AN UPDATE ON SB176 & HB184
We want to start by saying THANK YOU. On behalf of Tennessee nurses, thank you to every nurse and nurse advocate who contacted their legislators and committee members in support of SB176 and HB184.
In the Senate Commerce Committee this past Tuesday there was discussion about SB176. Senator Lundberg, the sponsor of SB176, informed the committee how talks and negotiations between the Tennessee Medical Association/Coalition for Collaborative Care and the nursing community coalition Access to Care in Tennessee had not happened because the physician community would not come to the table in a meaningful way. While the video of the committee is not yet posted you will be able to find it here once it is posted.
Senator Lundberg did an outstanding job this session for this legislation. His commitment to working with other legislators to work out areas of disagreement should be commended. He is a true supporter of nurses. We cannot thank him enough for his efforts alongside the House Sponsor, Rep. Bob Ramsey.
While we did not make it through committee, crucial contacts and connections were made with legislators. The committee made real commitments to hold a task force before next legislative session that will bring the medical community and stakeholders together to work through areas of disagreement.
While this is not the progress we wanted this year, it is still progress. To have a fact and evidence-based task force of legislators to work on this issue will lead to productive conversations and the legislators expect to craft legislation to be filed. To quote one Senator, "APRN Full Practice Authority is coming, we must pass some legislation."
Given the difficulties of advocating during a pandemic, we feel the momentum moving in our direction. So once again, our work is not done. We must continue our focus to strengthening these relationships and building our coalition so that it is stronger than ever before. We must continue our focus to strengthen relationships with legislators and provide them the information they need to make the right decision.
Rest assured that TNA is committed to fighting for access to health care for all Tennesseans. We serve as the voice for every Tennessee nursing professional and that is a responsibility we take seriously. We will not stop until every Tennessee patient has access to the best high-quality care possible. We continue to be aligned with the Access to Care Coalition to accomplish these objectives and the other legislation we have been advocating for.
Tennessee is home to incredible health care professionals, and we are grateful for the progress made. We will keep you updated on the timeline of the task force and how you can help the momentum growing.
Tennessee Nurses Association
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.
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:
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 PHYSICIAN 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: "PHYSICIANS 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 11 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.”
CONTACT YOUR STATE LEGISLATORS
To contact members of House Health Sub-Committee, click here.
To contact members of the Senate Commerce Committee, click here.
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