SB 2 AND SB 568 OVERVIEW

PRESENTED BY ANN SHEEHAN, DNP, RN, CPNPMI NAPNAP SPRING CONFERENCE

MARCH 28,2014

Advocacy is important to me, personally

64% Agree24% Strongly Agree11% Disagree

Advocacy is important to me, professionally

65% Agree32% Strongly Agree3% Disagree

Advocacy is important to the continuation of my career

64% Agree25% Strongly Agree11% Disagree

Advocacy is my responsibility

68% Agree24% Strongly Agree8% Disagree

Advocacy is the responsibility of my professional organization

54% Agree42% Strongly Agree4% Disagree

Have you ever been to your state or national capitol to talk to legislators and/or

their staff regarding an issue related to health care or APRN practice?

71% No29% Yes

How often do you contact your state and/or national legislator(s)?

Monthly25%

Annually 20%

Only when prompted to do so by my professional organization

83%

The Problem DefinedTaft, S. & Nanna, K. (2008)

“Policy is shaped by how policy makers learn about health

care issues and how those issues are

defined as problems.”

Policy Facts

Legislation is made by

personal stories and anecdotes

Regulations are made with facts

and figures

Michigan Legislation

Senate Bill 2

SB 2 Define the Scope of APRN Practice Allow NPs to provide health care services

within their scope of practice Allow for prescriptive authority within the

APRNs scope of practice Requires APRNs to consult with other health

professionals and make referrals

SB 2 Defines APRN Scope of Practice APRN

Nurse PractitionerNurse MidwifeClinical Nurse SpecialistNurse Anesthetist (this group of APRNs are not

included in SB 2)

The definition WILL NOT expand the scope of practice but WILL define the scope of practice for APRNs in the state of Michigan

Education

Training

Certification

Defines APRN

scope of practice

How Nurse Practitioner Scope of Practice Differs from Physician

Physician scope of practice, as defined by their education, training and experience

NEONATAL

GERONTOLOGY

ADULT

PRI

MARY

CARE

ADULT

ACUTE

CARE

PEDIATRIC

PRI

MARY

CARE

PEDIATRIC

ACUTE

CARE

FAMILY

PSYCH

MENTAL

HEALTH

COMMUNITY HEALTH

WOMEN’S HEALTH

Nurse Practitioner scope of practice, as defined by their education, training and experience

Consultation and Referrals

All health care

providers consult with each other

No one health care provider is

an expert in every field

SB 2 WILL NOT Require new or additional third party

reimbursement Mandate workers compensation benefits Mandate increased reimbursement rates for health

care services from health care insurers Allow NPs to form PLLC or PC Interfere with current or future health care insurers

requirements for direct reimbursement Interfere with current or future practice

arrangements made with employers and employees

SB 2 Facts Update Michigan’s Public Health Code to

reflect what is currently going on in practice 18 states and DC have defined scope of

practice with equal or better patient outcomes than physicians

Prescriptive authority and licensure allows for better tracking of patient outcomes and allows for improved transparency in billing and accountability

SB 2 Facts No data from states that impose greater

restrictions on APRN practice suggests safer or better patient care or that the roll of the physician has changed or deteriorated

Trends show that APRNs are moving out of states with restrictive practice acts decreasing patient access to care in those states

APRNs support the Patient Centered Team-based Model of Care that integrates interprofessional patient care with the specific needs of the patient at the forefront

SB 2 Actualizes the RWJ and IOM “The Future of Nursing” Report AND Governor Snyder’s Healthy

Michigan Initiate Nurses should practice to the full extent of their

education and training Nurses should achieve higher levels of education

and training to promote health care and improve patient outcomes

Nurses should be full partners with physicians in providing health care

Effective planning and policy making requires better data collection and improved infrastructure

Federal Trade Commission

The Federal Trade Commission supports unrestricted APRN practice acts in every state

The Federal Trade Commission has sent letters to state congressional leaders who have failed to pass unrestricted APRN practice acts sighting restraint of trade

SB 2 Bottom Line

APRNs in Michigan are already providing health care to many patients

20 years of research shows that APRNs Do not increase liability claims or costsHave equal or higher patient satisfaction Have equal or better patient outcomes

A recent study showed that underutilization of APRNs costs our nation nearly $9 billion annually

SB 2 on the Senate FloorNovember 13, 2013

SB 2 Amendments

1. Prohibit APRNs from opening independent

practices after the bill becomes law.

