History of NPs First nurse Practitioner Program developed at the - - PDF document

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Carolyn Montoya MSN, CPNP, Doctoral Candidate College of Nursing, University of New Mexico NMNPC April 11, 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. Henry K. Silver

 Goals of the First Program

 To test the expansion of the scope of practice of nurses for well child care in community-based settings  If successful have the findings integrated into collegiate nursing curricula  First program in the country?



JAMA Article 1969 “New Mexico Hamlet Avoids Medical Isolation with Family Nurse Practitioner”  First Family Nurse Practitioner – Martha Schwebach

 Hope Medical Center, Estancia, NM (pop.900)

 Dr. Robert Oseashohn

 Chairman of the UNM, SOM Department of Community Medicine and Epidemiology

First FNP in the Country 

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.

Where We Were…

Pearson, 1989

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

Twenty-two years ago in NM – 1991

 Revision to the nurse practice act defined advanced 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.

Where We Were…

Pearson, 1993



Twenty Years ago in NM Independent Practice!

Where We Were… 1993  How Did We Get There?

 United nursing community  Political strength  Supporting data

 State needs  Cost savings

 Formation of Coalitions

 Nursing  Non- Nursing

Birkholz & Walker, 1994



 Number of NPs in the US and states varies according to sources  Current estimate of NPs in the US  Estimate of 180, 233  NPs in NM – 1,167  State with the largest number of NPs?  State with the fewest number of NPs?

Kaiser Family Foundation, 2011, http://www.statehealthfacts.org/index.jsp

Where Are We As a Profession of NPs?  Where Are We As a Profession of NPs?

Phillips, 2013



 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

Where is NP Education?

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

 Current NP concentrations in NM

 UNM - Albuquerque

 FNP  ACNP/Gero  PNP (only offered ~ every 3 years)

 NMSU – Las Cruces

 Psych/Mental Health Nurse Practitioner  Offered as a DNP program

 University of St. Francis - Albuquerque

 FNP

Where is NP Education?  Where is NP Education?

DNP Clinical/Practice Degree

 Expectation that this be the standard degree for NPs as

• f 2015

 NMSU

 BSN to DNP & Post MSN to DNP

 UNM

 Post MSN to DNP for NEOL

 Summer 2013

 Future plans for Post MSN to DNP for FNP & ACNP/Gero

 Tentatively Summer 2015

PhD Research Degree

 Both UNM and NMSU have on-line Nursing PhD programs



 Continued resistance by outside forces to limit NP Scope of Practice (SOP)

 American Academy of Family Physicians

 White paper – September 18, 2012  Primary Care for the 21st Century – Ensuring a Quality, Physician-led Team for Every Patient

What are Our Challenges? 

 Failed state regulatory reforms

 Iowa – Failed to pass an update to Nurse Practice Act which included Board of Nursing (BON) ability to define SOP.  Kentucky – Failed at collaborative practice agreement for nonscheduled drugs.  Missouri – Failed to pass a bill authorizing independent practice of APRNs.

What are Our Challenges?

Phillips, 2013



Continued threat of Medical Boards or Medical Societies introducing restrictive regulations

 Oklahoma – Failure of regulations to require supervising physician to spend ½ day/week in APRN’s office.  Washington state – Failure of a bill to require all healthcare professionals holding a doctorate degree to identify their type of license, registration, or certification in all advertisements which contain their name.

What are Our Challenges?

Phillips, 2013



Continued threat of state laws becoming more restrictive

 Kentucky – Eliminated APRNs from owning pain management clinics.  Missouri – Limited certain specific procedures to physicians (e.g. placement of intrathecal infusion pumps; or spinal cord stimulators outside of a surgical, obstetrical, or post-op course of care).

What are Our Challenges?

Phillips, 2013

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

 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 Challenges? 

 Research

 Mundinger, et al., 2000 study published in JAMA!

 Comparable outcomes NPs & physicians

 Newhouse, et al., 2011, Nursing Economics

 Systematic Review of APRN outcomes 1990-2008  Similar outcomes when compared to physicians.

 Institute of Medicine Report – Future of Nursing, 2010

What are our Strengths? 

 Supporters of NPs

 National Governor’s Association - White Paper, 2012

 NPs well qualified to deliver primary care  Recommendation for states to change scope of practice & assure reimbursement

 Robert Wood Johnson Foundation & AARP

 Future of Nursing Campaign for Action http://campaignforaction.org/

 Low rates of malpractice cases  Public Approval

What are Our Strengths? 

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.

Where are We with HealthCare?

National Research Council and Institute of Medicine. (2013). U.S. Health in International Perspective: Shorter Lives, Poorer Health.

 Where are We with Health Care? New Mexico

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 Where are We with Health Care? New Mexico  Video

http://www.youtube.com/watch?v=0B-jUOOrtks

 What will the Future Look Like?  What will the Future Look Like? 

“LEANING IN” or “LEANING BACK”

What Should NPs Do?  What Should NPs Do?

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

 Birkholz, G., & Walker, D. (1994). Strategies for state statutory

• language. Changes granting fully independent nurse

practitioner practice. Nurse Practitioner, 19(1), 54-58.  “Mundinger, M.O., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians. A randomized trial. Journal of the American Medical Association, 283(1), 59-68.  National Governor’s Association. (2012). The role of nurse practitioners in meeting increasing demand for primary care. Retrieved from: http://www.nga.org/cms/home/nga-center- for-best-practices/center-publications/page-health- publications/col2-content/main-content-list/the-role-of-nurse- practitioners.html

References 

 National Research Council and Institute of Medicine. (2013).U.S. Health in International Perspective: Shorter Lives, Poorer Health.  New Mexico Hamlet Avoids Medical Isolation” (1969). Journal of the American Medical Association, 207(10), 1808-1809.  Newhouse, R.P. (2011). Advanced practice outcomes 1990-2008: A systematic review. Nursing Economics, 29(5), 1-21.  Pearson, L. J. (1989). How each state stands on legislative issues affecting advanced nursing practice. Nurse Practitioner, 14(1), 27-34.

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.

References 

http://www.youtube.com/watch?v=0B-jUOOrtks