
an improved information infrastructure.
• Remove scope of practice barriers.
• Expand opportunities for nurses to lead
and diffuse collaborative improvement
efforts.
• Implement nurse residency programs.
• Increase the proportion of nurses with a
baccalaureate degree to 80 percent by
2020.
• Double the number of nurses with a
doctorate by 2020.
• Ensure that nurses engage in lifelong
learning.
• Prepare and enable nurses to lead
change to advance health.
• Build an infrastructure for the collection
and analysis of interprofessional health
care workforce data.
Current State of Affairs
• Physician Supervision Diagnosing/Treatment
– According to the Pearson Report, with
respect to diagnosing and treating, states
are almost evenly split between those which
require no physician involvement (23 states
and the District of Columbia) and those
which require written documentation of
physician involvement (24 states). Four
states require physician involvement, but do
not require written documentation of a
relationship.
Physician Involvement – Diagnosis and
Treatment
None Required
Alaska, Arizona,
Colorado, District of
Columbia, Hawaii,
Idaho, Iowa, Kentucky,
Maine, Michigan,
Montana, New
Hampshire, New Jersey,
New Mexico, North
Dakota, Oklahoma,
Oregon, Rhode Island,
Tennessee, Utah,
Washington, West
Virginia and Wyoming.
Physician Involvement
Required
Alabama, Arkansas,
California, Delaware,
Florida, Georgia, Illinois,
Kansas, Louisiana, Maryland,
Massachusetts, Mississippi,
Missouri, Nebraska, Nevada,
New York, North Carolina,
Ohio, South Carolina, South
Dakota, Texas, Vermont,
Virginia, and Wisconsin.
* Connecticut, Indiana,
Minnesota, and
Pennsylvania do not require
written documentation.
Physician Involvement-Prescribing
• Only 14 states and the District of
Columbia allow nurse practitioners to
prescribe without written
documentation of physician
involvement.
• The states are: Alaska, Arizona,
Colorado, Idaho, Iowa, Maine, Montana,
New Hampshire, New Mexico, Oregon,
Rhode Island, Utah, Washington, and
Wyoming.
Work Force Development
• Nursing Shortage
– Practice
– Education (Severe shortage of PhDs for
teaching)
• Health Reform
– Concerns about health workforce shortage
• Rising Health Care Costs
• Focus on Primary Care
– Health Promotion/Disease Prevention
• Rise in the Use of Ambulatory Care
Settings
– Retail Clinics
What’s Next
• Develop and Implement a
National/State Plan of Action
• Address the Concerns of Physicians and
Elected Officials
– Identify weaknesses in training and
preparation
– Review credentialing
– Build relationships with your State
Legislators
• Reciprocity
Final Thoughts
• Circumstances require us to move
forward, pragmatism requires us to
move forward with all deliberate speed
and common sense requires us to do it
well.
Questions??
Melvin Neufeld
7405 15 Road
Ingalls, KS 67853
620-338-4915
mneufeld@ucom.net