WEBVTT 00:00:06.788 --> 00:00:11.380 position:50% align:middle - [Maryann] Well, it is my privilege to give you a report on the APRN Consensus 00:00:11.380 --> 00:00:15.805 position:50% align:middle Model Forum, which was held on April 10th, Chicago, Illinois 00:00:15.805 --> 00:00:19.237 position:50% align:middle and moderated by Dr. Stephanie Ferguson. 00:00:19.730 --> 00:00:26.390 position:50% align:middle I want to take a moment to review for you the resolution that was passed in August 00:00:26.390 --> 00:00:34.870 position:50% align:middle of 2018 by the delegate assembly, stated, "Whereas the APRN consensus model is 10 00:00:34.870 --> 00:00:41.640 position:50% align:middle years old, and whereas inconsistencies exist in the regulatory interpretation 00:00:41.640 --> 00:00:49.670 position:50% align:middle and implementation of the model among various states, and whereas the 2017 NCSBN 00:00:49.670 --> 00:00:53.820 position:50% align:middle roundtable meetings, reveal these inconsistencies, 00:00:53.820 --> 00:01:01.230 position:50% align:middle therefore be it resolved that NCSBN convene a forum of state board regulators 00:01:01.230 --> 00:01:06.749 position:50% align:middle with expertise in APRN issues to discuss these inconsistencies, 00:01:06.990 --> 00:01:09.850 position:50% align:middle as well as challenges and strategies. 00:01:09.850 --> 00:01:15.470 position:50% align:middle And be it further resolved that following this forum, the NCSBN Board of Directors 00:01:15.470 --> 00:01:21.080 position:50% align:middle evaluate how to address the challenges boards of nursing are experiencing 00:01:21.080 --> 00:01:26.160 position:50% align:middle in relation to the implementation of the APRN consensus model, 00:01:26.160 --> 00:01:31.350 position:50% align:middle and be it further resolved that the progress of these activities be reported 00:01:31.350 --> 00:01:33.984 position:50% align:middle to the NCSBN annual meeting." 00:01:35.130 --> 00:01:38.618 position:50% align:middle And so I stand before you to give you that report. 00:01:39.950 --> 00:01:48.330 position:50% align:middle Seventy-five members of NCSBN were in attendance at the meeting on April 10th. 00:01:48.330 --> 00:01:53.144 position:50% align:middle Each board was invited to have two participants and most of these were 00:01:53.144 --> 00:02:01.468 position:50% align:middle either/and executive officers and an APRN representative from the board. 00:02:01.468 --> 00:02:09.150 position:50% align:middle And to give people time to think about the inconsistencies, the challenges that they 00:02:09.150 --> 00:02:16.200 position:50% align:middle were facing at their state, we initially sent out a form to them to fill out. 00:02:16.750 --> 00:02:22.156 position:50% align:middle And it listed all the important aspects of the consensus model in there, 00:02:22.280 --> 00:02:27.571 position:50% align:middle all the major aspects that we all are trying to address and 00:02:27.571 --> 00:02:30.377 position:50% align:middle get passed on a state by state basis. 00:02:30.377 --> 00:02:35.020 position:50% align:middle So we thought we would give everybody a chance to think about and it will lay some 00:02:35.020 --> 00:02:38.990 position:50% align:middle groundwork for the discussion. 00:02:38.990 --> 00:02:44.740 position:50% align:middle And then the day of the meeting, we went through each of those areas of the 00:02:44.740 --> 00:02:51.240 position:50% align:middle consensus model, step by step, and had a discussion about each one. 00:02:51.240 --> 00:02:57.350 position:50% align:middle And so I'm going to summarize for you this afternoon, exactly the conversations and 00:02:57.350 --> 00:03:00.930 position:50% align:middle the important issues and discussion that resulted. 00:03:01.880 --> 00:03:04.690 position:50% align:middle First of all, title. 00:03:04.690 --> 00:03:09.580 position:50% align:middle And these, I'm capturing really what the essence of these discussions were 00:03:09.580 --> 00:03:10.849 position:50% align:middle on these slides. 00:03:11.720 --> 00:03:17.590 position:50% align:middle Two things were discussed, licensees want to be called NPs rather 00:03:17.590 --> 00:03:25.120 position:50% align:middle than APRNs, and there was a discussion about CRNAs wanting to change their title 00:03:25.120 --> 00:03:27.603 position:50% align:middle to nurse anesthesiologist. 00:03:29.660 --> 00:03:34.459 position:50% align:middle This is the result of those two issues. 00:03:35.350 --> 00:03:40.480 position:50% align:middle First of all, it was believed that changing the APRN title will have 00:03:40.480 --> 00:03:46.410 position:50% align:middle an impact on federal regulations at CMS that impact billing. 