New Nevada Law a 'Huge Win' for Patients and Nurses

The Nevada Action Coalition worked with proponents to enact a new law that is expected to ease shortages of primary care providers.

    • July 30, 2013

Nevada Gov. Brian Sandoval signed into law last month a bill that proponents say will help increase consumer access to primary care and prescription medication in the state.

Enacting the law was a key priority of the Nevada Action Coalition, a group of nurses and nurse champions working in the state to transform health care through nursing. Action Coalitions are the driving force behind the Future of Nursing: Campaign for Action, a national effort backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is advancing recommendations from a 2010 report on the future of nursing by the Institute of Medicine (IOM). Action Coalitions are in place in all states and in the District of Columbia.

“It’s a huge win,” said Debra A. Toney, PhD, RN, FAAN, executive director of the Nevada Action Coalition, former president of the National Black Nurses Association, and an alumna of the RWJF Executive Nurse Fellows program (2006-2009).The law frees advanced practice registered nurses (APRNs) from binding practice restrictions that required them to work under the supervision of physicians. The removal of that requirement, Toney said, will help increase consumer access to care and medication in a state that desperately needs it.

A heavily rural state with only two major metropolitan areas (Las Vegas and the area encompassing Carson City and Reno), Nevada has low physician-to-population ratios and an aging population. Demand for primary care will grow when the Affordable Care Act is fully implemented in 2014 and more patients enter the system.

The new law “will help close the primary care shortage gap for the state,” Toney wrote in response to a recent blog post. “This opens up opportunities for nurse-led clinics to provide greatly needed services in these communities.”

Signed into law in June, the bill gives APRNs full practice authority—a key goal of the IOM report on the future of nursing. Nevada is the 17th state, along with Washington, D.C., to allow APRNs to practice to the full extent of their education and training, according to the Campaign for Action. Learn more about the new law in a story on the Campaign for Action website.

The law is a colorful feather in the cap of the Nevada Action Coalition, which was officially recognized a little more than a year ago. In its first year of life, its leaders worked hard to overcome opposition to the law and win enough lawmaker support to pass it.

Other Priorities

Co-led by the Nevada Alliance for Nursing Excellence and the Nevada Governor’s Workforce Investment Board Health Care and Medical Services Sector Council, the Nevada Action Coalition has identified other priorities for the state, including developing nurse residency programs, advancing nurse education, removing scope-of-practice barriers, doubling the number of nurses with doctorates by 2020, and collecting more comprehensive data on the nursing workforce.

Like other Action Coalitions, it faces challenges raising awareness about the campaign and the funds to sustain it. Volunteers are going “above and beyond” to carry out the Action Coalition’s work, said Toney, who also serves as director of nursing at Nevada Health Centers in Las Vegas, a federally qualified health center with locations throughout the state.

But progress is on the horizon.

The Nevada Alliance for Nursing Excellence, for example, piloted a clinical faculty academy in northern Nevada to assist new faculty in becoming effective clinical instructors and plans to launch a similar program soon in the southern part of the state, Toney said. It also rewrote its bylaws to include a position statement supporting the goal that all graduates with associate degrees in nursing (ADN) obtain their bachelor’s degrees within 10 years of licensure, demonstrating what Toney called a “commitment to life-long learning.”

The Action Coalition is working to create a more streamlined education system in which nurses prepared with associate’s degrees can move more seamlessly into baccalaureate programs. It is tracking and supporting efforts to help the state’s community colleges offer baccalaureate programs in nursing and applied for a RWJF State Implementation Program (SIP) grant to bolster its work to advance nurse education. RWJF SIP grants provide Action Coalitions with $150,000 in matching funds to support work to implement the IOM report recommendations, Toney said. Read more about the grants here.

The Action Coalition is also working to expand nurse residency programs in the state to help nurses transition into new practice settings. There are currently programs at four hospitals that help new nurses transition into practice, and Action Coalition leaders want to expand programs for working nurses who are transitioning into new practice settings, Toney said. At present, there are not enough residencies for new graduate registered nurses in Nevada.

In addition, the Nevada Action Coalition is backing a collaborative effort led by the University of Nevada School of Medicine to establish minimum workforce data sets for nursing and other health care occupations, Toney said. And members are brainstorming ways to diversify the nursing profession in the state. “Diversity is a huge issue,” Toney said, noting that Nevada is home to a large Latino population, which is not reflected in the state’s nursing workforce. “Diversity is important and is integrated throughout all the work of the Action Coalition.”

In the meantime, Toney and others are raising awareness about the IOM report and the Action Coalition’s work to implement its recommendations. Toney, for example, has given presentations to the Nevada Organization of Nurse Leaders, Sigma Theta Tau International, the Nevada Alliance for Nursing Excellence, the Nevada Nurses Association, and other nursing organizations.

The Nevada Action Coalition drew inspiration for this work from a visit from Mary Dickow, MPA, statewide director of the California Action Coalition, and from a trip to Washington, D.C. to attend a national summit hosted by the Future of Nursing: Campaign for Action. Toney helped create the summit’s agenda and programming. Nevada Action Coalition co-leads Debra Collins, RN, BSN, president of the Nevada Alliance for Nursing Excellence, and Linda Yi, RNC, MPA, project director for the Governor’s Workforce Investment Board Health Care & Medical Services Sector Council, also attended.

“It was exciting to be at the summit because we had the opportunity to meet other members and leaders of Action Coalitions who have gone through some of the things we are going through, and to learn that we aren’t as behind on some of the recommendations as we thought,” Toney said. “It really put us in the right place and gave us the motivation to keep moving.”

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