Category Archives: Advance practice nurses
Linda H. Aiken, PhD, FAAN, FRCN, RN, is the Claire M. Fagin Leadership Professor in Nursing, a professor of sociology, and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Aiken is a research manager supporting the Future of Nursing: Campaign for Action and a National Advisory Committee member for the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. This is cross-posted on the Leonard Davis Institute Voices blog.
All too often, the debate about expanding the role of nurse practitioners (NPs) and physician’s assistants (PAs) takes place in a vacuum, as though these practitioners do not already deliver significant amounts of primary care. But they do, and existing evidence indicates that quality of care and patient satisfaction are good as a result.
Even before the passage of the Affordable Care Act, the nation had a shortage of primary care providers. The shortage is likely to intensify when the demand for primary care increases as millions become insured. The numbers of and roles assumed by NPs and PAs have been growing steadily, and allowing these providers to take on an even greater role could address the increased demand for primary care.
The Iowa Supreme Court ruled last week that advanced registered nurse practitioners (ARNPs) can supervise fluoroscopy, a high-tech X-ray and imaging procedure. The high court ruling was in response to a challenge by three nursing organizations to an earlier decision from a district court.
“We believe the district court erred in second-guessing the department of public health and nursing board on the adequacy of ARNP training to supervise fluoroscopy,” the Iowa Supreme Court wrote. “The record affirmatively shows ARNPs have been safely supervising fluoroscopy and are adequately trained to do so… Allowing ARNP supervision of fluoroscopy improves access to healthcare for rural Iowans and helps lower costs.”
Experts say the ruling has implications for patients, especially those living in rural areas with limited access to doctors, who will be able to get test results more quickly. That can alleviate fears if the fluoroscopy shows that a patient does not have a serious health problem or, conversely, it can facilitate quicker treatment if a patient needs it.
President Obama’s Fiscal Year 2014 budget proposal recommends a $20 million increase over previous budget proposals for the Title VIII Nursing Workforce Development Programs, the primary source of federal funding for nursing education.
“With the proposed increase to Title VIII funding, the Obama administration continues to recognize the invaluable contribution that nurses make in the delivery of care and the need to strengthen our primary care system,” American Nurses Association (ANA) President Karen A. Daley, PhD, RN, FAAN, said in a statement.
According to the Center to Champion Nursing in America (CCNA), the $20 million increase will expand the pool of primary care Advanced Practice Registered Nurses through the Advanced Education Nursing Traineeship Program. If enacted, and if the funding is sustained, the increase will produce an additional 1,800 primary care nurses over five years.
“The President's proposal to train 1,800 more primary care nurse practitioners would provide a much needed shot in the arm to our health care workforce,” said Winifred Quinn, MA, PhD, director of legislation and field operations at CCNA. “These new health professionals are key to boosting consumer access to primary and preventive care, and other innovative delivery system reforms we are counting on to improve quality and hold down costs.”
The ANA also applauded other health care investments in the budget, including funding for community health centers, new mental health programs, health reform implementation, medical research, and more.
This is part of the March 2013 issue of Sharing Nursing's Knowledge.
Study: APRN-Staffed Clinic Produces Shorter Wait for Diagnoses at Lower Cost for Women with Benign Breast Conditions
A nurse-based approach to diagnosing women with breast conditions is saving money and producing shorter wait times for diagnoses, according to an article in the January issue of Health Affairs.
In 2008, the Virginia Mason Medical Center, a Seattle-based multidisciplinary health care network that logs 800,000 outpatient and 17,000 hospital visits per year, opened a new breast care clinic, with the goal of streamlining the diagnosis and care for women with breast conditions. These include such benign conditions as cysts and fibrocystic breast disease, as well as breast cancer. As part of the clinic’s model, Advanced Practice Registered Nurses (APRNs) take the lead role in diagnosing patients, working with on-site equipment to perform mammography, ultrasound, and magnetic resonance imaging. Patients whose conditions cannot promptly be confirmed as benign meet with breast surgeons for diagnosis and care, if appropriate.
On Monday, U.S. Secretary of Health and Human Services Secretary Kathleen Sebelius announced a four-year, $200 million investment to support the training of advanced practice registered nurses (APRNs). The move was lauded by leaders of the Robert Wood Johnson Foundation (RWJF) and the Center to Champion Nursing in America.
