Summary of Potential Legislation Regarding Advanced Practice Registered Nurses (APRN)
Background:
There has been a push in recent years for legislation at the state level to adopt the national APRN consensus model
which sets forth standards for licensure, accreditation, certification and education for APRNs. The model has been
brought forward to the Minnesota state legislature by the MN APRN Legislative Coalition, which is a non-profit
organization that is comprised of representatives of the four nursing roles that the legislation would cover: Nurse
Practitioners, Clinical Nurse Specialists, Nurse Midwives and Certified Registered Nurse Anesthetists. Within the
legislation APRNs would need to declare a practice specialty in at least one of the following: family or individual
health; adult health and gerontology; neonatology; pediatrics; women’s and gender-related health; and psychiatric
mental health. The broad goal of this effort is to allow APRNs to expand their scope of practice, and do so without
physician supervision—this would include independent prescribing privileges. The Board of Nursing would be the
regulatory body under this model.
The Coalition states that studies show APRNs can provide safe, high quality and cost effective care. It also maintains
that implementing this model would mitigate the growing shortage of primary care providers by creating additional
patient access to care. It emphasizes that APRNs “would not practice medicine, but rather practice advanced
practice nursing”.
The Minnesota Medical Association has come out against the legislation as it now stands. MMA agrees that APRNs
have an important role in delivering care effectively and efficiently; however, they also support “patient-centered,
team-based care to ensure that patients receive the right care from the right practitioner”. If allowed, the
independent practice of APRNs would not be consistent with that model.
A coalition of physicians who would be most impacted by this change of practice scope for APRNs has been meeting
to develop an alternative proposal to the APRN consensus model currently making its way to the legislature. The
physician group is proposing a model that is compromise between the APRN stand and current legislation. To frame
their proposed position, the physician coalition has developed the following principles:
1. Collaboration
A major focus of all health reform proposals over the last five years has been promoting more collaborative
care. Legislation defining the scope of practice for APRNs must also promote collaboration of care to provide
the best care for patients.
2. Exclusion of Schedule II Controlled Substances
We all have concerns related to the current use of opioids and other highly addictive narcotics. If we are to
support independent prescribing for APRNs, schedule II controlled substances cannot be included in that
authority.
3. Focus on Workforce Needs
A major rationale for this bill is to mitigate the projected workforce shortages.
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Expanding the scope of practice for APRNs alone will not address our healthcare workforce needs.
If that is the impetus then the bill needs to be limited to professionals that will help with workforce
issues—nurse practitioners (NPs) and clinical nurse specialists (CNSs).
We have heard of no workforce issues with certified nurse midwives or certified registered nurse
anesthetists. Any changes should be limited to NPs and CNSs only.
4. Patient Disclosure
We believe it is important that patients know from whom they are receiving their care. Additional patient
disclosure and “truth in advertising” language may be needed to ensure this happens.
Recommendation:
It is recommended that Zumbro Valley Medical Association oppose the current APRN Coalition’s proposed
legislation, and instead support the physician coalition’s stated principles which reflect compromises on certain
points within the anticipated bill. To that end, it is recommended that the ZVMS Legislative Committee consider the
following motion:
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Whereas: A patient-centered, team-based care, that includes physicians, nurses, advanced practice
nurses, physician assistants, dieticians, care coordinators, pharmacists and others, ensures the most effective
use of the healthcare workforce.
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Whereas: Authorizing the independent practice of APRNs without maintaining the requirement that
they work in a collaborative manner conflicts with the strategy of team-based care.
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Whereas: The focus of any legislative change needs to be on patient safety, and the recognition that
certain medical procedures should only be performed by physicians with specific training.
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Whereas: Amid increasing concerns with prescription drug abuse, primarily opioid abuse, the authority
of APRNs to independently prescribe Schedule II narcotics should not be allowed
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Be it Resolved: Zumbro Valley Medical Society opposes the legislative bill as proposed by the Minnesota
APRN Legislative Coalition
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Be It Further Resolved: Zumbro Valley Medical Society supports the physician coalition’s principles and
that these principles be reflected in any legislation attempting to expand APRN scope of practice.