By Jennifer Thew, RN
In May 2015, the National Council of State Boards of Nursing introduced the licensure model called the APRN Compact. The model would allow advanced practice registered nurses to have one multistate license that provides the ability to practice in all compact states. The compact will go into effect when 10 states have enacted legislation.
So the American Medical Association's November 2017 resolution to create a strategic campaign to oppose legislation that includes the APRN Compact model and independent practice is perplexing.
Thus far, Idaho, North Dakota, and Wyoming have passed legislation in favor of the compact while Nebraska and West Virginia have legislation pending.
The idea of the APRN Compact makes sense. I am not an APRN, but when I worked in telehealth, I had to maintain multiple licenses—California and New York in addition to my Illinois license.
The process of applying for multiple licenses is time-consuming and cumbersome because each state has different requirements. Maintaining multiple licenses is a feat as well since each state has different continuing education requirements and different renewal time frames.
And, as I wrote about in the June HealthLeaders magazine, APRNs Improve Quality Outcomes, Cost of Care, decades of evidence shows that both APRNs and physician assistants produce quality outcomes similar to or better than physicians.
In this changing healthcare industry where technology has the potential to improve access to a healthcare provider, healthcare professionals need flexibility to efficiently work across state-lines. The APRN Compact would help APRNs provide high-quality care and improve patient outcomes in a larger geographic setting.
Nursing Groups Speak Out
The amendment to the AMA's resolution 214 occurred at the organization's Interim Meeting of the House of Delegates on November 11–13 in Honolulu.
According to its website, the American Society of Anesthesiologists, pushed for the resolution to engage "the entire house of medicine in a strategic initiative to oppose the efforts of non-physicians at the state and federal level to dismantle physician-led team-based models of care and, specifically, to oppose the harmful Advanced Practice Registered Nurses (APRN) Compact."
The ASA has typically opposed independent practice among certified registered nurse anesthetists. The group was vocal about this topic during last year's public comment period on extending full-scope of practice authority to APRNs working at the Department of Veterans Affairs. The result—a final rule that the VA granted full-practice authority to certified nurse midwives, clinical nurse specialists, and nurse practitioners, but not CRNAs.
Many nursing groups, including the American Association of Nurse Anesthetists, were not pleased with the AMA House of Delegate's recent move.
"Patients across the United States, especially those in medically underserved areas of the country and the military, rely on non-physician providers such as CRNAs for excellent, timely healthcare," says Bruce Weiner, DNP, MSNA, CRNA, AANA president in a news release. "Yet once again, here comes the AMA with its latest resolution seeking to prevent CRNAs and other highly qualified healthcare experts, who are not medical doctors or doctors of osteopathy, from caring for patients to the full scope of their education, training, and licensure."
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association, calls for an end to the long-standing "turf war" between some physicians and APRNs.
"For AMA to imply that APRNs are incapable of providing excellent care or that their care puts the patient at risk is blatantly dishonest. The future of healthcare calls on all healthcare professionals to work together as a team to meet the growing demand for healthcare services. This dated way of thinking does a disservice to the public and is in direct conflict with the evidence-based recommendations advanced by the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine). Research clearly shows that nurses consistently deliver exceptional care with high patient satisfaction," she says in an ANA statement.
"The AMA's resolution 214 aims to perpetuate longstanding turf wars between some physicians and nurses, which foster unnecessary impediments to patients receiving quality healthcare services. ANA invites leaders of the AMA to work with us on measures that will increase access to care," she says.