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SB 2 and SB 568 Overview Presented by Ann Sheehan, DNP, RN, CPNP MI NAPNAP Spring Conference March 28 ,2014. Advocacy is important to me, personally. Advocacy is important to me, professionally. Advocacy is important to the continuation of my career. Advocacy is my responsibility . - PowerPoint PPT Presentation
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SB 2 AND SB 568 OVERVIEW
PRESENTED BY ANN SHEEHAN, DNP, RN, CPNPMI NAPNAP SPRING CONFERENCE
MARCH 28,2014
Advocacy is important to me, personally
64% Agree24% Strongly Agree11% Disagree
Advocacy is important to me, professionally
65% Agree32% Strongly Agree3% Disagree
Advocacy is important to the continuation of my career
64% Agree25% Strongly Agree11% Disagree
Advocacy is my responsibility
68% Agree24% Strongly Agree8% Disagree
Advocacy is the responsibility of my professional organization
54% Agree42% Strongly Agree4% Disagree
Have you ever been to your state or national capitol to talk to legislators and/or
their staff regarding an issue related to health care or APRN practice?
71% No29% Yes
How often do you contact your state and/or national legislator(s)?
Monthly25%
Annually 20%
Only when prompted to do so by my professional organization
83%
The Problem DefinedTaft, S. & Nanna, K. (2008)
“Policy is shaped by how policy makers learn about health
care issues and how those issues are
defined as problems.”
Policy Facts
Legislation is made by
personal stories and anecdotes
Regulations are made with facts
and figures
Michigan Legislation
Senate Bill 2
SB 2 Define the Scope of APRN Practice Allow NPs to provide health care services
within their scope of practice Allow for prescriptive authority within the
APRNs scope of practice Requires APRNs to consult with other health
professionals and make referrals
SB 2 Defines APRN Scope of Practice APRN
Nurse PractitionerNurse MidwifeClinical Nurse SpecialistNurse Anesthetist (this group of APRNs are not
included in SB 2)
The definition WILL NOT expand the scope of practice but WILL define the scope of practice for APRNs in the state of Michigan
Education
Training
Certification
Defines APRN
scope of practice
How Nurse Practitioner Scope of Practice Differs from Physician
Physician scope of practice, as defined by their education, training and experience
NEONATAL
GERONTOLOGY
ADULT
PRI
MARY
CARE
ADULT
ACUTE
CARE
PEDIATRIC
PRI
MARY
CARE
PEDIATRIC
ACUTE
CARE
FAMILY
PSYCH
MENTAL
HEALTH
COMMUNITY HEALTH
WOMEN’S HEALTH
Nurse Practitioner scope of practice, as defined by their education, training and experience
Consultation and Referrals
All health care
providers consult with each other
No one health care provider is
an expert in every field
SB 2 WILL NOT Require new or additional third party
reimbursement Mandate workers compensation benefits Mandate increased reimbursement rates for health
care services from health care insurers Allow NPs to form PLLC or PC Interfere with current or future health care insurers
requirements for direct reimbursement Interfere with current or future practice
arrangements made with employers and employees
SB 2 Facts Update Michigan’s Public Health Code to
reflect what is currently going on in practice 18 states and DC have defined scope of
practice with equal or better patient outcomes than physicians
Prescriptive authority and licensure allows for better tracking of patient outcomes and allows for improved transparency in billing and accountability
SB 2 Facts No data from states that impose greater
restrictions on APRN practice suggests safer or better patient care or that the roll of the physician has changed or deteriorated
Trends show that APRNs are moving out of states with restrictive practice acts decreasing patient access to care in those states
APRNs support the Patient Centered Team-based Model of Care that integrates interprofessional patient care with the specific needs of the patient at the forefront
SB 2 Actualizes the RWJ and IOM “The Future of Nursing” Report AND Governor Snyder’s Healthy
Michigan Initiate Nurses should practice to the full extent of their
education and training Nurses should achieve higher levels of education
and training to promote health care and improve patient outcomes
Nurses should be full partners with physicians in providing health care
Effective planning and policy making requires better data collection and improved infrastructure
Federal Trade Commission
The Federal Trade Commission supports unrestricted APRN practice acts in every state
The Federal Trade Commission has sent letters to state congressional leaders who have failed to pass unrestricted APRN practice acts sighting restraint of trade
SB 2 Bottom Line
APRNs in Michigan are already providing health care to many patients
20 years of research shows that APRNs Do not increase liability claims or costsHave equal or higher patient satisfaction Have equal or better patient outcomes
A recent study showed that underutilization of APRNs costs our nation nearly $9 billion annually
SB 2 on the Senate FloorNovember 13, 2013
SB 2 Amendments
1. Prohibit APRNs from opening independent
practices after the bill becomes law.