00:03:46.410 --> 00:03:51.750 position:50% align:middle Number two, states are still striving to adopt the model and we need 00:03:51.750 --> 00:03:55.220 position:50% align:middle to strive towards consistency. 00:03:55.220 --> 00:04:00.460 position:50% align:middle Three, the public is still learning the titles and changing them now would really 00:04:00.460 --> 00:04:03.594 position:50% align:middle cause more confusion than anything else. 00:04:04.120 --> 00:04:11.650 position:50% align:middle And it was believed by the group that changing CRNA title to nurse 00:04:11.650 --> 00:04:21.090 position:50% align:middle anesthesiologist would only exacerbate existing tensions with physicians. 00:04:21.090 --> 00:04:23.305 position:50% align:middle Roles and population foci. 00:04:24.830 --> 00:04:27.430 position:50% align:middle The issues in discussion. 00:04:27.430 --> 00:04:32.850 position:50% align:middle Many states and representatives talked about the fact that the model does not 00:04:32.850 --> 00:04:39.380 position:50% align:middle allow for NPs to be educated across the spectrum of care, that they have to pick a 00:04:39.380 --> 00:04:41.520 position:50% align:middle role and a specific population. 00:04:41.520 --> 00:04:45.760 position:50% align:middle It was discussed that market need is driving something different 00:04:45.760 --> 00:04:46.612 position:50% align:middle from the model. 00:04:46.612 --> 00:04:50.563 position:50% align:middle We need to support access to care in rural communities. 00:04:51.520 --> 00:04:58.010 position:50% align:middle Some believed that there was a need for a generalist category of APRNs and gave the 00:04:58.010 --> 00:05:04.440 position:50% align:middle example of physician assistants not being restricted to a role and population and 00:05:04.440 --> 00:05:08.394 position:50% align:middle some also even cited physicians not being restricted. 00:05:09.510 --> 00:05:15.900 position:50% align:middle But ultimately, and what I tell you is what evolved after a lot of discussion 00:05:15.900 --> 00:05:17.499 position:50% align:middle in this category. 00:05:17.760 --> 00:05:20.930 position:50% align:middle These were the primary beliefs that emerged. 00:05:20.930 --> 00:05:26.870 position:50% align:middle The setting the APRN works in should be irrelevant because some people still 00:05:26.870 --> 00:05:31.769 position:50% align:middle believe that the setting should dictate what an APRN does. 00:05:32.140 --> 00:05:36.150 position:50% align:middle And again, it's according to her knowledge and certification. 00:05:36.150 --> 00:05:42.865 position:50% align:middle Acute primary care foci should not be tied to setting, but to rather the practice 00:05:42.865 --> 00:05:44.274 position:50% align:middle of the APRN. 00:05:45.300 --> 00:05:52.400 position:50% align:middle It was pointed out that PAs are educated as generalists, a very different education 00:05:52.400 --> 00:05:56.840 position:50% align:middle of APRNs and they require supervision. 00:05:56.840 --> 00:06:01.606 position:50% align:middle APRNs may have a more narrow scope, but are taught to be independent. 00:06:02.300 --> 00:06:08.160 position:50% align:middle APRNs must be careful to differentiate themselves from physicians who do have 00:06:08.160 --> 00:06:12.400 position:50% align:middle 10,000 hours of generalist training. 00:06:12.400 --> 00:06:17.220 position:50% align:middle And finally, it was brought to the attention of the group that recent 00:06:17.220 --> 00:06:23.860 position:50% align:middle research suggests that when barriers are removed, APRNs do fill the provider gap 00:06:23.860 --> 00:06:31.170 position:50% align:middle in rural underserved areas without compromising education and certification. 00:06:31.170 --> 00:06:37.070 position:50% align:middle I think this was something that many people in the group strongly believed and 00:06:37.070 --> 00:06:42.500 position:50% align:middle a conclusion that was arrived at that there is a regulatory responsibility 00:06:42.500 --> 00:06:47.840 position:50% align:middle to hold licensees accountable for what they have been prepared to do 00:06:47.840 --> 00:06:50.521 position:50% align:middle through their education and certification. 00:06:51.280 --> 00:06:56.560 position:50% align:middle And it was also suggested that there be a scope of practice decision tree 00:06:56.560 --> 00:06:58.679 position:50% align:middle available for APRNs. 00:07:01.270 --> 00:07:01.910 position:50% align:middle Licensure. 