3/20/2013 History of NPs First nurse Practitioner Program developed at the University of Colorado School of Nursing in 1965 Collaborative effort Dr. Loretta C. Ford and Dr. Carolyn Montoya MSN, CPNP, Doctoral Candidate Henry K. Silver College of Nursing, University of New Mexico NMNPC April 11, 2013 Goals of the First First FNP in the Country Program JAMA Article 1969 To test the expansion of the scope of practice of “New Mexico Hamlet Avoids Medical Isolation with Family nurses for well child care in community-based Nurse Practitioner” settings First Family Nurse Practitioner – Martha Schwebach If successful have the findings integrated into collegiate nursing curricula Hope Medical Center, Estancia, NM (pop.900) Dr. Robert Oseashohn First program in the country? Chairman of the UNM, SOM Department of Community Medicine and Epidemiology Where We Were… Twenty-four years ago - 1989 Linda Pearson published the first annual update on state scope of practice for advance nursing practice in the Nurse Practitioner Journal (known as the “blue journal) NPs had legislative authority to prescribe in 28 states NPs in NM Practice defined in the nurse practice act for more than 10 years. Prescriptive privileges were under our own signature with written protocols & physician supervision. Pearson, 1989 1
3/20/2013 Where We Were… Where We Were… 1993 Twenty-two years ago in NM – 1991 Twenty Years ago in NM Revision to the nurse practice act defined advanced Independent Practice! practice as being in collaboration with a physician NPs needed to submit proof of national certification; completion of an approved program; and letter of collaboration with a physician NPs could prescribe non-controlled substances with supervision of a physician – Rx pad needed to have both the NP and the physician names preprinted on Rx. Pearson, 1993 Where Are We As a How Did We Get There? Profession of NPs? Number of NPs in the US and states varies according to sources United nursing community Political strength Current estimate of NPs in the US Supporting data Estimate of 180, 233 State needs NPs in NM – 1,167 Cost savings State with the largest number of NPs? Formation of Coalitions State with the fewest number of NPs? Nursing Non- Nursing Kaiser Family Foundation, 2011, http://www.statehealthfacts.org/index.jsp Birkholz & Walker, 1994 Where Are We As a Where is NP Education? Profession of NPs? United States All programs were originally certificate granting programs. New Mexico Certificate granting program out of the School of Medicine in the 1970’s. Master’s Program at the College of Nursing started in 1989 - originally only accepted 8 students. More than 200 students have completed FNP concentration Phillips, 2013 2
3/20/2013 Where is NP Education? Where is NP Education? DNP PhD Clinical/Practice Degree Current NP concentrations in NM Research Degree Expectation that this be the UNM - Albuquerque Both UNM and NMSU standard degree for NPs as have on-line Nursing FNP of 2015 PhD programs ACNP/Gero NMSU PNP (only offered ~ every 3 years) BSN to DNP & Post MSN to DNP NMSU – Las Cruces UNM Psych/Mental Health Nurse Practitioner Post MSN to DNP for NEOL Offered as a DNP program Summer 2013 University of St. Francis - Albuquerque Future plans for Post MSN to DNP for FNP & ACNP/Gero FNP Tentatively Summer 2015 What are Our Challenges? What are Our Challenges? Failed state regulatory reforms Iowa – Failed to pass an update to Nurse Practice Act Continued resistance by outside forces to limit NP which included Board of Nursing (BON) ability to Scope of Practice (SOP) define SOP. American Academy of Family Physicians Kentucky – Failed at collaborative practice agreement White paper – September 18, 2012 for nonscheduled drugs. Primary Care for the 21 st Century – Ensuring a Quality, Missouri – Failed to pass a bill authorizing Physician-led Team for Every Patient independent practice of APRNs. Phillips, 2013 What are Our Challenges? What are Our Challenges? Continued threat of Medical Boards or Medical Continued threat of state laws becoming more Societies introducing restrictive regulations restrictive Oklahoma – Failure of regulations to require Kentucky – Eliminated APRNs from owning pain supervising physician to spend ½ day/week in management clinics. APRN’s office. Missouri – Limited certain specific procedures to Washington state – Failure of a bill to require all physicians (e.g. placement of intrathecal infusion healthcare professionals holding a doctorate degree to pumps; or spinal cord stimulators outside of a identify their type of license, registration, or surgical, obstetrical, or post-op course of care). certification in all advertisements which contain their name. Phillips, 2013 Phillips, 2013 3
3/20/2013 What are Our Challenges? Virginia HB 346 - requirement that NPs practice as part of a patient care team led by a physician. Increase number of NPs a physician can enter into a collaborative agreement. What are our Strengths? What are Our Strengths? Research Supporters of NPs Mundinger, et al., 2000 study published in JAMA! National Governor’s Association - White Paper, 2012 Comparable outcomes NPs & physicians NPs well qualified to deliver primary care Newhouse, et al., 2011, Nursing Economics Recommendation for states to change scope of practice & assure reimbursement Systematic Review of APRN outcomes 1990-2008 Robert Wood Johnson Foundation & AARP Similar outcomes when compared to physicians. Future of Nursing Campaign for Action Institute of Medicine Report – Future of Nursing, 2010 http://campaignforaction.org/ Low rates of malpractice cases Public Approval Where are We with Health Where are We with Care? New Mexico HealthCare? United States US ranks at or near bottom on almost all indicators of mortality, survival, and life expectancy among high- income countries. 2001-2006 Mortality rates children 1-19 years higher in US than peer countries except Portugal (n = 17) Americans live shorter lives; experience more injuries & illness than individuals in other high-income countries. National Research Council and Institute of Medicine. (2013). U.S. Health in International Perspective: Shorter Lives, Poorer Health . 4
3/20/2013 Where are We with Health Video Care? New Mexico http://www.youtube.com/watch?v=0B-jUOOrtks What will the Future Look What will the Future Look Like? Like? What Should NPs Do? What Should NPs Do? “ LEANING IN” or “LEANING BACK” 5
3/20/2013 References References National Research Council and Institute of Medicine. Birkholz, G., & Walker, D. (1994). Strategies for state statutory (2013). U.S. Health in International Perspective: Shorter language. Changes granting fully independent nurse Lives, Poorer Health . practitioner practice. Nurse Practitioner, 19 (1), 54-58. New Mexico Hamlet Avoids Medical Isolation” (1969). “Mundinger, M.O., et al. (2000). Primary care outcomes in Journal of the American Medical Association, 207 (10), patients treated by nurse practitioners or physicians. A 1808-1809. randomized trial. Journal of the American Medical Association, 283 (1), 59-68. Newhouse, R.P. (2011). Advanced practice outcomes 1990-2008: A systematic review. Nursing Economics, National Governor’s Association. (2012). The role of nurse 29 (5), 1-21. practitioners in meeting increasing demand for primary care. Retrieved from: http://www.nga.org/cms/home/nga-center- Pearson, L. J. (1989). How each state stands on for-best-practices/center-publications/page-health- legislative issues affecting advanced nursing practice. publications/col2-content/main-content-list/the-role-of-nurse- Nurse Practitioner, 14 (1), 27-34. practitioners.html References Pearson, L. J. (1993). How each state stands on legislative issues affecting advanced nursing practice. Nurse Practitioner, 18 (1), 23-38. Phillips, S. (2013). Evidence-based practice reforms improve access to APRN care. Nurse Practitioner, 38 (1), 18-42. http://www.youtube.com/watch?v=0B-jUOOrtks 6
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