The Road to Independence: Pursuit of Full Practice Authority. Dr. Elaine Crain, DNP, CNP Lorraine Diana, MSN, CNP. Abstract

Transcription

1 The Road to Independence: Pursuit of Full Practice Authority Dr. Elaine Crain, DNP, CNP Lorraine Diana, MSN, CNP Abstract Under current law in many states, Advanced Practice Registered Nurses (APRNs) do not have full practice authority (FPA). As the Affordable Care Act (ACA) is enacted, rural, inner city, and low-income populations, who are already isolated from the healthcare system, may paradoxically become more vulnerable as more of the population accesses the healthcare system in the United States (U.S.) and the number of providers diminishes (Nanji, Ferris, Torchiana, & Meyer, 2013). The fact that lacking health insurance has long been associated with an increased risk of subsequent mortality (Jurkovitz et al., 2013; Wilper et al., 2009) is well covered in the arguments presented by both the government and the press; what is sometimes lost in their grandiose statements is where the providers will come from and how will they practice (Tolman, 2011). The purpose of this presentation is to motivate APRNs to participate in the legislative and regulatory processes to update their Nurse Practice Act and familiarize them with the tools that have been used successfully in attaining FPA. Evidence supports the need for APRN full practice authority (Naylor & Kurtzman, 2010; Oliver, Pennington, Revelle, & Rantz, 2014; Weinberg & Kallerman, 2014) and the effectiveness of using social media to enlighten and motivate groups and fundamentally change the status quo (Chung & Tan, 2003; Huang & Benyoucef, 2013; Mishra & Koehler, 2009; Von Dran, Zhang, & Small, 1999). Without face-to-face human interaction in the web environment, adjustments based on verbal or nonverbal (such as body language) cues are impossible. Thus the design of the website is of even greater importance in delivering the

2 service (Von Dran et al., 1999, p. 899). Several studies outline ways to create a website that can catch a readers attention and engage users more effectively. Users perceptions of information systems benefits and their acceptance of information systems are largely determined by whether unique, reliable, and up to date information can be delivered to meet their needs (Huang & Benyoucef, 2013, p. 251). Without the skill to change the state practice environment by legislation or regulation, APNs cannot expect to obtain full practice authority (Birkholz & Walker, 1994). According to Bolman and Deal (2013) as political actors, organizations need to master many of the basic skills of individual managers as politicians: develop an agenda, map the environment, manage relationships with both allies and enemies, and negotiate compacts, accords, and alliances (p. 323). The greatest influence on expanding statues to include full practice authority has been policymaker and public education (Hansen- Turton et al., 2009; Safriet, 2002). The DNP Conference audience will be introduced to social media used in fashioning a working community of APNs; information on legislative and regulatory processes; and methods for crafting and delivering credible arguments for full practice authority for policymakers and other stakeholders. Purpose/Goal Educate APNs in how to lay the groundwork to update their Nurse Practice Act. Collaborating with other healthcare providers, professionals, the public and policymakers is a skill that can be learned and refined by the example of others. Collaborative partnerships with intra and inter-professional colleagues are a necessity to obtain full practice authority and ultimately transform healthcare in rural and vulnerable areas.

3 Objective 1 By the end of this presentation the participant will be able to understand the implication of full practice authority (FPA) and current barriers to obtaining FPA. By 2023, 24 million of those currently uninsured will have healthcare coverage (Congressional Budget Office [CBO], 2013). This will generate a subsequent increase of 103 million office visits by 2025, with the majority of these visits to primary care providers (Petterson et al., 2012). Fifty years ago, about half of physicians were in primary care practices, by 2010, the number had declined to about 31 percent (Tobler, 2010). Due to this reduction in the number of primary care providers across the nation, finding a provider and accessing care will continue to be a significant issue in the future (Safriet, 2011). Objective 2 By the end of this presentation the participant will be able to locate resources to fashion a community of APNs using social media. As more individuals and groups become comfortable with using the Internet, and websites in particular, as venues for education and repositories for information, customer centered websites can be repurposed to enlighten and motivate groups and fundamentally change the status quo (Mishra & Koehler, 2009; Von Dran et al., 1999). According to Huang and Benyoucef (2013) social commerce as an Internet-based commercial application is oriented toward networking, collaborating, and information sharing and involves online communities that support social connection to enhance conversation between customers. All of these trends indicate that websites are used to educate and inform, and allow widespread populations to communicate effectively.

4 Objective 3 By the end of this presentation the participant will be able to appreciate the legislative and regulatory processes. Many APRNs do not have formal training in the legislative and regulatory processes as Master s programs tend to focus on clinical issues and leave the leadership portion to post masters programs (Dracup, 2014). Most Americans had an introduction to the legislative process in the 5 th grade but few ever revisit that knowledge this has been amusingly pointed out on the 2007 TV show: Are you smarter more than a 5 th grader? There are several available representations online, from the simple and entertaining to complex charts. Objective 4 By the end of this presentation the participant will be able to demonstrate how to find and collate arguments for APN FPA. In order to find current information about APN practice, the will be introduced to the concept of a search strategy table, research matrix and the IOM and LACE reports. Objective 5 By the end of this presentation the participant will be able to create a plan for approaching and debating with policymakers. Review of the APRNPractice.org website and its use in updating the Maryland NPA.

5 References American Association of Nurse Practitioners. (2016). State Practice Environment. Retrieved from AANP.org: Birkholz, G., & Walker, D. (1994, January). Strategies for state statutory language changes granting fully independent nurse practitioner practice. Nurse Practitioner, 19, Bolman, L. G., & Deal, T. E. (2013). Reframing organizations: Artistry, choice, and leadership (5th ed.). San Francisco, CA: Jossey-Bass. Chung, J., & Tan, F. B. (2003, November 13). Antecedents of perceived playfulness: An exploratory study on user acceptance of general information-searching websites. Information & Management, 41, Hansen-Turton, T., Ritter, A., & Valdez, B. (2009, February). Developing alliances: How advanced practice nurses became part of the prescription for Pennsylvania. Policy, Politics, & Nursing Practice, 10, Huang, Z., & Benyoucef, M. (2013). From e-commerce to social commerce: A close look at design features. Electronic Commerce Research and Applications, 12, Jurkovitz, C. T., Li, S., Norris, K. C., Saab, G., Bomback, A. S., Whaley-Connell, A. T., & McCullough, A. (2013, April). Association between lack of health insurance and risk of death and ESRD: results from the Kidney Early Evaluation Program (KEEP). American Journal Of Kidney Diseases, 61,

6 Mishra, P., & Koehler, M. (2009, May). Using the TPACK framework: You can have your hot tools and teach with them, too. Learning and Leading with Technology, Retrieved from Nanji, K. C., Ferris, T. G., Torchiana, D. F., & Meyer, G. S. (2013, March). Overarching goals: A strategy for improving healthcare quality and safety? BMJ Quality & Safety, 22, Naylor, M. D., & Kurtzman, E. T. (2010, May). The role of nurse practitioners in reinventing primary care. Health Affairs, 29, Oliver, G. M., Pennington, L., Revelle, S., & Rantz, M. (2014, August 1). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook. Safriet, B. J. (2002, January 1). Closing the gap between can and may in health-care providers scope of practice: A primer for policymakers. Yale Law School Legal Scholarship Repository, Tolman, D. R. (2011, July/August). Breaking away: The ethical case for nurse practitioner independence. The American Journal for Nurse Practitioners, 15, Von Dran, G. M., Zhang, P., & Small, R. (1999). Quality websites: An application of the Kano Model to website design. Retrieved from Association for Information Systems:

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