The Improving Care and Access to Nurses Act (ICAN), H.R. 8812, promotes patient access to health care services delivered by the provider of their choice by removing outdated Medicare and Medicaid barriers on advanced practice registered nurses (APRNs). We’re calling all CNSs to start a conversation in person and online about ICAN. Let’s continue to advocate and break down barriers for CNSs. To learn more about ICAN visit the American Nurses Association Website.
Nursing News
A 21st Century Renaissance Man: Sean M. Reed Puts Diverse Experience to Work
Read the most recent press release from our affiliate the Rhode Island Association of Clinical Nurse Specialists
We are pleased to introduce the Rhode Island Association of Clinical Nurse Specialists (RI-CNS). RI-CNS serves to meet the needs of CNSs across the state regardless of specialty or area of practice. The mission of RI-CNS is to promote the full scope of practice for CNSs, and to promotes the value and increases the visibility of the CNS among healthcare organizations, administrators, healthcare professionals and the public.
Nurse Coffee Talk: Unstoppable Advocacy with Dr. Phyllis Whitehead, President NACNS
Augustana University to add master’s of science in nursing program this fall
Augustana University is planning to offer a master’s of science in nursing program starting this fall.
The program will have an emphasis in two areas: adult-gerontology acute care nurse practitioner (AG-ACNP) and adult-gerontology clinical nurse specialist (AG-CNS).
By the summer of 2023, the university will also offer two post-master’s certificate options, including AG-ACNP and AG-CNS.
The program additions are part of Augustana’s “Viking Bold: The Journey to 2030″ strategic plan, which identified the goal of developing graduate degree programs, responsive to new and emerging student interests and community needs.
To gauge the level of demand for graduate nursing programs in Sioux Falls and across the region, the Department of Nursing conducted a feasibility study that included an environmental scan of competitive local and regional nursing programs, comparing curriculum and costs, as well as surveys of prospective students and AU alumni.
The 2021 South Dakota Nursing Workforce Report indicated that more than 78% of certified nurse practitioners in South Dakota are family nurse practitioners and less than 11% had an acute care certification, according to a press release from the university.
The 2021 report also showed that the number of clinical nurse specialists (CNSs) in the state decreased by nearly 13% from 2018, with another 41% of CNSs stating that they planned to retire or leave practice in the next five years, according to the university.
Prospective students indicated an interest in attaining a graduate nursing degree across more than a dozen areas of specialties, including nursing administration and leadership, ACNP and CNS.
“We are really excited to be entering this phase of nursing education,” Dr. Lynn White, associate professor of nursing, said. “At the same time, we’re also very concerned about, and have an eye on, the nursing and health care workforce needs of the community.”
Currently, South Dakota does not have academic programming that trains acute care nurse practitioners or clinical nurse specialists, according to Augustana University.
And there are very few adult-geriatric acute care nurse practitioners, Pamela Barthle, assistant professor of nursing and an AG-ACNP in cardiology at Sanford Health, said.
“There’s not an abundance in South Dakota because there are really no resources for that,” Barthle said. “I believe the hospitals see the benefit in having that specialty.”
White also said that there’s a gap in clinical nurse specialist education, and there aren’t many CNSs in the workforce in South Dakota and many of those who are in the workforce are of retirement age.
Nurses who hold a Bachelor of Science degree and valid nursing license with nursing practice experience are eligible to apply to Augustana’s graduate nursing program.
The program will be delivered in a hybrid model with the curriculum designed to accommodate students who work while enrolled in the program. The certificate programs will provide an opportunity for nurses who already have received their master’s degree in a different nursing specialty area to become certified as an ACNP or CNS.
Full practice authority: What it means for NPs
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Liability considerations as nurse practitioners’ scope of practice expands
Multiple studies have proven the effectiveness of nurse practitioners (NPs) in improving patient outcomes, yet for many years, the push for NPs to gain full practice authority (FPA) has been an uphill battle. Fortunately, recent developments have led to significant progress with achieving FPA for NPs in the United States. This is good news for NPs — and for patients — but it’s crucial to understand that FPA comes with professional responsibilities and the need to protect yourself against potential liability.
FPA defined
According to the American Association of Nurse Practitioners (AANP), state practice and licensure laws related to NPs fall into three categories: restricted, reduced, and full.
