KEY MESSAGES OF THE INSTITUTE OF MEDICINE 2010 REPORT 1) Nurses should practice to the
full extent of their education and training.
2) Nurses should achieve higher
levels of education and training
system that promotes seamless
through an improved education academic progress.
3) Nurses should be full partners
with physicians and other health
health care in the United States.
care professionals, in redesigning
4) Effective workforce planning
and policy making require better
data collection and an improved information infrastructure.
Even before the ACA was passed, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) identified the inability of advanced practice nurses to consistently practice to their full scope as a major concern. In 2008, they launched a two year initiative to assess and transform the nursing
It further states that “readily available” means the physician
profession. A committee was appointed that was tasked with
must be in near proximity and able to be contacted either in
producing an action-oriented blueprint for the future of nursing
person or by telecommunications or other electronic means
(see box above). In preparing their report, The Future of Nursing:
to provide consultation and advice to the NP, CNM, or CNS
Leading Change, Advancing Health, the committee considered all obstacles nurses face, paying particular attention to the legal barriers in many states that prohibit advance practice registered nurses from practicing to their full education and training. The committee determined that such constraints must be lifted in order for nurses to play a significant role in meeting increasing health care demands and the decreasing pool of qualified providers. The legal barriers vary widely among states. In South Carolina, the Nurse Practice Act states that a licensed Nurse Practitioner (NP), Certified Nurse Midwife (CNM), or Clinical Nurse Specialist (CNS) performing delegated medical acts must do so under the general supervision of a licensed physician or dentist who must be readily available for consultation. The Practice Act defines “delegated medical acts” as additional acts delegated by a physician or dentist to the NP, CNM, or CNS and may include formulating a medical diagnosis and initiating, continuing, and modifying therapies, including prescribing drug therapy, under approved written protocols as provided in Section 40-33-34. Both the Board of Nursing and the Board of Medical Examiners must approve the delegated medical acts.
performing delegated medical acts. When application is made
6
Lifelines
FALL | WINTER 2012
for more than three NP’s, CNM’s, or CNS’s to practice with one physician, or when an NP, CNM, or CNS is performing delegated medical acts in a practice site greater than 45 miles from the physician, the Board of Nursing and Board of Medical Examiners must review each application to determine if adequate supervision exists. So what is the real issue here? Currently South Carolina has some of the poorest health outcomes in the nation and yet many areas of the state go without primary care because of restrictions on APRN practice – restrictions that do not exist in many other states. It is as if we are asking our APRNs to practice with one hand tied behind their back. Why educate someone to be a competent primary care clinician, and then limit their ability to practice? In this publication of Lifelines we will challenge the rhetoric and critically examine APRN practice as it relates to access, quality, safety and the economics of care. This is about your health and your health care. We ask you to decide what is the right thing to do and when is the right time for change.