ISAPN President Interviewed by Advance for Nurses
Wednesday, July 14, 2010
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Posted by: Michelle Miles
ISAPN President, Julie Adkins, CNP, was recently interviewed by ADVANCE Newsmagazines.
Filling the Primary Care Gap
Opportunity knocks for APNs, but mandates limit realities of practice in Illlinois
By Robin Hocevar, for ADVANCE Newsmagazines
For advanced practice nurses, the immediate future is the best of times and the worst of times.
As the dust begins to settle on the Patient Protection and Affordable Care Act, one concept is very clear. Advanced practice nurses will take center stage in the new healthcare delivery system.
In a measure designed to increase access and availability of healthcare services to the 47 million Americans currently uninsured, the government will be providing more support for nurse-managed health clinics. In increasing numbers, APNs will provide comprehensive primary care to underserved or vulnerable populations.
Taking into account the looming primary care physician shortage and countless statistics confirming APNs reduce the rate of hospitalization, job potential in this specialty appears almost limitless. Come 2014, Americans will be rewarded for staying out of the hospitals and APNs are perfectly positioned to provide care in retail health and nurse-managed clinics nationwide.
"Too many doctors see a problem and refer, refer, refer,” said Julie Adkins, CNP, president of the Illinois Society for Advanced Practice Nurses."That raises healthcare costs. Nurse practitioners are the listeners. We look more holistically at a problem and that makes us more responsible and cost-effective for chronic disease management.”
Privileging & Credentialing
With such bright horizons, it would seem APNs should be dancing a jig right about now. In Illinois and many other states, however, the mandatory collaborative agreements restrict the APN’s scope of practice.
In private practice (where the need for nurse-managed care is greatest), the physician must approve any duties a collaborating NP can perform in the office based on their specific licensing. NPs are not allowed to perform any duties that doctors don’t perform in the clinic. The arrangement sounds cut-and-dry but, as Adkins points out, if you’re partnered with a strict collaborator or if your collaborator leaves, the nurse is in a bind.
"It’s different in hospitals. If I work in a hospital, I don’t need a collaborator,” Adkins explained, "but if I want to write you a script and you want to fill it at Walgreens, I need a collaborator. You can’t fill a prescription at a pharmacy without a collaborative agreement.”
Adkins is devoting her presidency to eliminating collaborative agreements and finalizing Schedule II prescriptive authority. Illinois passed the Schedule II act in 2007, but the paperwork necessary to legalize the measure is still waiting at the Drug Enforcement Administration offices in Washington, D.C.
"Many other states have Schedule II, III, IV or V,” said Adkins. "It’s important for pediatric nurse practitioners, nurse midwives or anyone in pain management to have Schedule II authority,”she said.
Even in states offering advanced practice nurses high levels of independence, hospitals can curtail their authority. Ann Scott Blouin, PhD, RN, executive vice president of accreditation and certification operations at the Joint Commission, remembers her years at Prentice Women’s Hospital at Northwestern Memorial where APNs treated low-risk pregnancies and referred those requiring C-sections to a physician. She later transferred to another facility, still within Illinois and governed under the same law, where hospital rules and regulations forbid midwives from using their APN skills.
Assessing Our Own
In light of the complications surrounding CMS statutes and APN duties, the Joint Commission is compiling a zip drive that spells out the pertinent information, due for release on its intranet site this fall. Along with the Metropolitan Chicago Healthcare Council, the Joint Commission is in the process of refining APN competency and assessment.
"Currently, in absence of other peers, a doctor is providing peer reviews for NPs. We’re trying to recommend a peer-to-peer system for NPs, similar to what exists for doctors,” said Blouin.
In the coming years, a great many details have to be worked out for the advanced practice nurse. Regardless of which mandates are amended or removed, everyone is in agreement that the APN will only be gaining more visibility.
"This is an exciting time for advanced practice nurses,” said Blouin. "The Joint Commission is pleased to support the role APNs play in promoting quality and safety. We are excited for Americans to increase access to primary care and chronic disease management.”
ADVANCE Newsmagazines.
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