The Advanced Practice Nurse in Massachusetts

The Advanced Practice Nurse in Massachusetts

November 2014

Contents

About the Massachusetts Action Coalition:.......................................................................................ii APRN Scope of Practice Work Product ...........................................................................................iv Introduction ............................................................................................................................................ 1 Scope of Practice Vignette: NP Practice in the Northeast ..................................................................... 1 NCSBN Consensus Model.....................................................................................................................7 Massachusetts Nurse Practice Act and the NCSBN Consensus Model ............................................. 7 Titling and Scope of Practice ............................................................................................................. 8 Licensure ............................................................................................................................................ 8 Prescribing, Ordering, Dispensing, and Furnishing ........................................................................... 9 Oversight for Nursing Practice ........................................................................................................ 10 Education and Preparation of APRNs..................................................................................................10 Clinical Outcomes................................................................................................................................11 Certified Nurse Midwife Vignette ....................................................................................................... 11 Certified Nurse Midwife .................................................................................................................. 12 Nurse Practitioner Vignette..................................................................................................................12 Nurse Practitioner ............................................................................................................................ 13 Certified Registered Nurse Anesthetist Vignette ................................................................................. 14 Certified Registered Nurse Anesthetist............................................................................................14 Advanced Practice Psychiatric Nurses (PCNS and Psychiatric CNP) Vignette .................................. 15 Advanced Practice Psychiatric Nurses (PCNS and Psychiatric CNP).............................................16 History and Regulation of APRN Practice in Massachusetts .............................................................. 17 Massachusetts Healthcare: Systems and Physician Access ................................................................. 20 APRNs: Access and Cost....................................................................................................................21 Summary and Discussion.....................................................................................................................24 References ............................................................................................................................................ 27

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Preface

About the Massachusetts Action Coalition:

The Massachusetts Action Coalition (MAAC) is part of the nationwide Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation (RWJF) and the AARP Foundation to implement the recommendations in the Institute of Medicine's 2010 landmark report on the future of nursing. With the Massachusetts Department of Higher Education and the Organization of Nurse Leaders of MA & RI as co-leaders, the MAAC is engaging health care providers, nurse educators, and public sector leaders to affect and support changes in how nurses are educated, trained, and practice in order to better serve the health care needs of the Commonwealth.

The MAAC's goals are to:

Broadly disseminate the recommendations of the Institute of Medicine report;

Build a statewide consensus in support of academic progression for all nurses;

Implement a plan to increase diversity in the nursing workforce;

Promote statewide adoption of the Nurse of the Future Nursing Core Competencies? in academic and practice settings;

Use demographic data to inform health care workforce plans;

Remove scope of practice barriers for Advanced Practice RNs; and

Strengthen inter-professional collaboration within the health care community.

In 2014, Massachusetts became one of nine states to receive a second two-year $300,000 grant from the RWJF for the second phase of its Academic Progression in Nursing (APIN) program to advance state and regional strategies aimed at creating a more highly educated, diverse nursing workforce.

In awarding the grant, the RWJF noted that the funding will allow Massachusetts and the other states "to continue working with academic institutions and employers to expand their work to help nurses in their states get higher degrees, so they can be essential partners in providing care and promoting health, as well as more easily continue their education and fill faculty and primary care nurse practitioner roles. The Action Coalitions in all these states have been encouraging strong partnerships between community colleges and universities to make it easier for nurses to transition to higher degrees."

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To learn more about the MAAC's progress and join our efforts to improve health care, visit .

In its efforts to implement the recommendations of the IOM report on the future of nursing, the MAAC has formed project teams of nursing professionals with specialized knowledge and expertise to explore a variety of topics.

The goal of this report is to add to the knowledge base on scope of practice issues for the Advanced Practice Nurse in Massachusetts and to stimulate further dialogue on this topic.

The authors are solely responsible for the content of the report, which does not represent the opinions or recommendations of the MAAC's co-leading organizations.

Acknowledgements:

MAAC APRN Scope of Practice Project Team Co-Chairs

Stephanie Ahmed, DNP, FNP-BC, DPNAP, Massachusetts Coalition of Nurse Practitioners Patricia M. Noga, PhD, RN, MBA, NEA-BC, Organization of Nurse Leaders, MA-RI

MAAC APRN Scope of Practice Project Team and Contributing Authors

Stephanie Ahmed, DNP, RN, CNP, DPNAP, Massachusetts Coalition of Nurse Practitioners Steve Alves, PhD, CRNA, Massachusetts Association of Nurse Anesthetists, American Association of Nurse Anesthetists Margaret Beal, PhD, CNM, American College of Nurse Midwives (ACNM), ACNM-Mass. Affiliate, MA Board of Registration in Nursing Kathryn Kravetz Carr, CNM, MSN, American College of Nurse Midwives-Mass. Donnell Carter, CRNA, MS, Massachusetts Association of Nurse Anesthetists Carrie Consalvi, RN, BS, NCN, Association of Perioperative Registered Nurses, Sigma Theta Tau Mary Sue Howlett, MS, FNP-BC, CEN, Massachusetts Nurses Association Alex Hoyt, RN, PhD, MGH Institute of Health Professions Sandra M. Kelly, MS, RN, ANP, MA Board of Registration in Nursing Ann Malley, NP (Acute Care, Adult), CCRN, Massachusetts Coalition of Nurse Practitioners Kathleen Miller, EdD, ACNP-BC, GNP-BC, FAAN, FAANP, Massachusetts Coalition of Nurse Practitioners Patrice K. Nicholas, DNSc, DHL (Hon), MPH, MS, RN, ANP, FAAN, Brigham and Women's Hospital and the MGH Institute of Health Professions Patricia M. Noga, PhD, RN, MBA, NEA-BC, Organization of Nurse Leaders, MA-RI Nancy O'Rourke, MSN, ACNP, ANP, FAANP, American Association of Nurse Practitioners Barbara Rosato, MSN, RN/NP, ANP, Massachusetts Coalition of Nurse Practitioners Laurie Talarico, MS, RN, CNP, MA Board of Registration in Nursing Virginia Tay, RN, PC, PhD, Massachusetts Association of Advanced Practice Psychiatric Nurses Katherine Toig, FNP-BC, ANCC, Massachusetts Coalition of Nurse Practitioners Eleftheria Tsavoussis, PMHCNS-BC, Sigma Theta Tau Julianne Nemes Walsh, MS, PNP-BC, National Association of Pediatric Nurse Associates and Practitioners, Massachusetts

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