FPA laws and regulations enable NPs to practice to the full extent of their education, training, and certification, without physician oversight. NPs can evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments (including prescribing medications and controlled substances) under the licensing authority of the State Board of Nursing.
Reduced practice limits NPs’ ability to engage in at least one element of their practice. For example, the NP may not be able to prescribe controlled substances. The law requires NPs to have a collaborative agreement with another healthcare provider to provide patients care or limits the setting of one or more elements of NP practice.
When their practice is restricted, NPs are restricted in their ability to engage in at least one element of their practice, and they are required to have supervision, delegation, or team management by another health provider to provide care.
According to the AANP, 24 states and the District of Columbia allow FPA, 15 have reduced practice, and 11 have restricted practice.
Drivers of FPA
Trends driving FPA include the COVID-19 pandemic, recognition of how NPs can improve the nation’s healthcare, a shortage of primary care providers, and the shift in care away from hospitals.
The COVID-19 pandemic prompted several states and the Centers for Medicare & Medicaid Services to ease or suspend supervision requirements and modify some practice requirements to enhance providers’ ability to provide care and address physician shortages. It’s expected that many of these changes will remain even after the pandemic subsides. The demand for care created by the pandemic came on top of an aging population and the implementation of the Affordable Care Act in 2010, which enabled millions of people to obtain coverage for healthcare.
NPs’ role in the nation’s health received major support from the 2021 report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. The report, published by the National Academies of Sciences, Engineering, and Medicine, calls for eliminating restrictions on the scope of practice; doing so will “increase the types and amount of high-quality health care services that can be provided to those with complex health and social needs and improve both access to care and health equity.”
According to data from the Health Resources & Services Administration, as of November 2021, 85 million people list in areas with a shortage of primary care providers. Rural areas are more likely than urban areas to have shortages. In 2020, the Association of American Medical Colleges predicted that the shortage of primary care physicians would be between 21,400 and 55,200 by 2033. (Those figures jump to 54,100 and 139,000 when specialty physicians are included.)
About 70% of NPs deliver primary care, according to the AANP, making them an ideal source to provide care in underserved areas. In fact, a 2021 study by Xu and colleagues noted that many NPs are already working in states with an inadequate supply of primary care providers to care for patients who are dual-eligible for Medicare and Medicaid. Yet these states, primarily in the Southeast, often restrict practice, hampering access. In addition, a 2018 report from UnitedHealth estimated that if NPs had FPA, there would be a 70 percent reduction in the number of people living in areas with a primary care shortage.
The shift of care away from hospitals has driven the need for NPs with FPA so they can practice autonomously. For example, NPs provide much of the care in retail clinics and urgent care centers. Models that focus on population health, such as accountable care organizations, also provide an ideal setting for the autonomous NP. And NPs are playing greater roles in home and long-term care.
It’s worth noting that a diverse group of organizations support FPA for NPs, including AARP, the Federal Trade Commission, National Academy of Medicine, National Council of State Boards of Nursing, and the Department of Veterans Affairs, which granted FPA to NPs in 2016.
FPA and liability
FPA is the gold standard for NP practice, but it also may increase the risk of liability, particularly in areas related to the scope of practice, medications, and diagnosis. For example, according to the NSO Nurse Practitioner Claim Report: 4th Edition, claims related to diagnosis rose from 32.8 percent in 2012 to 43 percent in 2017. In the same time frame, the percent of claims related to medications increased from 16.5 percent to 29.4 percent, and those related to scope of practice jumped from 0.5 percent in 2012 to 4.2 percent.
To protect yourself, periodically review your coverage with your insurance provider to ensure it is sufficient based on your practice specialty (e.g., adult medical/primary care and family practice made up 53.7 percent of closed claims in the NSO report) and location (the most common areas of closed claims are physician or NP office practices and aging services/skilled nursing settings). You also should have coverage related to actions that could be brought against your license.
Avoiding liability
To avoid liability as an NP, ensure you are practicing under the laws and regulations in the state(s) where you are licensed. You can find a summary of information at the AANP website
(https://www.aanp.org/practice/practice-information-by-state), but you’ll still need to review the state’s Nurse Practice Act in detail.
