Unleashing the Potential of CA APRNs:A View from ANA

__________________________________ Lisa Summers, CNM, DrPH

Senior Policy Fellow, Department of Nursing Practice & Policy

April 30, 2011APRN SummitSan Pedro, CA

Overview

ANA Advocacy on APRN Issues (a national - or perhaps “inside the beltway” - perspective)

Four Thoughts to Offer (as a supportive “outsider”

Discussion

ANA Advocacy on APRN Issues

With limited seating at many policy tables, ANA is often in a position to be the sole voice of nursing. This position has become increasingly crucial, yet sensitive, with the growth of nursing specialties and the increasing importance of varied nursing roles. As a historical convener of the larger nursing community, ANA seeks to fully and accurately represent the nursing community. Each of the following is prefaced with “work with other organizations representing APRNs and key stakeholders to ….”

ANA Advocacy on APRN Issues

Ensure the ability of APRNs to practice to the full extent of their education and training. ANA’s “Regulatory Rapid Response Team” is being vigilant with regard to the implementation of the Affordable Care Act, including a host of issues that impact APRNs.– Hot topic: 475 pages of regulatory language on

implementation of the provision establishing Accountable Care Organization

ANA Advocacy on APRN Issues

Embed IOM definition of primary care in all legal and regulatory work on health system reform, particularly the medical (or primary care) home.– Lots of recent activity on Joint Commission Primary Care

Home Standards and EPs

Facilitate a widespread understanding of and acceptance for the Consensus Model for APRN Regulation and work to implement the model.

ANA Advocacy on APRN Issues

Advocate for increased funding for advanced practice nursing education, including expansion of recently enacted graduate nurse education (GNE) demonstration projectAchieve equitable reimbursement for APRNs Provide a legal challenge to arbitrary practice restrictionsFacilitate the ability of APRNs to be privileged as LIPs in institutions.

ANA Advocacy on APRN Issues

Ensure that nurses are involved in the design, development and implementation of HIT systems, and that APRNs are eligible for funding to enhance adoption of HIT. Ensure that ANA’s expansive work in the national quality enterprise is in concert with APRNs efforts to be included in national performance measurement programs currently designed for physicians. Gather and disseminate workforce and payment data

Kudos to CA APRNS

Goal: create a strong coalition to address barriers to APRN practice in CAWhite paper: to create a unified message for CA legislators about how APRNs can help fill healthcare needs in CA

Four Thoughts

Carpe diem!

Continued coalition building is key

Carefully consider the role of the white paper

Be forward looking

Carpe diem

Unique moment in time…open door…tipping point …harmonic convergenceConsensus Model for APRN Regulation – solutions to long-standing problems; everyone gave a littleHealthcare reform – unity in the Nursing Community was fruitful; can be leveraged despite a legislators view of ACAIOM report: Future of Nursing – potential impact of Flexner Report?Unprecedented consumer engagement

Coalition building

“Usual” challenges of APRN coalition building– 4 unique professional roles– multiple organizations

Unique challenges of coalition building in CA:– Geography– Statutory language– Somewhat rocky history and interorganizational

relationships; “fragmented”– Board of Nursing in the headlines

Coalition building

A coalition is an alliance of organizations that come together to address a specific problem and reach common goals. Within a coalition, groups attain– Strength in numbers– Increased credibility– Professional networking opportunities– Increased knowledge-sharing– Better media reach– Better access to legislators and regulators

Coalition building

A state coalition – particularly one that is broad-based (beyond nursing) provides a unique platform to be heard

Helps audiences understand that it’s not just individual professions fighting for turf...

it’s a bigger access issue.

Building partnerships beyond nursing

The Coalition for Patient’s Rights – formed to counter the AMA Scope of Practice Partnership– www.patientsrightscoalition.org

AARP – 2010 policy statement– http://championnursing.org/resources/aarp-2010-policy-supplement-s

cope-practice-advanced-practice-registered-nurses

Citizen Advocacy Center – Reforming Scope of Practice Toolkit– www.cacenter.org/cac/SOP

The white paper

The white paper

Recall that it was part of an overall strategy.It is a means to an end, not an end in itself.Don’t be burdened by it.Don’t let the perfect be the enemy of the good.The process has been important and valuable.Remember the ultimate audience, as you appreciate what it has done for you internally.

The white paper – key messages

From the legislators perspective – Californians need health care– It’s expensive– They have to balance the budget– Lobbyists and $$ fuel the process, but– They have a broad constituency in the voters

Scope of practice: it’s not a doctor-nurse turf war; it’s about responding to the need for increasing access and controlling costs

Be forward looking

It’s all about the relationships (positive and negative)Let go of hard feelings and ancient past; focus on the futureEach of the 4 APRN roles faces unique problems and opportunities,as does each of the 4 LACE entities. ANA seeks to represent the interests of the entire nursing profession, including the each of the 4 APRN roles.

The coalition looking forward

Narrowing the focus, defining the mission• Know your allies/opponents

“Step 1: What needs changing?– There are a host of complex rules and regulations that

need to be carefully analyzed to determine what needs changing.

– The answer to this key question will not always be the same for each the 4 APRN roles – again, effective coalition building in the states will be key!”

ANA’s February Consensus Model Update for our state associations

The coalition looking forward

Devise a strategy for action– Very difficult to do without talented lobbyists who

collaborate and facilitate communication– “The hesitancy in some states/organizations to ‘implement

the Consensus Model’ is a result of a well-founded concern that we ‘first, do no harm.’”

– For those reluctant to “open the practice act,” remember that whenever the legislature is in session, anyone can introduce legislation to change your practice

The coalition looking forward

5 Golden Rules of a Coalition Coalition for Patients Rights State Based Coalition Building Program

– Be inclusive not exclusive– All members must be treated as equals– Participation is required, not always agreement– Diplomacy always wins– Communicate often and be transparent

Understand the differences; act on the commonalities.

Thank you!

Questions? Discussion

Lisa Summers, CNM, DrPHSenior Policy Fellow, Department of Nursing Practice &

PolicyLisa.Summers@ana.org

301-628-5058