Bold Voices - August 2017 - 16

AT THE BEDSIDE

Addressing Barriers to
APRN Practice

A

www.aacnboldvoicesonline.org

16

dvanced practice registered nurses (APRNs) still
face barriers despite research indicating quality
of care is comparable between states granting
them full-practice authority and those requiring physician
oversight.
"The Case for Removing Barriers to APRN Practice,"
a 10-page report from the Robert Wood Johnson
Foundation, updates progress made since 2010's "The
Future of Nursing: Leading Change, Advancing Health"
called for removing laws, regulations and policies
preventing APRNs from practicing to the full extent of
their education. The new report also describes the various
challenges to overcome.
For example, it addresses public misperceptions about
what APRNs do and responds to myths associated with
granting full-practice authority. It also examines collaborative practice agreements (CPAs), which many states
require in order for APRNs to practice.
"Physicians often charge APRNs for collaborative
services," the report states. "The cost of CPAs is unregulated and can be onerous, amounting to thousands or
even tens of thousands of dollars a year."
Among the breakthroughs:
* As of March 2017, 22 states and the District of
Columbia allow nurse practitioners (NPs) full-practice authority, and at least 12 others are considering
legislation to remove practice barriers for one or
more APRN roles.
* In December 2016, a Veterans Health
Administration rule change granted APRNs in three
roles full-practice authority in its facilities.
Changing legislation is only one step, says Mary
Chesney, an NP and clinical professor at the University of
Minnesota School of Nursing, who advocated for APRN
practice changes in her state.
"The systems that will fare the best as we move to
value-based payment," Chesney adds, "are the ones that
use folks to the full extent of their expertise - that use
NPs for primary care and chronic care; CNMs [certified
nurse-midwifes] for healthy pregnancies; and physicians
for acute care management, high-risk pregnancy and
complex chronic disease."
The report was "written shortly after the passage of
the Affordable Care Act. With the possibility that the law
may be repealed, the context for future efforts will almost
certainly change, bringing challenges - and opportunities - that are difficult to predict."

Hospital Staff Becoming
Product Innovators
Since the program
began in 2015, 134
applications have
been submitted,
with medical devices
and mobile apps the
most popular.

I

n a move that could be
adopted at other hospitals, Children's Hospital
of Philadelphia (CHOP)
has created the Office
of Entrepreneurship and
Innovation (OEI) to turn
healthcare experiences into
products and services to
help patients.
"Children's Hospital
Encourages Staff to Turn Health Improvement Ideas Into
Marketable Products and Services," part of CHOP's 2016
annual report, notes that since the program began in
2015, 134 applications have been submitted, with medical
devices and mobile apps the most popular. OEI works with
outside partners, including designers, software developers
and prototype fabricators, to explore product viability and
assist with focus groups and potential manufacturers.

©Children's Hospital of Philadelphia

Michele Davey, a nurse at CHOP for more than 20
years, is developing See-IV, a protective device with a
plastic window that provides a clear view of IV sites. The
product features quiet-release fasteners that won't wake
up patients when removed, which can be an issue with the
Velcro system. "This has brought a whole new spark to my
career. It's exciting to identify a problem and see the institution make a commitment to support you to fix it," she
adds in the report.
According to the report, 58 devices, 48 mobile apps
and 25 software programs are some of the categories of
applications that have been submitted since the program's
inception. Two OEI projects have become standalone
companies: Bainbridge Health, which makes software to
improve medication pump safety, and Diagnostic Driving,
which helps companies diagnose potential problems with
fleet drivers and coach them to improve.


http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf435543 http://ar.chop.edu/stories/employees-entrepreneurs/ http://ar.chop.edu/stories/employees-entrepreneurs/ http://ar.chop.edu/stories/employees-entrepreneurs/ http://www.aacnboldvoicesonline.org

Table of Contents for the Digital Edition of Bold Voices - August 2017

Another Angle
Pres Note Front Teaser
Masthead
New Online Toolkit Shows Crucial Roles of Nurses in Serious Illness Communication
Oct. 31 Deadline to Apply for AACN Research Grants
PCCN or CCRN: Which Certification Is Right for You?
Failed Resuscitations May Increase Stress for Nurses
Updated Cardiac Nursing Course and CMC Review Course Online
New Behavior-Based Pain Assessment Tool
Hospital Rooftop Is a Hive of Activity
Former ICU Nurse Collects 100K Objects for Medical Mosaic
Interventions Reduce Wrong-Patient Orders in NICUs
Increasing Acceptance of Pediatric Telemedicine
The Privilege of Nursing
Effects of Dexmedetomidine
Seizure Risk Much Higher for Sepsis Survivors
Studies Provide Insights Into Reducing Opioid Use
Short-Term Oral Corticosteroids Increase Risk of Adverse Effects
Hospital Staff Becoming Product Innovators
Addressing Barriers to APRN Practice
Survival Rates Higher During Joint Commission Surveys
Effect of Rudeness on Pediatric Team Performance
Glasgow Coma Scale Stands the Test of Time
ECRI Introduces Patient Identification Tools
Reducing Risk Factors in Pediatric Delirium
Bundle Compliance Increases Survival, Reduces Delirium
Fostering Resilience in Healthcare Professionals Who Are Also Moms
Members: Enhance Your Career With an AACN Scholarship
In Our Journals
Transitions
President’s Note
Bold Voices - August 2017 - Cover1
Bold Voices - August 2017 - Cover2
Bold Voices - August 2017 - Pres Note Front Teaser
Bold Voices - August 2017 - Masthead
Bold Voices - August 2017 - Oct. 31 Deadline to Apply for AACN Research Grants
Bold Voices - August 2017 - PCCN or CCRN: Which Certification Is Right for You?
Bold Voices - August 2017 - 7
Bold Voices - August 2017 - Updated Cardiac Nursing Course and CMC Review Course Online
Bold Voices - August 2017 - New Behavior-Based Pain Assessment Tool
Bold Voices - August 2017 - Former ICU Nurse Collects 100K Objects for Medical Mosaic
Bold Voices - August 2017 - Increasing Acceptance of Pediatric Telemedicine
Bold Voices - August 2017 - The Privilege of Nursing
Bold Voices - August 2017 - 13
Bold Voices - August 2017 - Seizure Risk Much Higher for Sepsis Survivors
Bold Voices - August 2017 - Short-Term Oral Corticosteroids Increase Risk of Adverse Effects
Bold Voices - August 2017 - Addressing Barriers to APRN Practice
Bold Voices - August 2017 - Effect of Rudeness on Pediatric Team Performance
Bold Voices - August 2017 - ECRI Introduces Patient Identification Tools
Bold Voices - August 2017 - Bundle Compliance Increases Survival, Reduces Delirium
Bold Voices - August 2017 - Members: Enhance Your Career With an AACN Scholarship
Bold Voices - August 2017 - Transitions
Bold Voices - August 2017 - President’s Note
Bold Voices - August 2017 - Cover3
Bold Voices - August 2017 - Cover4
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