00:07:04.276 --> 00:07:09.570 position:50% align:middle And as you know in the model, the model now is that an APRN must hold 00:07:09.570 --> 00:07:15.640 position:50% align:middle licensure as an RN and APRN and there was a division. 00:07:15.640 --> 00:07:19.797 position:50% align:middle On this particular topic, there were definitely two opinions. 00:07:20.240 --> 00:07:27.420 position:50% align:middle Some people believe that both licenses are necessary, and some believe only an APRN 00:07:27.420 --> 00:07:31.413 position:50% align:middle would be necessary for an advanced practice registered nurse. 00:07:33.620 --> 00:07:41.220 position:50% align:middle But what came out in the discussion was the history of why two licenses were 00:07:41.220 --> 00:07:43.760 position:50% align:middle recommended and put into the model. 00:07:43.760 --> 00:07:51.274 position:50% align:middle And number one, was related to discipline because it was believed that if an APRN is 00:07:51.274 --> 00:07:57.310 position:50% align:middle disciplined due to an error that she makes and her license is suspended for a period 00:07:57.310 --> 00:08:03.870 position:50% align:middle of time, she can at least still work as an RN, having an RN license. 00:08:03.870 --> 00:08:10.630 position:50% align:middle And number two, it was pointed out that requiring an RN license assures that 00:08:10.630 --> 00:08:17.030 position:50% align:middle every APRN, especially internationally educated nurses, have passed the NCLEX. 00:08:20.100 --> 00:08:23.010 position:50% align:middle Education. 00:08:23.010 --> 00:08:29.990 position:50% align:middle As I'm sure you recall, the education requirement for an APRN is that an APRN 00:08:29.990 --> 00:08:38.150 position:50% align:middle must have a master's degree or higher, education must provide the three Ps, 00:08:38.150 --> 00:08:43.038 position:50% align:middle advanced physical assessment, physiology, and pharmacology. 00:08:47.000 --> 00:08:51.450 position:50% align:middle So let me tell you what those issues and discussions were. 00:08:51.450 --> 00:08:58.510 position:50% align:middle Some people at the meeting were that all APRN programs should be in person, 00:08:58.510 --> 00:09:01.080 position:50% align:middle then an online program should not be allowed. 00:09:01.080 --> 00:09:06.390 position:50% align:middle And again, I'm trying to bring you, if you weren't there, as close to the 00:09:06.390 --> 00:09:08.360 position:50% align:middle discussion as possible. 00:09:08.360 --> 00:09:11.980 position:50% align:middle Some of these were just pointed out by a few people. 00:09:11.980 --> 00:09:16.255 position:50% align:middle But again, I'm trying to capture for you what was brought up. 00:09:17.580 --> 00:09:21.980 position:50% align:middle Some brought up the question of are the three Ps still sufficient 00:09:21.980 --> 00:09:24.060 position:50% align:middle as basic requirements? 00:09:24.060 --> 00:09:27.480 position:50% align:middle Should there be a grade requirement in these courses? 00:09:27.480 --> 00:09:32.430 position:50% align:middle And should they be specialized by role and population? 00:09:32.430 --> 00:09:36.390 position:50% align:middle And at the conclusion, it was brought out that if the three Ps 00:09:36.390 --> 00:09:42.350 position:50% align:middle are specialized, and an APRN wishes to change the population foci, 00:09:42.350 --> 00:09:44.520 position:50% align:middle then they need to repeat those three. 00:09:44.520 --> 00:09:52.130 position:50% align:middle So they can't just go on and get a new population, but they would need 00:09:52.130 --> 00:09:55.732 position:50% align:middle to repeat a lot of extra coursework. 00:09:57.410 --> 00:09:59.300 position:50% align:middle Certification. 00:09:59.300 --> 00:10:05.760 position:50% align:middle The model requires that an APRN, obtain and maintain national certification 00:10:05.760 --> 00:10:08.457 position:50% align:middle in a role and population foci. 00:10:11.800 --> 00:10:16.020 position:50% align:middle A lot of the discussion was really centered around questions 00:10:16.020 --> 00:10:17.345 position:50% align:middle that were raised. 00:10:17.710 --> 00:10:21.709 position:50% align:middle What to do if a certification exam is retired? 00:10:23.260 --> 00:10:25.678 position:50% align:middle Should there be a generalist exam? 00:10:26.070 --> 00:10:29.840 position:50% align:middle Many people believed that that would really be of assistance 00:10:29.840 --> 00:10:37.070 position:50% align:middle in preparing APRNs, and some of the concerns also were that recertification 00:10:37.070 --> 00:10:41.960 position:50% align:middle is inconsistent, that there is no universal definition of a 00:10:41.960 --> 00:10:43.846 position:50% align:middle currency of certification. 