This does not apply to non-
profits such as NMHCs
2. Extends a mentorship
agreement for new APRN grad from 2 years to 4
years. The mentor can either be a physician or a licensed APRN
3. Adds 2 physicians to the
newly created APRN taskforce
(this taskforce will provide
disciplinary action for APRNs when
necessary)
4. Holds APRNs that practice
independently (without
supervision of a physician) to the same standards as physicians in
cases of malpractice
On to the House of Representatives
Currently sitting in the House Health Policy Committee
Still called SB 2
House Health Policy Committee Members Gail Haines (Chair) 43rd District Mike Calton (Maj. Vice-Chair) 87th District Hugh Crawford, 38th District Bob Genetski, 80th District Mike Shirkey, 65th District Thomas Hooker, 77th District Ken Yonker, 72nd District Dale Zorn, 56th Disctrict Joseph Graves, 51st District Klint Kesto, 39th District George Darany, (Min Vice-Chair), 15th District David Knezek, 11th District Kate Segal, 62nd District Thomas Stallworth, 8th District Winnie Brinks, 76th District Phil Cavanagh, 10th District
All of this has to be accomplished by December 31, 2014 or this bill
dies and the process starts all
over again
1. Voted out of House HP Committee
2. Vote on the House Floor
3. Must come out of the House the same as it
came out of the Senate
4 .Committee to reach a consensus
5. Goes to the Governors
desk for signature
MSMS Propaganda
http://www.youtube.com/watch?v=qDotJFkPw6Y
MSMS Propaganda Under SB 2, "Nursing care provided by a CNP includes ordering,
performing, supervising, and interpreting laboratory and imaging studies." This is effectively the definition of a pathologist and a radiologist. These specialties generally require between 8-10 years of specialized training and often perform extremely complicated genetic and molecular tests.
Under SB 2, Advance Practice Nursing includes, "diagnosing, treating, and managing patients with acute and chronic illnesses and diseases." This definition is extremely broad and could potentially encompass any patient that would walk into my office or through the hospital doors.
Under SB 2 , Certified Nurse Midwives could offer "treatment of male partners for sexually transmitted infection, and reproductive health." Reproductive health is extremely broad, and could include extremely invasive procedures.
MSMS Propaganda Are you willing to put Michigan citizens at risk? Together, physicians and nurses work for the
general welfare of patients in Michigan, and their partnership fosters the development of groundbreaking advances in medicine.
It's a partnership focused patient care. It's a partnership that's working. It's a partnership worth preserving
Michigan Legislation
Senate Bill 568
SB 568 Introduced by Senator Marleau as a counter
to SB 2Introduced in October 2013
Senator Marleau is the Chair of the Senate Health Policy Committee
Supported by physician groups Bill currently sits in the Senate Health Policy
CommitteeIt has not had a first reading in this committee yet
SB 568 Will Replace the regulatory boards and disciplinary
subcommittees with separate task forces for allopathic physicians, osteopathic physicians, PAs and APRNs
Allow health professional licensees to form a patient care team and require the team to have a practice agreement
Create the Michigan Patient Care Board and require it to establish a model practice agreement for the patient care teams
Require a PA or APRN to be a care team member in order to practice
SB 568 Will Eliminate references to CNM and CNP specialty fields
and provide for the licensure of CNMs, CNPs, and CNSs as APRNs
Extend to APRNs certain provisions that apply to PAs Include a PA and an APRN in the definition of
“prescriber” in the Pharmacy Practice and Drug Control Act
If a licensee organized as a PC or PLLC with other licensees, each stakeholder of the corporation or member of the company must comply with all applicable requirements to engage in his/her health profession
SB 568 and Michigan Business Includes APRN and nurse anesthetist in the
definition of professional services Authorizes a physician to organize a PC or
PLLC with any other licensed individualsExpands this option to more than just PAs
Allows a licensed physician to organize a PLLC with one or more CRNA
Eliminates ban on PAs from forming PCs or PLLCs without other professionals
SB 568 and Patient Care Creates a Michigan Patient Care Board with
the Department of Licensing and Regulatory Affairs (LARA) 3 allopathic physicians3 osteopathic physicians3 PAs3 APRNs7 public members
Board would establish a model practice agreement for use by physicians and PAs and APRNs who organize a patient care team
SB 568 and Patient Care Task Force Patient Care Taskforce designed to regulate various
health professions Make recommendations to the Patient Care Board
regarding improvements for patient care Create separate Regulatory and Disciplinary Task
Forces for each health professionSets forth rules for implementation of its power and dutiesSets forth rules to establish the requirements for education,
training and/or experience of a health profession for licensure in MI
Establishes criteria for the evaluation of programs for educating and training the individual health professions to determine whether grads of programs have the knowledge and skills necessary for practice
