CAROLYN AOYAMA, CNM, MPH INDIAN HEALTH SERVICE Senior Consultant for Women s Health Senior Consultant for Advanced Practice Registered Nursing
The Indian Health Service Advanced Practice Nurse Practitioners Meeting the Need
Goals of My Presentation Inform you of the Indian Health Service (IHS) Inform you of APRN practice within the IHS
Indian Health Service An agency of the U.S. Department of Health and Human Services that provides direct medical, dental, water and sanitation services to American Indian and Alaska Natives from 566 federally recognized tribes across the United States.
The Mission of the Indian Health Service To raise the physical, mental and spiritual health of American Indian and Alaska Native people to the highest level.
The Goal of the Indian Health Service To assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people.
The Foundation of the Indian Health Service To uphold the Federal Government s obligations to promote healthy American Indian and Alaska Native people, communities and cultures, and to honor and protect the inherent sovereign rights of Tribes.
Why Do We Serve Indian People? Government to Government relationship from 1787, based on the Constitution Numerous treaties, laws, supreme court decisions and executive orders have shaped the relationship
The American Indian and Alaska Native Population Total of 1.5 million American Indians and Alaska Natives in the U.S. Currently 557 federally recognized tribes in 35 States
Indian Health Service Sites 12 Area Offices 48 Hospitals 270 Clinics Across 30 States
Hospital
Burden of Disease / Health Disparities 5.0 greater risk of death from TB 5.5 greater risk of death from alcohol related causes 2.0 greater risk of death from diabetes 1.6 greater risk of death from suicide 1.7 greater risk of death from pneumonia / influenza Life expectancy 2.4 years less than US all races Infant mortality rate of 10/1000 live births compared to 7/1000 for US all races.
Common Diseases and Disorders Diabetes Mellitus Heart Disease Rheumatologic Diseases Cholelithiasis Alcoholism and Alcohol-related Disease Pneumonia, Bronchitis and Bronchiectasis Gestational Diabetes Preeclampsia and HELP Syndrome Severe OB Hemorrhage
APRNs and Their Contributions
Who Are the APRNs Who Provide Care? 443 total APRNs 295 NPs 18% vacancy rate 85 CNMs 9% vacancy rate 61 CRNAs 3% vacancy rate
IHS Certified Nurse Practitioners 295 Nurse Practitioners FNPs Psych-MH NPs PNPs Adult NPs Women s Health NPs
IHS Certified Nurse Midwives 85 Certified Nurse Midwives Large midwifery practices in: Chinle, Fort Defiance, and Tuba City, AZ Shiprock and Gallup, NM Claremore, OK Anchorage, AK
IHS Policy: National Scopes of APRN Practice The Indian Health Service has specifically regulated the credentials and qualifications required to practice as an Indian Health Service APRN pursuant to Part 4, Chapter 3, Section 11, Advanced Practice Registered Nurses, Indian Health Policy Manual.
APRN National Scopes of Practice It is the policy of the Indian Health Service that except for controlled substances, the Agency will exercise its authority and the power of Federal preemption to define inpatient and outpatient scopes of practice for APRN working for the IHS. In accordance with 21 CFR Section 1306.03, "Persons Entitled to Issue Prescriptions," the health care practitioner's State of licensure/registration must authorize prescription of controlled substance. Each IHS facility that permits APRN to prescribe controlled substances is responsible for ensuring that such practitioners are authorized to do so by their State of licensure and for complying with the limitations and restrict ions on that authority. Part 4, Chapter 3, Section 11, Advanced Practice Registered Nurses, Indian Health Policy Manual
Federal Supremacy and Preemption The preemption doctrine derives from the Supremacy Clause of the Constitution which states that the "Constitution and the laws of the United States...shall be the supreme law of the land...anything in the constitutions or laws of any State to the contrary notwithstanding." This means that any federal law, even a regulation of a federal agency, trumps any conflicting state law.
The IHS National Scopes of APRN Practice has standardized the scopes of clinical practice for APRNs working in IHS has simplified the credentialing and privileging process has reduced the complexity of monitoring multiple State licenses at individual sites
What is the Role of State Boards of Nursing? State Boards of Nursing retain jurisdiction over licensees employed on Federal enclaves when their actions are not subject to Federal preemption such as disciplinary actions. A State cannot enforce its law on a Federal enclave when it is preempted by Federal Law The authority of APRNs working in IHS to prescribe Schedule II drugs is retained by State Boards of Nursing as are all disciplinary actions
APRNs in IHS are Meeting the Need! Most of the babies born in IHS hospitals are delivered by CNMs! Most of the anesthesia that is provided in IHS hospitals is delivered by CRNAs! Nearly all of the sexual assault forensic examinations are provided by CNMs and NPs
APRN Leadership in IHS The Service Line Manager for Women and Infant Care at the Phoenix Indian Medical Center is a CNM CNMs pioneered prenatal substance abuse treatment within the Midwifery Clinic at a large IHS hospital An FNP created the very first IHS Pain Clinic A Psych-MH NP pioneered our first Tele-Psych Service
APRN Leadership in IHS Developed the Sexual Assault Response Policy identifying the standard of care for sexual assault victims Established a partnership with the Department of Justice, Office on Victims of Crime and the FBI Establishing Sexual Assault Examiner services at all IHS hospitals
Goals for IHS Nursing The Chief Nurse, IHS has established an IHS Nurse Residency Program funding nurses to get their DNP or PhD The Alaska Native Medical Center is a Magnet Hospital, and we want more Five IHS hospitals are certified Baby Friendly, and we are aiming for all 12 maternity hospitals by the end of 2014
Thank You So Much Questions or Comments