Driving APRN Policy: A Legislative Success

James LaVelle Dickens, DNP, FNP-C, FAANP

Texas ranks 47th in the country in the supply of primary care physicians

Out of the 254 counties in Texas, 185 are designated as medically underserved

Historically, policies limited APRNs scope of practice and restricted APRNs ability to address the primary care shortage

Primary care shortages will continue and the aging population is on the rise

The number of primary care providers per 100,000 rural population is significantly less than in metropolitan areas

0

2000

4000

6000

8000

10000

12000

2001 2011

Number of APRNs

Senate Bill 406 “Texas Team”

Action Coalition

The Future of

Nursing: Leading

Change,

Advancing Health

June 14, 2013 Senate Bill (SB) 406 was signed into law by Governor Rick Perry

SB 406 - first piece of legislation in over a decade that significantly broadens APRN scope of practice

October 2010 - Institute of Medicine (IOM) report released, The Future of Nursing: Leading Change, Advancing Health

IOM Recommendation – remove barriers that prevent APRNs from practicing to the fullest extent of their education and experience

The Future of Nursing: Campaign for Action was created under the Robert Wood Johnston Foundation

Texas based action coalition was “born” and named “The Texas Team; Advancing Health through Nursing”

The Texas Team worked to increase access to care for Texans through expanded scope of practice for Advanced Practice Registered Nurses (APRNs)

And employed specific strategies to achieve a successful inter-professional collaboration.

November 2011, “The Texas Team” convened the APRN Roundtable

Texas Nurses Association, Coalition for Nurses in Advanced Practice, APRN specialty organizations were represented at the roundtable

APRN Roundtable - strategies were identified by the groups to achieve consensus on scope of practice expansion

May 2012 – APRN groups testified to legislative committee

Intent to move forward with legislative change in Prescriptive Authority model

Dr. Ray Perryman issued report regarding the economic benefit in greater utilization of APRNs

Senator Jane Nelson, Chair of Senate Health and Human Services Committee

Representative Lois Kolkhorst, Chair of the Public Health Committee

Legislators encouraged collaboration between nursing and medicine

Negotiations began on new model Texas Nurses Association

Coalition for Nurses in Advanced Practice

Texas Nurse Practitioners

Texas Medical Association

Texas Academy of Family Physicians

Texas Academy of Physician Assistants

Senator Jane Nelson and staff

Representative Lois Kolkhorst and staff

SB 406 was filed on February 26, 2013

Signed by Governor on June 14, 2013

Effective November 1, 2013

Eliminates the requirement for onsite physician supervision

Allows physicians to delegate drug and durable medical devise prescribing authority to an APRN or PA

Increases the number of APRNs or PAs to whom a physician can delegate prescriptive authority from 4 to 7

Improved coordination between the Texas Medical Board and the Board of Nursing

Allows physicians to delegate prescribing authority to APRNs and PAs for Schedule II controlled substances in hospital and hospice settings

Outcomes

Lessons learned

Moving Forward

Peck, J. L., Addressing the Texas Health Care Crisis: Effective Use of Advanced Practice Registered Nurses. The Journal for Nurse Practitioners. 2013; 9 (2):116-120.

Tovar, S. APRNs Achieve First Expansion of Prescriptive Authority in a Decade. Texas Nurses Association. The Nursing Voice. July 2013