Advanced Practice Nursing: Providing Care and Promoting Health

Jul 29, 2014, 10:50 AM, Posted by Susan Dentzer

Watch the recording of the August 1 Google+ Hangout with the Campaign for Action and RWJF.

The U.S. population is growing, getting older and suffering from more chronic disease. Thanks to the Affordable Care Act (ACA), more people are gaining health coverage and the means to obtain care. And there’s a widespread view that the country faces a drastic shortage of doctors—and primary care providers in particular.

So why are so many states seemingly determined not to let advanced practice registered nurses deliver the primary care they specifically trained to provide—and help millions of patients in the process?

Across the country, 31 states impose varying limits on the ability of nurse practitioners (one of the four types of advanced practice registered nurses) to evaluate patients; diagnose, order and interpret diagnostic tests; and to initiate and manage many treatments, including prescribing medications.

Although these limits are often staunchly defended by medical societies and other physician groups, that posture seems hard to defend. After all, federal workforce projections show that the primary care shortage would significantly decrease by 2020 if growing populations of advanced practice nurses and physicians’ assistants were allowed to practice at a level commensurate with their education and training.

Making the argument that states should drop their limits and allow advanced practice nurses to practice in line with their education and training is a key focus of the Future of Nursing: Campaign for Action, an initiative of AARP and the Robert Wood Johnson Foundation (RWJF). (Read more about it.) The Campaign, now in its fourth year, grew out of an RWJF-funded Institute of Medicine (IOM) report in 2010 that recommended raising the level of nursing education and training and making better use of nurses in redesigning and delivering U.S. health care.

All 50 states and the District of Columbia have Action Coalitions organized around the Campaign’s goals, notes Campaign Director Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing. And although there is considerable distance left to travel, there has been progress, as follows:

Building the business case

To recruit more allies, the Campaign for Action has sought to educate corporate leaders, health system executives, and insurers, on the value that advanced practice nursing can bring to their bottom line. Broad and convenient access to primary care is essential to health—and if “employers’ workforces are healthy, they are much more likely to show up at work, and if [employees’]  family members are healthy, it means less stress for them,” says Winifred V. Quinn, PhD, director of Advocacy and Consumer Affairs, Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and RWJF.

The center has organized a coalition of companies advocating that states modernize their scope of practice policies; it includes corporations such as Target, whose network of in-store clinics relies largely on advanced practice nurses to deliver care. Quinn says the effort is paying off, as more lawmakers in states like California move to adopt model legislation allowing advanced practice nurses to practice a level of care commensurate with their education and training. In the meantime, a white paper by the Bay Area [California] Economic Institute calculates that enacting such reforms would lead to an increase in the number of nurse practitioners in practice; more primary care visits; and, because of increased visits,  lower per-visit costs.

Getting to “80 by ‘20”

A key IOM recommendation is to raise the overall level of nursing education, with a particular goal of 80 percent of the nation’s nurses having bachelor’s degrees—or even higher ones, such as master’s or doctorates—by 2020. According to the Campaign for Action’s “dashboard” indicators, in 2010, 49 percent of the nation’s nurses held bachelor’s degrees in the science of nursing (BSNs); in 2013, 51 percent did—a 2 percent increase. The rise represents about 30,000 more nurses with bachelor’s degrees—and Hassmiller says that the numbers will rise further as more nurses with associates’ degrees from community colleges enroll in programs to complete their bachelor’s. Since the release of the IOM study, the American Association of Colleges of Nursing reports a 53 percent increase in enrollment among registered nurses advancing to bachelor’s  degrees.

More nurses on boards

The IOM report recommended that more nurses be placed in leadership positions to influence the transformation of health care. In Texas, the local Campaign for Action Coalition has partnered with the Texas Health Care Trustees foundation to train 400 nurses for board service.  “We’re very fortunate that Texas is leading the way on this,” says Alexia Green, professor and dean emerita at Texas Tech University’s School of Nursing, who helped to found and formerly co-led the Texas campaign.

“By virtue of its numbers and adaptive capacity, the nursing profession has the potential to effect wide-ranging changes in the health care system,” the IOM report said. Thanks to the Campaign for Action, that potential is several steps closer to becoming reality.