00:10:44.780 --> 00:10:48.970 position:50% align:middle And I might add, that we were kind of left with those questions. 00:10:48.970 --> 00:10:53.547 position:50% align:middle A lot of those may be better answered by the certifiers. 00:10:54.970 --> 00:10:58.690 position:50% align:middle Finally, independent practice and prescribing. 00:10:58.690 --> 00:11:05.440 position:50% align:middle As you know, the model recommends that every APRN have an independent or full 00:11:05.440 --> 00:11:10.867 position:50% align:middle practice authority, as we call it now, and prescribing privileges. 00:11:11.860 --> 00:11:17.020 position:50% align:middle And so somebody pointed out that there is a negative connotation of the term 00:11:17.020 --> 00:11:21.800 position:50% align:middle independent practice, that can be interpreted and implied 00:11:21.800 --> 00:11:24.924 position:50% align:middle that APRNs do not consult with colleagues, 00:11:25.140 --> 00:11:29.332 position:50% align:middle and therefore, the term full practice authority is ideal. 00:11:30.950 --> 00:11:35.850 position:50% align:middle I do believe we are moving away from that term, independent practice. 00:11:35.850 --> 00:11:39.790 position:50% align:middle It still remains in the model, but I know most states when they're 00:11:39.790 --> 00:11:47.921 position:50% align:middle putting forward legislation do refer to it as full practice authority. 00:11:50.210 --> 00:11:55.910 position:50% align:middle And finally, there was a discussion about holistic nurses. 00:11:55.910 --> 00:12:02.520 position:50% align:middle Every state board has received a letter from Holistic Nurses wanting to have that 00:12:02.520 --> 00:12:07.899 position:50% align:middle specialty become part of the model, to have a specific population 00:12:07.899 --> 00:12:09.933 position:50% align:middle for holistic nurses. 00:12:09.933 --> 00:12:16.302 position:50% align:middle And the belief was that they are already covered under the model. 00:12:18.090 --> 00:12:24.160 position:50% align:middle So in summary, this event, I think, I received much feedback from the 00:12:24.160 --> 00:12:29.530 position:50% align:middle participants that it was a very good opportunity for discussion. 00:12:29.530 --> 00:12:33.700 position:50% align:middle But at the end of the day, there was agreement that the consensus 00:12:33.700 --> 00:12:36.640 position:50% align:middle model should not be revised. 00:12:36.640 --> 00:12:42.010 position:50% align:middle Many states have strived towards fully adopting the model and making changes 00:12:42.010 --> 00:12:45.496 position:50% align:middle would be disruptive and confuse the public. 00:12:45.496 --> 00:12:49.430 position:50% align:middle And if I can tell you that if there were underlying threads that were woven 00:12:49.430 --> 00:12:56.330 position:50% align:middle throughout the day, everybody talked about consistency, uniformity, 00:12:56.330 --> 00:13:00.090 position:50% align:middle the need to protect the public, and the need to continue 00:13:00.090 --> 00:13:02.040 position:50% align:middle to promote the model. 00:13:03.080 --> 00:13:04.500 position:50% align:middle Do you have any questions? 00:13:08.383 --> 00:13:08.470 position:50% align:middle - [Lisa] Hi, Maryann. 00:13:08.470 --> 00:13:10.060 position:50% align:middle Lisa Emmerich from Ohio. 00:13:10.060 --> 00:13:14.910 position:50% align:middle The report that came from this day, I may have missed it. 00:13:14.910 --> 00:13:16.585 position:50% align:middle Is it in the business book? 00:13:17.040 --> 00:13:22.230 position:50% align:middle - It is not in the business book, but every Board of Nursing was 00:13:22.230 --> 00:13:23.646 position:50% align:middle emailed a copy. 00:13:24.792 --> 00:13:28.258 position:50% align:middle - May I ask, was there a reason it is not in the business book? 00:13:28.258 --> 00:13:36.530 position:50% align:middle - Nothing specific, but the only reason was, we reported that to the board 00:13:36.530 --> 00:13:40.940 position:50% align:middle of directors in July, and it was too late to get it 00:13:40.940 --> 00:13:42.080 position:50% align:middle into the business book. 00:13:42.080 --> 00:13:46.120 position:50% align:middle But if you would like a copy of it, I would be happy to send it to you. 00:13:46.120 --> 00:13:48.050 position:50% align:middle - Thank you very much. 00:13:50.500 --> 00:13:52.903 position:50% align:middle - Anyone else? 00:13:54.560 --> 00:13:55.692 position:50% align:middle Thank you.