Florida Coalition for Advanced Practice Nursing: Talking Points and Key Messages

1.  Advanced Registered Nurse Practitioners (ARNPs), Certified Nurse Midwives (CNMs), Certified Registered Nurse Anesthetists (CRNAs) and Clinical Nurse Specialists (CNSs) are expert clinicians with advanced education and skills. They manage and provide primary care, acute care, anesthesia care, pregnancy and delivery of newborns, psychiatric care and specialty services.

• ARNPs have a graduate degree with advanced clinical training and have met rigorous national certification requirements
• ARNPs are skilled at disease prevention services, diagnosing, and treatment of disease.  They also  prescribe medications,  order and interpret diagnostic tests, and counsel and educate  patients

2.  ARNPs provide high quality cost-effective, patient-centered and personalized health care

• More than 100 studies on the health care outcomes comparing ARNP and physician outcomes indicate that ARNPs provide superior or equivalent health care compared with physicians. 1
• .Systematic reviews of over 50 studies found the quality of care provided by ARNPs is superior to or as high as that of physicians. Resource utilization and costs are equivalent for ARNPs and physicians, and satisfaction is higher for ARNPs. ARNPs provide greater  communication with patients and offered more patient centered information and advice 2,3  
• ARNPs focus on health and wellbeing of the whole person. ARNPs skills in helping patients with chronic conditions such as diabetes and hypertension improve health and reduce unnecessary health care utilization such as ER visits.4  

3.  The 15,000 ARNPs in Florida are solutions to Florida’s Health Care shortage but are underutilized and limited by outdated regulations

• The Florida Legislature’s Office of Program Policy Analysis Government Accountability identified  that expanding the scope of the ARNP and physician assistants (PAs)practice would  save Florida $7 million to $44 million each year for Medicaid care,  $744,000 to $2.2 million for state employee health insurance and $339 million across Florida health care system.5
• Floridians face a severe shortage of primary care providers. ARNPs can provide 80% of the primary care needs of Floridians.  Only 2 percent of medical students plan to be primary care providers.6
• The Florida Senate Committee on Healthcare Legislation report concluded that “ARNPs are skilled nursing professionals with advanced clinical training that prepares them to provide primary care services. Giving ARNPs the authority to prescribe controlled substances will enhance the ability of ARNPs to manage their patients’ care and reduce delays and costs for patients in obtaining needed medications.”6
• While over half the states recognize NPs are independent professionals, Florida NPs must work under a supervising physician, often for a fee. The “fee” and the supervisory requirements raise healthcare costs care and limit Floridians’ access to care.
• The 2010 Institute of Medicine research report, The Future of Nursing, calls for, as part of the solution to the national healthcare needs, removing scope of practice barriers so that all nurses can work to the full extent of their education and skills.7 This will allow ARNPs to increase access to care, especially in underserved areas. 
• In a comparison of consumer-friendly regulations of ARNPs in 50 states and the District of Columbia, Florida scored an F. 8

References

1. Bauer, J. (2010). Nurse practitioners as an underutilized resource for health reform: Evidence-based demonstrations of cost-effectiveness. Journal of the American Academy of Nurse Practitioners 22 (2010), 228–231.
2. Laurant M, Reeves D, Hermens R, et al (2006) Substitutions of doctors by nurses in primary care. Cochrane Database of Systemic Reviews, Issue I.
3. Horrocks S, Anderson E, Salisbury C. Systematic Review of Whether Nurse Practitioners Working in Primary Care can Provide Equivalent Care to Doctors BMJ.  2002;324:819-823.
4. Doddington J Sands L (2008) Cost of health care and quality of care at nurse-managed clinics . Nursing Economics 26(2) 75-94.
5. Office of Program Policy Analysis Government Accountability (2010).”Expanding Scope of Practice for  Advanced Registered Nurse Practitioners, Physician Assistants, Optometrists, and Dental Hygienists. The Florida Legislature
6. Florida Senate Committee on Healthcare Legislation (2008).  Interim Report: Authorization for Advance Practice Nurse Practitioners to Prescribe Controlled Substances.
7. Institute of Medicine (2010), Future of Nursing: Leading Change, Advancing Healthcare. National Academy of Science Press. www.nap.edu
8. Lugo N, O’Grady E, Hodnicki D; Hanson C (2007). “Ranking State NP Regulation:  Practice Environment and Consumer Health Care Choice,” American J for Nurse Practitioners, 11(4):8-24.