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Where Does the Legislation Stand?

Nurse practitioners continue to make strides towards national full practice authority

Nurse practitioners have long since been recognized as a driving force in the United States healthcare system and instrumental to positive patient outcomes. However, with regulations that restrict their ability to practice with the autonomy they deserve, NPs can find it difficult to utilize their extensive education and skillset.

"Nurse practitioners are equipped with a higher level of education than many state laws allow them to provide for their patients. That disconnect makes it more challenging for NPs to practice effectively," explained Taynin Kopanos, DNP, NP, vice president of State Government Affairs, American Association of Nurse Practitioners (AANP). "Every day they have to weigh what they have the ability to do versus what they are legally allowed to do. That shortchanges patients from getting the full service they deserve and adds another layer of complexity to nurse practitioner practice that doesn't need to be there."

"The bottom line is patients need direct access to nurse practitioners services that are not contingent on another provider and are covered by their insurance plan, which is why it is so important that every state allow NPs to have full practice authority," she continued.

Progress Report
As it stands, 21 states and the District of Columbia have passed legislation that supports full practice authority for NPs.

Nebraska and Maryland are the most recent states to enact such laws in April 2015 and May 2015 respectively.

"The legislative leadership we've seen in states like Maryland illustrates how lawmakers are increasingly rallying behind nurse practitioners as essential providers, especially equipped to meet the healthcare needs of constituents," said Ken Miller, PhD, RN, CFNP, FAAN, FAANP, immediate past president of AANP, in a press release. "We urge all states considering similar legislation to champion this tried-and-true, no-cost healthcare solution that is gaining momentum all throughout the nation."

On top of the continued success of the full practice authority movement, the NP profession is gaining ground when it comes to streamlining care by recognizing NP signature authority and authorizing NPs to "treat the paperwork."

"We are seeing multiple states move to update paperwork requirements that will recognize the signature of NPs," said Kopanos. "And even more exciting than fixing past issues, we are finding more states are introducing or amending upcoming or pending legislation to be provider inclusive from the very beginning."

Legislative progress for the nurse practitioner profession has not been confined to individual states. At the federal level, the "Frontlines to Lifelines Act (S 297)" was heard by the U.S. Senate Veterans Affairs Committee in June. If passed, the legislation "would better ensure timely access to care for our nation's veterans by granting the more than 4,000 nurse practitioners who practice in the Veterans Health Administration full-practice authority, meaning the ability to practice to the full scope of their education and clinical training," according to AANP.

SEE ALSO: A Changing Landscape

Getting Involved
The profession's continued legislative successes are in large part due to the growing number of NPs getting involved in healthcare policy.

"As a family nurse practitioner, I first became engaged in policy because I saw the challenges that my patients were facing and while I knew that everything I was doing at the clinic level was making a difference, I recognized that a change in policy was also needed," recalled Kopanos. "Today, we are finding more NPs realizing that what we're doing at the practice site isn't enough to really move the profession and patient care forward. We need to share their stories at a policy level."

For those NPs embracing their role in healthcare policy for the first time, Kopanos recommends they begin by joining their state and national association. "These organizations are going to be able to provide the resources and support NPs need to be able to utilize their time and energies most effectively," she explained. "NPs need someone who knows the legislative landscape and knows how to position the issues well.

"Legislation truly is a team sport," she emphasized. "Rarely does one individual alone move legislation."

A NPs most powerful tool is their experience and the stories they can share. "Nurse practitioners practice at the intersection of healthcare policy and patient care experience. Nobody can do a better job of explaining the challenges patients are experiencing than the NP who is standing at that intersection with them," said Kopanos. "Your stories are what legislators need to know to better to understand what patients are experiences and how NPs can help meet that need better if they were fully equipped to do so."

The recent success of Nebraska and Maryland are perfect examples of the different each and every NP can make in healthcare policy. "At AANP, we see NPs from around the country engaging and sharing their stories with their legislators," noted Kopanos. "We worked with Nebraska and Maryland on their grassroots advocacy efforts. When we would call for advocacy messages to be sent to legislators, we had several hundred NPs responding to our request and reaching out to legislators."

"Then, in the committee hearings, we frequently heard legislators use the stories that the NPs had shared with them to support the need for changes in nurse practitioner policy," she continued. "Every single NP voice truly does make a difference in transforming healthcare policy and improving patients' lives. If we don't advocate for our patients nobody else will."

Forward Momentum
With growing support, more and more states continue to introduce legislation that supports full practice authority.

"There has been tremendous momentum," noted Kopanos. "We have seen seven states introduce and accept full practice authority for nurse practitioners in the last four years."

This momentum, according to Kopanos, is driven by a number of factors, including an increase in healthcare needs and costs as well as workforce challenges. "Policymakers are more aware than ever that there is a group of healthcare professionals out there who can meet those needs and help address those challenges," she emphasized. "We are facing an aging population and a growing number of people with chronic disease and we've got a healthcare workforce policy that is not aligned to be able to address those challenges effectively."

"Additionally, states are facing a workforce challenge. We have seen that those that adopt full practice authority increase the number of NPs practicing in their state," Kopanos continued. "So, states that need an increased healthcare workforce and want to ensure that they have access to care are going to be making these changes so that they can recruit more providers."

By 2020, AANP aims to have 90% of states achieve full practice authority and it is a goal the organization is confident can be reached. "We currently sit at just over 40% and we anticipate that we will get there," said Kopanos. "And given the growing momentum we are hopeful that we can succeed in even less time."

"As a profession we are improving patients' lives through our policy advocacy and years from now patients will have better health because of the actions that individual NPs are taking today at their legislature," she concluded.

Catlin Nalley is the associate editor. Contact: cnalley@advanceweb.com

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