This does not apply to non-

profits such as NMHCs

2. Extends a mentorship

agreement for new APRN grad from 2 years to 4

years. The mentor can either be a physician or a licensed APRN

3. Adds 2 physicians to the

newly created APRN taskforce

(this taskforce will provide

disciplinary action for APRNs when

necessary)

4. Holds APRNs that practice

independently (without

supervision of a physician) to the same standards as physicians in

cases of malpractice

On to the House of Representatives

Currently sitting in the House Health Policy Committee

Still called SB 2

House Health Policy Committee Members Gail Haines (Chair) 43rd District Mike Calton (Maj. Vice-Chair) 87th District Hugh Crawford, 38th District Bob Genetski, 80th District Mike Shirkey, 65th District Thomas Hooker, 77th District Ken Yonker, 72nd District Dale Zorn, 56th Disctrict Joseph Graves, 51st District Klint Kesto, 39th District George Darany, (Min Vice-Chair), 15th District David Knezek, 11th District Kate Segal, 62nd District Thomas Stallworth, 8th District Winnie Brinks, 76th District Phil Cavanagh, 10th District

All of this has to be accomplished by December 31, 2014 or this bill

dies and the process starts all

over again

1. Voted out of House HP Committee

2. Vote on the House Floor

3. Must come out of the House the same as it

came out of the Senate

4 .Committee to reach a consensus

5. Goes to the Governors

desk for signature

MSMS Propaganda

http://www.youtube.com/watch?v=qDotJFkPw6Y

MSMS Propaganda Under SB 2, "Nursing care provided by a CNP includes ordering,

performing, supervising, and interpreting laboratory and imaging studies." This is effectively the definition of a pathologist and a radiologist. These specialties generally require between 8-10 years of specialized training and often perform extremely complicated genetic and molecular tests.

Under SB 2, Advance Practice Nursing includes, "diagnosing, treating, and managing patients with acute and chronic illnesses and diseases." This definition is extremely broad and could potentially encompass any patient that would walk into my office or through the hospital doors.

Under SB 2 , Certified Nurse Midwives could offer "treatment of male partners for sexually transmitted infection, and reproductive health." Reproductive health is extremely broad, and could include extremely invasive procedures.

MSMS Propaganda Are you willing to put Michigan citizens at risk?  Together, physicians and nurses work for the

general welfare of patients in Michigan, and their partnership fosters the development of groundbreaking advances in medicine.

It's a partnership focused patient care. It's a partnership that's working. It's a partnership worth preserving

Michigan Legislation

Senate Bill 568

SB 568 Introduced by Senator Marleau as a counter

to SB 2Introduced in October 2013

Senator Marleau is the Chair of the Senate Health Policy Committee

Supported by physician groups Bill currently sits in the Senate Health Policy

CommitteeIt has not had a first reading in this committee yet

SB 568 Will Replace the regulatory boards and disciplinary

subcommittees with separate task forces for allopathic physicians, osteopathic physicians, PAs and APRNs

Allow health professional licensees to form a patient care team and require the team to have a practice agreement

Create the Michigan Patient Care Board and require it to establish a model practice agreement for the patient care teams

Require a PA or APRN to be a care team member in order to practice

SB 568 Will Eliminate references to CNM and CNP specialty fields

and provide for the licensure of CNMs, CNPs, and CNSs as APRNs

Extend to APRNs certain provisions that apply to PAs Include a PA and an APRN in the definition of

“prescriber” in the Pharmacy Practice and Drug Control Act

If a licensee organized as a PC or PLLC with other licensees, each stakeholder of the corporation or member of the company must comply with all applicable requirements to engage in his/her health profession

SB 568 and Michigan Business Includes APRN and nurse anesthetist in the

definition of professional services Authorizes a physician to organize a PC or

PLLC with any other licensed individualsExpands this option to more than just PAs

Allows a licensed physician to organize a PLLC with one or more CRNA

Eliminates ban on PAs from forming PCs or PLLCs without other professionals

SB 568 and Patient Care Creates a Michigan Patient Care Board with

the Department of Licensing and Regulatory Affairs (LARA) 3 allopathic physicians3 osteopathic physicians3 PAs3 APRNs7 public members

Board would establish a model practice agreement for use by physicians and PAs and APRNs who organize a patient care team

SB 568 and Patient Care Task Force Patient Care Taskforce designed to regulate various

health professions Make recommendations to the Patient Care Board

regarding improvements for patient care Create separate Regulatory and Disciplinary Task

