Maryland Action Coalition

Shannon Idzik, DNP, CRNP

Recommendation #1:

Remove scope-of-practice barriers.

Advanced practice registered nurses should be able to practice to the full extent of their education and training.

Goals # 1

• Goal: – Remove scope-of-practice barriers to conform to the National

Council of State Boards of Nursing (NCSBN) Model Nursing Practice Act and Model Nursing Administrative Rules (Article XVIII, Chapter 18).

• Measureable Outcome:

– Elimination of all references to collaboration based on the model practice act.

• Timeframe: – April 2013

Goals # 1

• Leaders: Lorraine Diana and Susan Delean-Botkin– Comparing Current Law and Rule with the APRN Consensus Model Jurisdiction: Maryland

APRN Requirements

Consensus Model

Current Law and Rule

Comment

Title Advanced practice registered nurse (APRN) Advanced Practice Nurse

Roles Recognized Certified registered nurse anesthetist (CRNA)Certified nurse-midwife (CNM)Clinical nurse specialist (CNS)Certified nurse practitioner (CNP)

CRNA Nurse Midwife

Nurse Psychotherapi

st

CRNP

Education Graduate degree or post-graduate certificate Yes Yes Yes Yes

Population Foci Available Family/individual across the lifespanAdult/gerontology (acute and primary)Pediatric (acute and primary)NeonatalWomen’s health/gender relatedPsychiatric/mental health

Psych/Mental Health

All population foci available

Certification National Certification Yes Yes Yes YesLicensure State grants APRN license separate from RN license Certification Certification Certification Certification

Practice Autonomy Independent Collaborative Collaborative Independent Collaborative

Prescriptive Authority Independent: pharmacologic and non-pharmacologic None Collaborative None Collaborative CRNA and CNS standards of practice do not mention prescribing

Goals # 1

• Leaders: Lorraine Diana and Susan Delean-Botkin

– Comparing Current Law and Rule with the APRN Consensus Model Jurisdiction: Maryland

– Recommended changes: • Titling should be changed to Advanced Practice Registered Nurse (APRN)• The clinical nurse specialist role should be recognized in place of nurse psychotherapist• Nurse midwife and nurse practitioner titles should be changed to certified nurse-

midwife and certified nurse practitioner• All four roles should be licensed by the BON: CRNA, CNM, CNS and CNP• All four roles should be authorized to practice and prescribe independently• All population foci should be listed in BON rule

– Currently starting the very early grass roots “investigation” phase of this.

Goal #2• Goal:

– Unify APRNs of Maryland by creating a forum (“coalition”) to share ideas, build consensus, and advance APRNs in the State of Maryland.

• Measureable Outcome: – Formation of a Council of Advance Practice Registered Nurses.

• Timeframe: – Completed

Goal #2• Leaders: Paul Thurman and Jan Lazear

– Council has been created and named the Council of Advanced Practice Registered Nurses• 1st meeting was in January• 2nd meeting scheduled for end of this month

– Members include local organization and regional representative from national organizations: • Nurse Practitioner Association of Maryland (NPAM)• Maryland Academy of Advanced Practice Clinicians (MAACP)• Maryland Association of Nurse Anesthetists (MANA)• American College of Nurse Practitioners (ACNP)• American Academy of Nurse Practitioners (AANP)• National Association of CNS• American Psychiatric Nurse Assoc. (APNA)• American College of Nurse Midwives (ACNM)• National Association of Pediatric NPs (NAPNAP) • Gerontological Advanced Practice Nurses, (GAPNA)• National Association of Neonatal Nurses (NANN)• American Association of Nurse Anesthetists (AANA)• Maryland Association of Nurse Anesthetists (MANA)• APRN BON representative

Goal # 3• Goal:

– Remove language that restricts APRN scope-of-practice in regulation, state, or county agency policy, where appropriate.

• Measurable Outcome: – Where appropriate, “physician” with “physician and/or

advanced practice nurses, consistent with their education and training, as appropriate.” (provider neutral language).

• Timeframe: – April 2013

Goal # 3• Leader: Veronica Gutchell

– Looking at term “Physician” in COMAR to find places that is should say “Provider”• Meeting with research librarians

– SON liaison librarian – Katherine Downton– Law school research librarian (Maxine Grosshans)

» WESTLAW database • State administrative codes • COMAR

• Searched the word “physician”• 1,298 citations• 20 reviewed – took 1 hour 10 minutes

• Copied code to excel spreadsheet and gave brief description of issue in order to keep track of the issues.

Goal # 3• Leader: Veronica Gutchell

– Surveyed APRNs by contacting the leadership of the APRN council groups.

– The following issues were identified from the responses:• Workman’s compensation forms for Federal employees

(includes post-office)• Forms for home and hospital education for the Board of

Education• Long term care/skilled nursing—cannot be considered the

PCP/attending • Authorization for pediatric growth hormone therapy• BGE forms for not turning off electricity• Psychiatric involuntary commitment and emergency petition

issues

Goal #4• Goal:

– Remove language that restricts APRN scope-of-practice in the private sector, where appropriate.

• Measurable Outcome: – Where appropriate, “physician” with “physician and/or advanced

practice nurses, consistent with their education and training, as appropriate.” (provider neutral language).

– Re: BGE, hospitals, granting of admitting privileges to APRNs

• Timeframe: – April 2013

Goal #4• Leader: Tonya Appleby

• Progress: Just started

More to come:

• Lobby insurance agencies

• Heading to Congress

• Here we come CMS

• FTC…you’re on standby

• Contact me for more information:

• Shannon Idzik, DNP, CRNP

– Nurse Practitioner Association of Maryland, President– Idzik@son.umaryland.edu– 410.706.8129