Reforming America’s Healthcare System Through Choice and Competition
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
U.S. DEPARTMENT OF THE TREASURY
U.S. DEPARTMENT OF LABOR
Section 3 Healthcare Workforce and labor Markets
Recommendations: Broaden Scope of Practice
States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their license, utilizing their full skill set.
The federal government and states should consider accompanying legislative and administrative proposals to allow non-physician and non-dentist providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care.
States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (e.g., physician assistants, hygienists) that are not justified by legitimate health and safety concerns.
States should evaluate emerging healthcare occupations, such as dental therapy, and consider ways in which their licensure and scope of practice can increase access and drive down consumer costs while still ensuring safe, effective care. P.31
“For example, advanced practice registered nurses (APRNs),96 physician assistants (PAs),97 pharmacists,98 optometrists, 99 and other highly trained professionals can safely and effectively provide some of the same healthcare services as physicians, in addition to providing complementary services. Similarly, dental therapists and dental hygienists can safely and effectively provide some services offered by dentists, as well as complementary services. P.100
SOP statutes and rules often unnecessarily limit the services these “allied health professionals”101 can offer. A 2011 Institute of Medicine (IOM) report surveyed “[e]vidence suggest[ing] that access to quality care can be greatly expanded by increasing the use of . . . APRNs in primary, chronic, and transitional care,”102 and expressed concern that SOP restrictions “have undermined the nursing profession’s ability to provide and improve both general and advanced care.”103 In fact, research suggests that allowing allied health professionals to practice to the full extent of their abilities is not a zero sum game for other medical professionals, and may actually improve overall health system capacity.104 The previously mentioned IOM report found that APRNs’ scope of practice varies widely “for reasons that are related not to their ability, education or training, or safety concerns, but to the political decisions of the state in which they work.” P.105
State decisions about scope of practice and reimbursement can also affect the development and utilization of allied health professionals, particularly in public programs. Private insurance has the flexibility to incentivize patients to find lower-cost, higher-quality provider alternatives when feasible. Public programs, more restricted by state regulations, can be less responsive to such changes in the healthcare workforce, even after scope of practice regulations accommodate them. Currently, for example, states vary widely in the degree to which they permit their Medicaid programs to reimburse allied health professionals directly for services. Services provided under the direct supervision of a physician are reimbursed as if the physician provided those services. State Medicaid programs can also pay for PA, nurse practitioner, and certified nurse midwife (CNM) services provided outside of a physician’s office, but only if state scope-of-practice laws do not require onsite supervision by physicians. Some states allow allied health professionals to bill Medicaid directly, while other states require them to bill under the physician’s number. For patients to realize the benefits of changes to state SOP restrictions, state Medicaid programs would need to reimburse allied health professionals independently for their services.”
Nurses on the NJCCN Board discuss New Jersey’s residency programs.
Nurses, Be Counted!
You may know that the Nurses on Boards Coalition is in the midst of its annual campaign to register nurses’ board service. If you serve on a board, and haven’t already registered, please visit the Nurses on Boards Coalition website, and be counted.
The mission of the Nurses on Boards Coalition is to improve the health of communities and the nation through the service of at least 10,000 nurses on boards by 2020.
Please also share with other nurses in your network, and on social media. Suggested tweets are below:
We are still inviting proposals for the George J. Hebert Legacy Grant Award! Proposals can be submitted by nurse researchers (PhD), nurses with a current DNP, or doctoral nursing students (DNP or PhD) currently working on an IRB approved project that addresses nursing workforce related topics. Priority will be given to the following topics:
Outcomes on Residency Programs (Specialty area transitions and post-acute care settings)
Emerging roles for LPNs in a changing healthcare environment
Impact of school nurses in the community
Strategies to address the nursing faculty shortage
Funding will be up to $2500, and the application deadline is December 5, 2018.
Applications can be sent via e-mail to Dr. Edna Cadmus, . Questions may be directed to Victoria Field, , (973) 353-2715.
October 12th Grant Writing Workshop
Download the Grant Writing Workshop Flyer
Writing a grant proposal can be daunting, and we would like to help you! Whether you are applying for the George J. Hebert Legacy Grant Award, or you plan to respond to a different Request for Proposal (RFP), Dr. Teri Wurmser’s interactive presentation will prepare you with the technical skills and know-how to write a winning proposal. Our grant writing workshop will assist beginners and those who wish to strengthen their grant writing skills with each step of the planning, budgeting, and writing processes associated with RFPs. Register now to attend on October 12, 2018.
NJCCN published a one-page summary of nurse faculty vacancy rates from 2015-2017. This summary uses data from the American Association of Colleges of Nursing (AACN) and NJCCN’s own Educational Capacity Report. Click here to view a printer-friendly version of the report. In September of 2018, NJCCN formed a committee to address address the growing nursing faculty shortage and review solutions.
S. nursing schools turned away64,067 qualified applicants from baccalaureate and graduate nursing programs in 2016 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints.
AACN 2016 survey of 832 nursing schools with baccalaureate and graduate nursing programs:
1,567 vacancies were identified
An additional 133 faculty positions are needed to meet student demand
National nurse faculty vacancy rate = 7.9%
8% of vacancies were for faculty positions requiring or preferring a doctoral degree.
AACN 2015-2016 report average age of doctorally-prepared nurse faculty:
Professor – average age 62.2 years
Associate Professor – average age 57.6 years
Assistant Professor – average age 51.1 years
Average salary for a master’s prepared Assistant Professor in schools of nursing = $77,022. (AACN, 2016)
“Geneva, Switzerland; 6 August 2018 – The International Council of Nurses (ICN) has released a new position statement on Evidence-based safe nurse staffing(click link to view pdf), which calls for increased investment in safe, effective and needs-based nurse staffing levels in order to improve patient outcomes and create positive practice environments.
“The position statement, which was developed with the input of international experts and in consultation with ICN’s members associations, sets out both principles and key elements of approaches to ensuring safe staffing which is intended to help and support all those involved in determining staffing levels and ensure there is clear nursing leadership on this vital issue.”
Dr. Edna Cadmus, our Executive Director, discussed nursing workforce data with Darcy Grabenstein in Episode 36 of the SmartLinx podcast! Follow the link below for a recording and full transcript of the episode.
We were excited to have this opportunity to share our data and discuss issues such as the nursing faculty shortage, demand projections, and long-term goals for nursing Education. Dr. Cadmus also explained the potential role of nurse practitioners in providing primary care for an aging population, and identified opportunities to move care beyond the walls of hospitals and into community settings.