Forces for each health professionSets forth rules for implementation of its power and dutiesSets forth rules to establish the requirements for education,

training and/or experience of a health profession for licensure in MI

Establishes criteria for the evaluation of programs for educating and training the individual health professions to determine whether grads of programs have the knowledge and skills necessary for practice

SB 568 and Patient Care Teams Licensees can form patient care teams to

collaboratively provide patient care in the best interest of the patient’s health

Patient Care Team is made up of at least 2 licensed health professionals, including at least 1 physician

The team’s practice agreement has to be available to the Board at any timeMake physician continuously available to other

members of the team

Patient Care Teams and APRNs

In order to engage in practice, a PA or APRN would have to enter into a practice agreement as a member of a patient care team

Bill would require referral to a PA or APRN in his/her capacity as a patient care team member, rather than a person performing a delegated task under a physicians supervision

Other revisions and SB 568 Defines a prescriber as a licensed dentist,

podiatrist, optometrist, veterinarian, or other licensed health professional acting under the delegation and using, recording, or otherwise indicating the name of the delegating physician

Refer to APRNs rather than CNMs and CNP

SB 568 Facts Michigan Patient Care Board is physician dominated Patient is defined as an individual who is under the

care of a physician or a patient care team Definition of APRN does not include CRNA Only APRNs and PAs are required to be part of a

patient care team RNs and CRNAs would continue to be regulated

under the BON while CNS, CNPs, and CNMs would be regulated under the new Patient Care Board and new APRN taskforce and the BON for the RN license

SB 568 Facts Definition of collaboration means that

communication and decision making process occurs among members of a patient care team

Definition of patient care team means a team of 2 or more licensed health professionals including at least 1 physician

Physicians are not required to practice in a team, while APRNs and PAs are subject to practice in collaboration with a physician in a patient care team

SB 568 Facts Allows for a 19 member patient care board to

establish a model practice agreement Patient care teams must have a practice

agreement in place as previously described APRNs and PAs must enter into a practice

agreement as a member of a patient care team

APRNs and PAs can ONLY provide medical care services as a member of a patient care team

SB 568 Facts APRNS and PAs may make calls or go on

rounds, in collaboration with a physician APRNs and PAs may prescribe drugs if they

are a member of a patient care team

Each APN needs to Talk to YOUR House Member

Especially if your member sits on the House HP Committee Create Talking Points Create an Elevator Speech Repeat your talking points and elevator speech to everyone

so it rolls off your tongue when you are asked about NPs and legislation related to NPs

Stick to your points, don’t get caught up in arguments that don’t have merit or evidence

Ask for evidence when you are presented with challenges Collect Personal Stories Join a Professional Organization

Creating Michigan’s APRN Future

A change in health care

delivery will not be realized until APRNs become

comfortable advocating for

themselves and their profession

The days of silently standing

by as other professions prescribe

nursing’s fate should be long

gone

Need to create opportunities for

nurses to participate in

advocacy activities with or without a mentor

Empowered Advocates

Mentorship

Stay Informed

Opportunities

Preparation for a Legislator Visit Review your talking points/the points you want to

makeCreate a leave behind one-pager

Research the legislators voting record and know what committees he/she sits onThank him/her for support on legislation you are interested

in Bring examples that demonstrate how your APRN

role is a critical part of the health care for your legislator’s constituents

Be prepared to tell personal stories to illustrate your points

During your Legislator Visit Introduce yourself, where you work and where you live Ask if the legislator has knowledge or personal

experience with an APRN (or more specific: NP, NMW, CNS)What does he/she know about NPs?Does he/she know any NPs?

Briefly describe your practice and what a typical work day is like for you, the type of activities you do in assessing and managing your patient’s care

Ask what the legislator’s main priorities and/or concerns are for his/her constituents related to health care, then start your conversation there

Building Legislative RelationshipsRule of 5’s

Attend a “meet the candidate” or “open house” eventOrganize an event with several APRNs for your legislator

Donate time and/or money to support a candidate that is running for office

Write a note of congratulations to the candidate that wins and remind them that you can be a consultant on health issues or other expertise you have

Send a thank you note when he/she does something good that has nothing to do with health care

Copy news articles that might be of interest related to a bill you are for or against

The Last WordsEducate, Educate, Educate

Many Legislators don’t know the difference between an LPN and an NP

What will happen if you ignore or don’t participate in this discussion?You could be educated for a career that does not exist any

longer in Michigan It took DOs 100 years to get their scope of practice

issues worked outThe NP profession is 49We are about half way there!

Participate in this health care reform TODAY

It is a long walk to the Capitol by yourself!