The Secretary went to Duke University’s School of Nursing to announce that the Graduate Nurse Education Demonstration program will reimburse costs associated with training APRNS (nurse practitioners, nurse anesthetists, nurse midwives and nurse specialists) at five networks of hospitals, nursing schools, and community-based clinics and health centers. They are: the Hospital of the University of Pennsylvania, in Philadelphia; Duke University Hospital, in Durham, N.C.; Scottsdale Healthcare Medical Center, in Ariz.; Rush University Medical Center, in Chicago, Ill.; and Memorial Hermann-Texas Medical Center Hospital, in Houston, Texas.
The goal, officials said, is to help these highly skilled nurses gain the skills necessary to provide primary and preventive care for Medicare beneficiaries, including in underserved communities.
“This announcement marks a historic moment of investment in the crucial and growing role of nurses in our health care system,” RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, said. “With 8,000 baby boomers turning 65 and qualifying for Medicare daily, patients everywhere can benefit from the expertise of advanced practice nurses and the expanded access to care they potentially can provide. The decision to extend Medicare funding to nurses recognizes the urgent need to expand the workforce to care for the growing population of Medicare recipients.”
“This relatively modest investment will pay big dividends for consumers by preparing more highly skilled nurses to provide care when and where it is needed,” agreed Susan Reinhard, PhD, RN, FAAN, senior vice president of the AARP Public Policy Institute and chief strategist of the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and RWJF. “These new health professionals will improve access to crucial primary, preventive, and transitional care across a range of settings—from the hospital, to the home, to convenient care clinics,”
Half of the clinical training provided at the five demonstration sites must take place in the community, outside of hospital settings. The aim is to ensure that APRNs have skills to provide primary, preventive and transitional care, and to help patients manage chronic conditions. The funding is authorized under the Affordable Care Act.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the latest nursing news, research and trends. Here are descriptions of some of the stories in the April issue:
Though men comprise a small percentage of the nursing workforce, and an even smaller percentage of nurse faculty, men are enrolling in nursing programs at higher rates than in the past. Still, the nursing profession needs to do more to speed up the gender diversification and inclusion of the workforce, experts say. More visible and powerful male nurse educators can serve as recruiters and role models.
Read a profile of RWJF Executive Nurse Fellow Shirley Orr, MHS, ARNP, NEA-BC, a leader in the field of public health nursing. During her tenure at the Kansas Department of Health and Environment, Orr co-founded the Kansas Public Health Leadership Institute, which aims to support public health leaders and bring officials from health care organizations, academic institutions and other settings together to improve population health.
The RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) held its annual conference in April, celebrating seven successful years and 40 landmark research projects conducted by INQRI-funded interdisciplinary research teams. At the conference, members of those teams and others who have worked with the program discussed how far interdisciplinary research has come since INQRI began and the benefits of this approach for health care research, for health professionals, and for patients.
The Missouri Action Coalition is working to advance the recommendations of the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health. The Coalition has already made progress in allowing nurses to practice to the full extent of their education and training, making it easier for associate degree-prepared nurses to move into baccalaureate programs through a seamless articulation agreement, and working to establish a state nursing workforce center to collect nursing data.
Expanded Advanced Practice Registered Nurse Scope of Practice Laws: Can We Ignore Economic Motives and Effects?
By Mark V. Pauly, PhD, Bendheim Professor of Health Care Management, Wharton School, University of Pennsylvania and co-director, Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI)
The recent and useful article by Patricia Pittman and Benjamin Williams, “Physician Wages in States with Expanded APRN Scope of Practice,” examined annual earnings of salaried physicians in states with and without expanded Scope of Practice (SOP) laws. It found that there is no smoking gun to support the hypothesis that laws which permit registered nurses to do more result in lower primary care physician salaries. While there may still be reasons why physicians and others may be skeptical of such laws, and whatever suspicions people may harbor, proven financial harm to physician salaries would not appear to be one of them; primary care physician salary levels were not different, either absolutely or relative to surgeon salaries, in states with expansion laws.
In my view, these results definitely help in the debate about expanded SOP rules, potentially moving it to a different (and probably more appropriate) level where it is about quality and access, not about economics. However, the results are, as the authors note, far from definitive as proof that no causal impact exists. In addition, they raise more questions than they answer about how primary care workforce markets actually function. Paradoxically, if there are no financial impacts, there may be no cost savings either. Here I first lay out the questions which these results raise for understanding how markets are working, and then specify some empirical issues that would need to be addressed for more definitive empirical conclusions.