Update as of August 28
Governor Bill Lee signed Executive Order No. 59 to extend certain, targeted provisions of Executive Order Nos. 36, 38, 49, 50, 54, and 55 through September 30, 2020 to facilitate the continued treatment and containment of COVID-19 through regulatory flexibility, promoting social distancing and wearing face coverings in public places, and protecting vulnerable populations.
The full order can be accessed here: Executive Order 59.
Governor Lee also signed Executive Order Nos. 60 and 61, which extend through September 30 provisions that allow for electronic government meetings subject to transparency safeguards and remote notarization and witnessing of documents, allowing for implementation of best practices developed during COVID-19 for providing live broadcasts of electronic meetings and safely conducting in-person transactions, respectively, beginning October 1.
Update as of July 21
Sharing updated CDC guidance regarding COVID-19 via the Tennessee Department of Health. Access the full PDF here.
Update as of June 29
Governor Lee has issued Executive Order 50, which extends Tennessee's State of Emergency through to August 29, 2020 and extends the provision that allows nursing students to practice under supervision without examination.
COVID-19 TNA Member Survey Results
This survey comprises the responses from 471 TNA members between March 18 and March 25. The survey sought to gauge TNA members' thoughts on their work environment's preparedness, PPE and other concerns and needs. The full survey results can be accessed here: COVID-19 Survey Results
Update as of May 12
Governor Lee has issued Executive Order 36, which allows nursing graduates who have applied and fulfilled all other requirements for licensure as a nurse, but have yet to take the National Council Licensure Exam, to practice nursing under the supervision of a licensed RN. The Order outlines that the expanded scope of practice provisions for nurses and physician assistants issued in Executive Orders 15 and 28 will not continue after May 18.
Update as of April 17
Governor Lee issued Executive Order 28 that removed additional regulatory barriers to facilitate the treatment and containment of COVID-19. In particular, the order suspends the collaborating physician requirement for nurse practitioners and physician assistants to provide increased flexibility regarding where these professionals can provide health care services to facilitate the COVID-19 response;
allows nursing school graduates waiting to take the national nursing exam to go to work during the emergency under the supervision of a licensed nurse to boost health care resources; and allows nurse practitioners and physician assistants to write orders for home health services to address the increased need for such services, among other things.
Update as of April 13
Governor Lee issued Executive Order 27 that extends the Stay-at-Home provisions of Executive Orders 17, 21, 22 and 23 to April 30.
Update as of March 30
The key to slowing and preventing the spread of COVID-19 is to stay at home and practice physical distancing. We've penned an open letter to Tennesseans in partnership with the Tennessee Pharmacists Association and the Tennessee Academy of Physician Assistants thanking them for staying home.
Update as of March 26
Governor Lee issued Executive Order 20, which furthered the mobilization efforts of healthcare workers by allowing retired healthcare professionals to aid in the COVID-19 response. A link to the full Executive Order can be accessed here: Executive Order 20.
Please assess your individual risk before volunteering, especially if you are in an at-risk group or have an underlying condition.
Update as of March 19
On March 19, Governor Lee issued Executive Order 15, which allows APRNs to treat patients impacted by COVID-19 without the restrictive red tape of collaborative practice agreements. This order is in effect until May 18, and demonstrates just how essential removing these unnecessary barriers is for increasing access to care when and where it is needed most. We applaud Governor Lee for issuing this measure that will increase care for Tennesseans as healthcare providers work to slow the spread of COVID-19.
A link to the full order can be accessed here: Executive Order 15
PUTTING PATIENTS FIRST
THANK YOU TO OUR SUPPORTERS
Thank you to all those who have demonstrated tremendous support for legislation that removes the mandate for a collaborative practice agreement with a physician in order for Advanced Practice Registered Nurses (APRNs) to practice and care for Tennesseans.
More information on the status of our proposed legislation can be found in the notice sent to members of the Tennessee Nurses Association.
To help support legislative candidates who support nurses and our patients, please consider making a donation to the TN Nurses PAC.
We will update this site with more information on next steps in the coming weeks and months.
RESPONSE TO THE PHYSICIANS FOR PATIENT PROTECTION GROUP OPINION PIECE
On March 26, The Tennessean issued an opinion piece from two members of the Physicians for Patient Protection Group regarding our legislation to update the Nurse Practice Act. This op-ed included several factual inaccuracies.
Our responses to these factual inaccuracies can be accessed here: TNA Response to Physicians for Patient Protection Group Opinion Piece
UPDATING THE NURSE PRACTICE ACT
Everyday access to care and options for care are increasingly becoming a great challenge to Tennesseans. We believe the most actionable and impactful solution is to clear the way for Advanced Practice Registered Nurses (APRNs - nurse practitioners, nurse midwives, nurse anesthetists, clinical nurse specialists) to do what they are educated and trained to do: serve communities and patients.
The only thing that stands in the way is outdated, unnecessary, costly regulation that forces career long physician oversight on APRNs. These burdensome regulations make it prohibitive for APRNs to set up practices to administer the care they are trained to do in areas that are underserved or could benefit from cost effective choice.
That’s why in 2020, the Tennessee Nurses Association and the Coalition for Access to Care for Tennessee has introduced updates to the Nurse Practice Act (SB2110/HB2203), which remove unnecessary and harmful regulations – and create new opportunities to improve access to care across the state.