SB 568 and Patient Care Teams Licensees can form patient care teams to
collaboratively provide patient care in the best interest of the patient’s health
Patient Care Team is made up of at least 2 licensed health professionals, including at least 1 physician
The team’s practice agreement has to be available to the Board at any timeMake physician continuously available to other
members of the team
Patient Care Teams and APRNs
In order to engage in practice, a PA or APRN would have to enter into a practice agreement as a member of a patient care team
Bill would require referral to a PA or APRN in his/her capacity as a patient care team member, rather than a person performing a delegated task under a physicians supervision
Other revisions and SB 568 Defines a prescriber as a licensed dentist,
podiatrist, optometrist, veterinarian, or other licensed health professional acting under the delegation and using, recording, or otherwise indicating the name of the delegating physician
Refer to APRNs rather than CNMs and CNP
SB 568 Facts Michigan Patient Care Board is physician dominated Patient is defined as an individual who is under the
care of a physician or a patient care team Definition of APRN does not include CRNA Only APRNs and PAs are required to be part of a
patient care team RNs and CRNAs would continue to be regulated
under the BON while CNS, CNPs, and CNMs would be regulated under the new Patient Care Board and new APRN taskforce and the BON for the RN license
SB 568 Facts Definition of collaboration means that
communication and decision making process occurs among members of a patient care team
Definition of patient care team means a team of 2 or more licensed health professionals including at least 1 physician
Physicians are not required to practice in a team, while APRNs and PAs are subject to practice in collaboration with a physician in a patient care team
SB 568 Facts Allows for a 19 member patient care board to
establish a model practice agreement Patient care teams must have a practice
agreement in place as previously described APRNs and PAs must enter into a practice
agreement as a member of a patient care team
APRNs and PAs can ONLY provide medical care services as a member of a patient care team
SB 568 Facts APRNS and PAs may make calls or go on
rounds, in collaboration with a physician APRNs and PAs may prescribe drugs if they
are a member of a patient care team
Each APN needs to Talk to YOUR House Member
Especially if your member sits on the House HP Committee Create Talking Points Create an Elevator Speech Repeat your talking points and elevator speech to everyone
so it rolls off your tongue when you are asked about NPs and legislation related to NPs
Stick to your points, don’t get caught up in arguments that don’t have merit or evidence
Ask for evidence when you are presented with challenges Collect Personal Stories Join a Professional Organization
Creating Michigan’s APRN Future
A change in health care
delivery will not be realized until APRNs become
comfortable advocating for
themselves and their profession
The days of silently standing
by as other professions prescribe
nursing’s fate should be long
gone
Need to create opportunities for
nurses to participate in
advocacy activities with or without a mentor
Empowered Advocates
Mentorship
Stay Informed
Opportunities
Preparation for a Legislator Visit Review your talking points/the points you want to
makeCreate a leave behind one-pager
Research the legislators voting record and know what committees he/she sits onThank him/her for support on legislation you are interested
in Bring examples that demonstrate how your APRN
role is a critical part of the health care for your legislator’s constituents
Be prepared to tell personal stories to illustrate your points
During your Legislator Visit Introduce yourself, where you work and where you live Ask if the legislator has knowledge or personal
experience with an APRN (or more specific: NP, NMW, CNS)What does he/she know about NPs?Does he/she know any NPs?
Briefly describe your practice and what a typical work day is like for you, the type of activities you do in assessing and managing your patient’s care
Ask what the legislator’s main priorities and/or concerns are for his/her constituents related to health care, then start your conversation there
Building Legislative RelationshipsRule of 5’s
Attend a “meet the candidate” or “open house” eventOrganize an event with several APRNs for your legislator
Donate time and/or money to support a candidate that is running for office
Write a note of congratulations to the candidate that wins and remind them that you can be a consultant on health issues or other expertise you have
Send a thank you note when he/she does something good that has nothing to do with health care
Copy news articles that might be of interest related to a bill you are for or against
The Last WordsEducate, Educate, Educate
Many Legislators don’t know the difference between an LPN and an NP
What will happen if you ignore or don’t participate in this discussion?You could be educated for a career that does not exist any
longer in Michigan It took DOs 100 years to get their scope of practice
issues worked outThe NP profession is 49We are about half way there!
Participate in this health care reform TODAY
It is a long walk to the Capitol by yourself!