Today’s guest post about Advanced Practice Registered Nurses (APRN) is by Dr. Elishia Featherston DNP, APRN, CPNP-PC, PMHS of True Connections Pediatrics. APRNs are a restricted and invaluable resource.
What is an advanced practice registered nurse (APRN)?
APRNs are also referred to as Nurse Practitioners (NP), Certified Nurse Midwifes (CNM), Clinical Nurse Specialist (CNS), and Certified Registered Nurse Anesthetist (CRNA).
These professions all began their career as a Registered Nurse (RN). Chances are you know a nurse of some kind. They are the front line of medical care.
APRNs have then furthered their training and education obtaining a masters or doctoral degree. During this training they complete 500 or more hours of direct patient care. After graduating, taking a national certification board, and becoming licensed by the state of Texas, they cannot work as a APRN.
Wait, what?
Yes, they cannot use any of the training they have just received. The state of Texas then requires them to find a physician that will sign a piece of paper, a delegation agreement, to allow them to care for patients.
24 other states do not require this. This creates a huge barrier to care for the citizens of Texas.
An APRN can own or work at a clinic and treat patients as long as this piece of paper exist. Even though the physician may never go to the clinic and never see a single patient at that location. This piece of paper comes with a price.
Elishia’s Story
I have been a RN for 17 years this year and an APRN for 13. I have been providing care to children in primary care for 13 years. I am passionate about caring for children and their families.
In 2017 I opened True Connections Pediatrics in Euless, Texas.
I opened the office so that I could provide evidence based, compassionate health care. I was exhausted with the red tape of big business and hospital systems. I was frustrated with frequent restrictions made by executives without healthcare experience.
I wanted to be able to not only provide healthcare to children but to become a support system to families. We have grown significantly over 2 years and have provided a safe place for our families that frequently are turned away by big systems.
Families who rely on support for insurance for their children, those who chose not to vaccinate, and our LGBTQ youth, are frequently finding themselves without a supportive medical home.
Many offices do not accept Medicaid/CHIPS, do not allow families to refuse vaccinations, and force their personal values on LGBTQ families. We practice evidence based healthcare while also practicing intentional kindness.
House Bill 1792
H.B. (House Bill) 1792 was recently filed in the Texas Legislature to remove this barrier to care.
H.B. 1792 wouldn’t allow APRNs to do anything more than what they are already doing today. It would simply allow APRNs to practice under their current Texas license and national board certifications, with one simple change: they wouldn’t have to ask or pay a physician to sign a piece of paper to let them practice.
The cost of this piece of paper is a business expense and a business risk that is a burden.
If something happens to the physician or they decide to retract the agreement the APRN cannot see patients. This would leave the patients, families, and staff without a medical home.
That cost is ultimately passed down to the patients. Not only does it bear a financial burden it keeps APRNs from doing what they were trained to do and practice to the full extent of their training.
The current legislation is barrier and main reason I have not expanded True Connections Pediatrics to more areas. Passing of HB 1792 would remove a huge business cost and risk.
Are APRNs a safe option for medical care?
Frequently the argument of patient safety arises. Many studies have shown APRNs to be safe, efficient, and to have a better bed side manner compared to physicians.
Anecdotal evidence on how APRNs are unsafe or lack sufficient education/training is just that — anecdotal. In over 40 years of peer-reviewed studies on the topic, the preponderance of research has shown that APRNs improve access to care and have similar or better patient outcomes when compared to physicians.
There are 24 states who have adopted full practice authority for APRNs, not a single one has reversed the policy or found evidence that the quality of patient care declined after passing full practice.
What do the studies say?
A 2018 study published in the Journal of General Internal Medicine shows that physicians, physician assistants and chiropractors tend to practice in more affluent areas with already high life expectancy, while nurse practitioners tend to treat patients in lower income areas with lower life expectancy.
According to this study, the areas with the highest income – compared to the lowest – had 30 percent more physicians and 15 percent fewer nurse practitioners. The distribution of chiropractors and physician assistants followed the physician trend.
Regarding health status, the counties deemed the least healthy had approximately 50 percent more nurse practitioners than the healthiest counties (Read the news summary here).
The Brookings Institute published a brief in 2018 stating that “Adams and Markowitz propose that state policymakers remove these barriers, enabling APRNs and PAs to practice in accordance with their education, training, and experience.
Specifically, the authors propose that state policymakers eliminate required supervisory or delegative practice arrangements, eliminate requirements for formal collaborative practice agreements and protocols”.
The American Enterprise Institute found that removing scope of practice barriers for nurse practitioners would improve health care access, reduce costs, and improve quality. These are two independent research entities at completely opposite ends of the ideological spectrum coming to the same conclusions.
How does H.B. 1792 change things for the better?
H.B. 1792 recognizes that an APRN does not need to pay or sign a contract with a physician to collaborate or work effectively on a team. Instead, by removing delegation agreements, APRNs will be more free to collaborate with different providers based on individual patient needs and provider availability.
Even though some of their primary and acute care services overlap with those of physicians, APRNs do not routinely perform surgery, diagnose rare diseases, manage high-risk pregnancies, or engage in a host of other complex medical interventions.
APRNs are appropriately educated to provide the scope of services for which they are licensed and certified, and, like other health professionals, they make referrals to their physician colleagues and other clinicians when their patients’ needs fall outside their scope or competence. In fact, they are required to do so by law, or risk losing their license.
This bill is widely supported
The Institute of Medicine, the AARP, the National Governor’s Association, the Federal Trade Commission, Brookings, the American Enterprise institute, and a dozen other organizations have all endorsed the policy.
Within Texas, full practice authority for APRNs is supported by over 20 business, consumer, and healthcare organizations, including the Texas Association of Business, Texas Public Policy Foundation, AARP-Texas, Center for Public Policy Priorities, Texas Organization of Rural and Community Hospitals, and others.
I urge you, a citizen of the great state of Texas to write, call, and visit your legislator. This affects all citizens of Texas including children. APRNs are the solution to the healthcare shortage we currently face in Texas. H.B. 1792 will allow the trained and willing medical professionals to serve the citizens of Texas to the full extent of their training.
Dr. Elishia Featherston DNP, APRN, CPNP-PC, PMHS
You can find Dr. Featherstone at True Connections Pediatrics in Euless, Texas. If you are looking for a care provider for your child that will listen to your needs as a parent and give exceptional care, you cannot go wrong here!
