Advanced Practice Nurses Working to Eliminate Practice Barriers
A trend toward allowing advanced practice nurses to practice to their full scope of education and training is spreading across the country. Nurse practitioners, who complete masters level work and significant clinical training, can set up independent practices in 17 states while 12 others currently require supervision. In the remaining 21 states, nurse practitioners must have a collaborative agreement with physicians, according to a recent Wall Street Journal report.
This trend is seen with other advanced practice nurses as well, as over 50 percent states do not require physician supervision of nurse anesthetists, who are educated at the masters or doctoral level with more than 800 hours of clinical training.
There is currently legislation in states such as California, where advanced practice nurses must have physician oversight that would allow them to practice independently. Published data shows both nurse practitioners and nurse anesthetists can safely treat patients and achieve the same similar outcomes as their practicing physician counterparts.
"The Institute of Medicine recently put out recommendations for the future of nursing and their number one recommendation is to remove scope of practice barriers," says Christine S. Zambricki, DNAP, CRNA, FAAN, Senior Director, Federal Government Affairs for the American Association of Nurse Anesthetists. "Advanced practice nurses should practice to the full extent of their education and training. The specific advice given from IOM to state legislatures is to reform the scope of practice regulations to achieve this goal.
"The evidence in peer-reviewed literature finds that advanced practice nurses are highly educated and provide excellent care. Due to factors such as our advanced education, the availability of leading edge technology and breakthroughs in modern pharmaceuticals, anesthesia professionals such as CRNAs provide safer care today than ever before," says Ms. Zambricki. "According to the Institute of Medicine, anesthesia is 50 times safer today than in the early 1980s. We take great pride in our patient safety record."
Advocates for advanced practice nursing also highlight the cost-effectiveness of these providers. According to a recent study in Nursing Economic$, nurse anesthetists working alone are 25 percent more cost-effective than the next least expensive anesthesia delivery model.
"Today, healthcare policy must be evidence-based," says Ms. Zambricki. "Patients should have a choice about who provides their care. Competition in healthcare will lower prices."
In many rural states, nurse anesthetists are the only providers at small hospitals that are 200-plus miles away from major facilities. CRNAs are also prevalent in urban settings. "It's really about access to care in this country, and we have to come up with a solution at a cost we can afford," says Ms. Zambricki. "Fortunately we have the opportunity now to collect information on Medicare patients and confirm that advanced practice nurses can provide the same level of care for less cost."
In the future, the federal government will likely continue to allow states to regulate advanced practice nurses individually.
"As we put the patient first and look at the evidence, we'll see how this all plays out at the state level," says Ms. Zambricki. "With the increased number of people who will be insured under healthcare reform, it's essential that we let everyone practice to the full extent of their education and training. We have to step back and look at the big picture, and keep patients at the center of everything we do. I think that decision makers at the federal and state level, as well as health care leaders in communities and health care facilities, will do the right thing."
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