New legislation concerning advanced practice registered nurses could offer area residents more access to high-quality, low-cost health care once it goes into effect in January 2015.
For the past four years, the MN APRN Coalition has worked toward obtaining independence for APRNs, which include nurse practitioners, nurse midwives, clinical nurse specialists and registered nurse anesthetists. These health care professionals are unable to practice independently and must enter into collaborative agreements with doctors in order to be able to work at clinics or other health care organizations.
According to Diana Neal, Minnesota Intercollegiate Nursing Consortium director and chair of the St. Olaf College Nursing Department, changing the process will offer affordable care to more patients, especially in rural communities.
“I am thrilled with the decision because it will increase the efficiency and reduce the cost for patients who receive care,” Neal said. “It will also provide a smoother transition for the elderly to transitional or long term care.”
The new law
The legislation, which passed by large margins in both the state house and senate, changes the way APRNs can practice. Instead of needing collaborative agreements with physicians, APRNs can practice independently once they’ve graduated and practiced a year full-time with a collaborative agreement.
“What I love about this is now we can truly practice to the full extent of our scope of practice,” said St. Olaf professor and pediatric nurse practitioner Nicole Beckmann. “We can treat, we can diagnose, we can provide great patient outcomes.”
While opponents argued that these health care providers wouldn’t be able to assure high-quality care to patients, MN APRN Coalition representatives stated that forcing APRNs to enter into collaborative agreements impeded the state’s goal of affordable health care for all patients. If an APRN has a collaborative agreement with a physician and the physician leaves the clinic, the APRN can’t practice until another physician signs a new agreement, leaving patients in need of care.
Another problem is when APRNs want to work in rural communities but can’t find a collaborator to sign the collaborative agreement. If there is no doctor in the area, the APRN can’t practice there either, leaving area patients without access to a good health care provider. This legislation allows APRNs to work in underserved areas and provide care to Minnesotans who may not have had care before or may have had to travel a great distance for care.
“It really opens the door for us to provide comprehensive care, and overall it’s going to improve health among all of these populations that are underserved,” Beckmann said.
In addition, collaborative agreements can be pricy, costing up to $10,000 a year, since physicians are wary about signing up for someone else’s liability when it comes to diagnosing conditions and prescribing medicine.
“There was no evidence to support that this written agreement did anything to ensure safe and better APRN care,” said Brian Goodroad, former president of MN Nurse Practitioners. “Removing that allows those APRNs to go to areas where there may not be anyone to sign a collaborative agreement and be able to provide care.”
Goodroad pointed out that states vary on what APRNs can do, and even individual physician agreements diverge widely; some states limit APRNs far more strictly than others.
“We have a significant need in Minnesota for access to care, so barriers that really don’t have any evidence that support their need should be removed,” he said.
In addition to allowing APRNs to practice independently, the legislation calls for the development of an advisory committee that will work with the MN Board of Nursing. This will allow for additional oversight of health care professionals.
A long road
The first attempt at this legislation stalled a few years ago, but the House and the Senate were able to work out a well-supported bill this year. The bill originated in the Senate this February, with Sen. Kathy Sheran, DFL-Mankato, sponsoring it. State Rep. Dan Schoen, DFL-St. Paul Park, sponsored the bill on the House side. The Senate bill passed May 1 with all 64 senators voting for it, and the House bill was passed May 8 with 119 members voting for it, including Northfield’s representative, David Bly.
“Having nurses that can deliver some of the health care needs will help Minnesota and take some of the burden off doctors,” Bly said about why he supported the bill.
Governor Mark Dayton signed the bill on May 16, and it will start to take effect January 2015.
Minnesota is the 20 state, along with the District of Columbia, to allow APRNs independent practice. Other states are still pushing for independence, while the National Council of State Boards of Nursing is overseeing the efforts on a national scale.
“This will continue in gaining momentum,” Goodroad said. “There’s too many decades of data that support that we should be having independent practice. It supports the safety and quality of registered nursing healthcare.”