Advanced Practice Nurses:  Quality Health Care for Coloradans

The need for primary care in the U.S.

As the American population ages and more citizens have access to obtain health insurance it is unclear how the existing population of practitioners can meet this increasing demand.  In a recent Federal Trade Commission (FTC) study it was determined that the U.S. faces a growing shortage of primary care physicians which will reduce access for our poorest citizens, including Medicare beneficiaries and those who live in rural communities (1). 

Colorado’s need: The Colorado Health Access Survey conducted by the Colorado Health Institute (2013

)

·         14.3% of Coloradan’s  are uninsured, 9.3% are Medicare beneficiaries and 7.3% are Medicaid recipients  

·         54.1% reported using an E.D. for their last visit because an office visit was not available as timely as their perceived need

·         50-100% of primary care is provided by NP’s in 4 Colorado counties and 25-50% in an additional 18 Colorado counties (2)

The Solution:  High Quality Care for Coloradans

An Advanced Practice Registered Nurse (APRN) is a Nurse Practitioner with a graduate nursing degree who has trained to provide a broad range of services, including the diagnosis and treatment of acute and chronic illnesses.  APRN’s hold masters’ or doctoral degrees and pass national certification exams.  There are four types of APRN’s; Nurse Practitioners (NP’s), Nurse Midwives (NMW), Certified Registered Nurse Anesthetists (CRNA’s) and Clinical Nurse Specialists (CNS).

A thorough systematic review in the publication Nursing Economics (2011) of 107 published studies from 1990 to 2008 examined the impact of APRN’s on primary care patient outcomes.  The results indicated that APRN’s deliver high quality patient care and can safely augment physician resources to support reform efforts to enhance the access to primary care.  Additionally, patient outcomes provided by APRN’s are similar and in some ways better than care provided by physicians alone. (3)

The National Governor’s Association (NGA) confirms these findings by examining process outcome measures to include patient satisfaction, time spent with patients, prescribing accuracy and the provision of preventative education.  In each of these categories, APRN’s performed at least equal in quality of care compared to traditional health care models. (4)

The Federal Trade Commission also supports these findings stating that empirical research strongly suggests that APRN’s are safe and effective providers of diverse primary care services. (1)

   

Colorado’s next steps

After the sun downing of the Nurse Practice Act in 2008, the Nurse Physician Advisory Taskforce for Colorado Healthcare (NPATCH) was formed to make recommendations for policy making entities (5). NPATCH determined that APRN’s in Colorado may receive full prescriptive authority only after completing

1.       An initial 1800 hour preceptor ship to obtain Provisional Prescriptive Authority –and

2.       An 1800 hour mentorship and one time articulation plan signed by a physician within 5 years

No other state has this requirement in place (6).  An unintended consequence of this regulation is that many APRN’s are not able to find physician mentors, are unable to find employment and are therefore moving out of the state of Colorado where there are less restrictive oversight requirements (5).

Constrained supervision requirements in the state of Colorado will result in decreasing the pool of available APRN’s to provide access to care for vulnerable populations in the state seeking primary care services. 

(1)     Federal Trade Commission (2014). Policy Perspectives: Competition and Regulations of Advanced Practice Nurses.  Available at: http://www.ftc.gov/reports/policy-perpectives-competition-regulation-advanced-practice-nurses

(2)     Colorado Health Access Survey (2013),  Courtesy of the Colorado Health Institute, www.ColoradoHealthInstitute.org/health/colorado-health-access-survey-1

(3)     Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G. & Weiner, J. P. (2011).  Advanced Practice Nursing Outcomes 1990-2008:  A systematic Review.  Nursing Economics, 29 (5), 230-251.

(4)     National Governor’s Association, NGA Paper: The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care (2012), http://www.nga.org/files/live/sites/NGA/files/pdf/1212NursePractitionersPaper.pdf

(5)     Hoback, J. (2014).  ‘Unfettered nursing’ required for Coloradans desperate for care.  http://www.healthnewscolorado.org/2014/02/26/unfettered-nursing-required-for-coloradans-desperate-for-care/

(6)     Pearson, L. J. (2012).  The Pearson Report, www.pearsonreport.com