You also should consider how you can reduce your risk of liability in a variety of areas, including your relationship with your patients (e.g., communicate clearly and work with patients to identify goals), documentation of patient information (e.g., keep records secure and don’t make subjective comments), informed consent (e.g., explain risks and take time to answer questions), patient education (e.g., use the teach-back method to ensure understanding and document education in the health record), and barriers to compliance (e.g., be nonjudgmental and identify patient concerns). Pay particular attention to medication safety (see: Reducing liability).
Positioned to succeed
NPs with FPA are well-positioned to improve patients’ access to care and to deliver excellent care to those who seek their help. However, NPs also must ensure that they protect themselves from liability related to lawsuits and actions against their licenses.
NACNS Sponsored Article by Georgia Reiner, MS, CPHRM, Risk Specialist, NSO
Download the full sponsored article here.
Barach Nursing Annual Report Highlights CNS
Produced and published by the Henry Ford Health System.
Informing and Supporting the New Clinical Nurse Specialist Prescriber
Advanced practice registered nurses (APRNs) in the United States are trained to diagnose and treat disease and illness, hence, to prescribe. Of the APRN roles, the clinical nurse specialist (CNS) is the least likely to prescribe. Prescribing is one of many advanced care interventions performed by CNSs, but the statutes regarding prescriptive authority are constantly changing. The purpose of this article is to inform and support the new CNS prescriber. The article reviews CNS prescribing, credentialing and privileging, safety strategies, and educational considerations that influence CNS prescribing and offers current recommendations for new CNS prescribers. Clinical nurse specialist prescribing can enhance the patient care experience and fill unmet prescriptive needs for patients. Overall, more reports on the outcomes of CNS prescribing are urgently needed, specifically, publications on CNS prescribing in acute care, where most CNSs practice.
Year in Review: Reflections on Nursing in 2021 With an Eye to the Future
To commemorate the 200th anniversary of the birth of Florence Nightingale, the World Health Organization (WHO) designated 2020 the International Year of the Nurse and the Midwife. The year turned out quite differently than expected, due to the onset of the COVID-19 pandemic.
But in recognition of the contributions made by the healthcare force, the WHO extended the celebratory year by designating 2021 the International Year of Health and Care Workers “in appreciation and gratitude for their unwavering dedication in the fight against the COVID-19 pandemic.”
In a speech in late 2020, the WHO regional director for Europe, Hans Kluge, MD, promised nurses: “We will push back COVID-19 and I promise: we will celebrate you.” Unfortunately, Kluge was unable to keep his promise about pushing back COVID-19, as the pandemic spilled over into 2021 and raged throughout the year, even with the availability of a vaccine. Rather than being a year celebrating nurses, it continued as a year fraught with turmoil as the pandemic challenged the capacity of hospitals and intensive care units (ICUs) worldwide.
The pandemic seemingly far from being over, 2021 is ending with severe staffing shortages and hospitals in many regions — both in the US and abroad — bursting at the seams with COVID-19 patients, to say nothing of those needing care for other conditions.
The work and sacrifice of nurses and other healthcare professionals during the pandemic did not go unnoticed, as headlines often focused on the challenges workers were contending with. However, at the same time, the pandemic also put a glaring and unforgiving spotlight on the deficiencies and shortfalls of the healthcare system — both in preparedness for an emergency and in basic support of its nursing staff.
Native American and Indigenous Nurses You Should Know About
Native Americans face disparities in healthcare, but these five trailblazing nurses confronted the medical system to improve healthcare access and outcomes for Indigeneous people. Read about their legacies.
The accomplishments of Native American nurses often remain overlooked. However, Native Americans and Indigenous people have a history in medicine that dates back thousands of years.
Healers in 1,000 B.C. used native plants, such as peyote, for anesthesia. Native Americans sang healing songs passed down from generations and made poultices for medicine. Indigenous nurses who recognized the benefits of traditional medicine have incorporated it into Western medicine, while often facing backlash.
Despite the important contributions made in healthcare, Native Americans and Indigenous people have a life expectancy of 5.5 years less than other communities in the United States, according to the Indian Health Service. More than 5 million Native Americans and Indigenous people face drastic health disparities. These communities encounter some of the highest rates for heart disease, diabetes, and chronic liver disease.
The five trailblazing Native American nurses featured here overcame discrimination to pursue their education and made it their mission to improve healthcare for their communities.