Why the Need in Tennessee? Why now?
Tennessee is facing a health outcome and access to care crisis.
Since 2010, 163 rural hospitals have closed in the United States according to the Cecil G. Sheps Center for Health Services Research. Tennessee has had 13 hospitals close during this time, the second most of any state. This means that everyday access to care and options for care are becoming a greater challenge to Tennesseans across the state.
These challenges aren’t just with closing hospitals, but include physician supply and capacity to meet the needs of an aging population. By 2032, our country potentially faces a shortage of approximately 122,000 physicians as the over-65 population grows by nearly 50%, according to the Association of American Medical Colleges.
Ranked 44th in health outcomes, the state of Tennessee is one of 11 states with the highest level of restrictions placed on advanced practice registered nurses. The state law requires career-long oversight and delegation or team management by another health provider for the advanced practice registered nurse to provide patient care.
As access to care becomes increasingly difficult, Tennesseans are not getting the care they need to improve their health outcomes. Now is the time to set up proper market conditions to increase access and help Tennesseans.
UNDERSTANDING OUR SOLUTION
As there is no shortage of information that supports the vital need for full practice for APRNs, what follows are tool kits, fact sheets, and talking points you may download to inform your conversations and share with colleagues and your legislators:
FULL PRACTICE ELEVATOR PITCH
CONTACT HEALTH COMMITTEE
WHAT IS FULL PRACTICE AUTHORITY
APRN EDUCATION FACT SHEET
LEGISLATIVE ADVOCACY PACKAGE
The following myths are often perpetuated and unfounded. Here, we will address each:
THEY SAY: “IN A TIME WHERE WE NEED MORE MEDICAL COLLABORATION, NOT LESS, THIS IS NOT THE RIGHT ACTION.”
The very charge of a nurse is collaboration. Updating the Nurse Practice Act ends a very costly and prohibitive need for Advanced Practice Registered Nurses to pay for a doctor to review charts several weeks after the patient is cared for. Advanced Practice Registered Nurses will continue to consult, refer and work closely with physicians and other healthcare providers based on the needs of their patients.
THEY SAY: “IF NURSES WANTED TO PRACTICE AS A DOCTOR THEY SHOULD GO TO MEDICAL SCHOOL.”
APRNs will practice only what they were effectively taught and trained to do. And they do it very well. All available data supports the fact that nurse practitioners have the professional acumen to match the primary care provided by physicians. Researchers have found that patients of both groups had comparable health outcomes. In fact, nurse practitioners were found to outperform doctors in measures of consultation time, patient follow-up, and patient satisfaction.
THEY SAY: "DOCTORS ARE A NECESSARY PART OF TREATMENT"
No data supports this. In fact the Federal Trade Commission reported the following: "We have not seen research suggesting that the safety or quality of primary care services declines when APRN supervision or collaborative practice requirements are lessened or eliminated."
THEY SAY: "THIS IS TOO RADICAL FOR TENNESSEE"
Tennessee is one of only 12 states with the most restrictive practice environments. And it is 44th in health outcomes. It is more radical to not allow for APRNs to practice more freely to the benefit of Tennesseans.
THIRD PARTY SUPPORT
There is no shortage of validating third party support for removing mandated and outdated regulation of APRNs. These can all be used to speak to the issue and share with your legislators:
The Federal Trade Commission: “We have not seen research suggesting that the safety or quality of primary care services declines when APRN supervision or collaborative practice requirements are lessened or eliminated.”
The National Governor’s Association: “Among the quality of care components that these studies measure are several process measures, among them patient’s satisfaction, time spent with patients, prescribing accuracy, and the provision of preventive education. In each of these categories, Nurse Practitioners provided at least equal quality of care to patients as compared to physicians.”
Institute of Medicine's Future of Nursing Report: “The contention that APRNs are less able than physicians to deliver care that is safe, effective and efficient is not supported by the decades of research that has examined this question.”
American Enterprise Institute: "We have reviewed sizable body of evidence related to whether there was any difference in quality of care when it was provided by APRNs rather than physicians. There is extensive empirical evidence that APRN practice outcomes are at least equivalent to those of physicians to which they are compared. And on some metrics, such as patient satisfaction, some studies have found APRN care is actually better."
The Cato Institute: “When physician groups argue to restrict the scope of practice of nurse practitioners, they argue that a broader scope of practice would threaten patient safety. Yet study after study has shown midlevel clinicians provide a level of quality equal to that of physicians performing the same services.”
NEWS & VIEWS
Your Access to Care TN Resource Center
ACCESS TO CARE TN MEMBERS
Working Towards Better Outcomes for Tennesseans
American Nurse Practitioner Association Regional Representative
American Nurse Practitioner Association – Tennessee Chapter
American Psychiatric Nurse Practitioners Association - Tennessee Chapter
Northeast Tennessee Nurse Practitioners Association
Greater Memphis Area Advanced Practice Nurses
Middle Tennessee Advanced Practice Registered Nurses
Music City Chapter of National Academy of Pediatric Nurse Practitioners
TN Affiliate of the American College of Nurse-Midwives
Tennessee Deans & Directors Council
Tennessee Nurses Association
Tennessee Nurse Practitioner Association
VA Memphis APRN Council
West Tennessee Advanced Practice Psychiatric Nurses Association