Governor signs: Full Practice Authority for Delaware Advanced Practice Nurses

Sept. 3, 2015--Delaware Gov. Jack Markell visited the University of Delaware Health Sciences Complex on the Science, Technology and Advanced Research (STAR) Campus on Tuesday to sign a pair of senate bills – SB57 and SB101 – that give Delaware advance practice nurses more independence. 

Markell was joined by State Sen. Bethany Hall-Long, other bill co-sponsors, and UD’s nursing community. Nurses were visibly moved as Markell announced that the bills were officially the law of the land, recognizing their capacity to provide high quality health care as independent health care providers. 

“Today is a wonderful day for Delaware and today is a wonderful day for nurses,” said Emily Hauenstein, Unidel Katherine L. Esterly Chair in Health Sciences and senior associate dean for nursing and health care innovation in the College of Health Sciences. 

So what do these state bills mean for the future of health care and nursing? In addition to updating requirements for licensure and prescriptions, Senate Bill 57 modernizes the title of Advanced Practice Nurse to Advanced Practice Registered Nurse (APRNs). And Senate Bill 101 includes provisions regarding the scope of practice for APRNs, allowing APRNs with advanced experience to provide care autonomously, without the requirement of a collaborative physician agreement. T

he bill will enable APRNs to operate at the top of their licenses, referring to and collaborating with specialty physicians as appropriate to provide high-quality, safe, and holistic patient care. “This launches Delaware ahead as nurses around the state can now practice more independently,” said Hall-Long, who is a professor in UD’s School of Nursing. “Hopefully, this legislation will serve as a model for other states.” 

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Morris and Essex County

NJ Memory & Behavioral Care is currently recruiting:

• A full-time Psychiatric Advance Practice Nurse to join our thriving private practice.
• We will also consider hiring part-time or per diem for the consultation (not office-based) role, minimum 5 hours/week.   This role could be performed in evenings or on weekends.

Full time position:

The successful candidate will be responsible for initial and follow-up Psychiatric consults in select skilled nursing facilities (approx. 80 to 90% of weekly duties), as well as a small office-based practice seeing some of our established patients for routine follow-up’s (approx. 10 to 20% of weekly duties).

Daily patient encounters will be between 10 to 15, depending on the mix of initial vs. follow-up services.   We use streamlined, one page note templates which facilitate efficient workflow. We only “make recommendations” in our consults (rather than “write orders”). 

There are no hospital-based services, no admissions, no discharges, minimal paperwork or administrative responsibilities beyond clinical documentation and billing submission. Participation in our on-call schedule will consist of 1 weeknight in 7 and 1 weekend per month – this is via phone only (no rounds).  

Schedule is flexible, position affords much autonomy/independence – but at the same time, support and assistance is always available from our two board certified psychiatrists. 

Compensation:  Choice of “Independent Contractor” or “Employee” contract structure is available.  We offer above market reimbursement up to $135,000 for Independent Contractors, as well as PTO and Holidays.

About NJMBC

Established in 2009, NJMBC is the full time private practice of Dr. Matthew Barnas - board certified in Geriatric and Adult Psychiatry.  Dr. Barnas completed his Geriatric training at Yale University, and was the Chief Resident at New Jersey Medical School prior to that.  Some of his past experiences include being the Associate Director of Geriatric Psychiatry at Overlook Hospital, Chief of Geriatric Psychiatry at Runnells Hospital, and Chief of Geriatric Psychiatry at the East Orange V.A.

Dr Unnati Patel is board certified in Adult Psychiatry.  She joined NJMBC in 2014, after being the Director of the Psychiatry Consultation service at Somerset Medical Center for 5 years.  Prior to that she was the Chief Resident of Psychiatry at New Jersey Medical School.

We are a successful and expanding group.  We foster a friendly, straightforward, empowering culture - without drama, politics, or layers of bureaucracy.  We are looking for the right candidate to join our team and share in our continued growth.

Dr. Barnas will serve as Collaborating Physician.

Contact Dr. Barnas drb@drbarnas.com

Cell: 201 519 7447

FOR IMMEDIATE RELEASE
July 1, 2015

Senate Bill 57 w/SA 1 and SS 1 for SB 101 Pass in Last Day of Legislative Session

Dover, DE (July 1, 2015) During the last hours of the 148th General Assembly legislative session, Senate Bill 57 w/SA 1 and  SS 1 for SB 101 passed the House to bring the Delaware Nurse Practice Act in line with the APRN Consensus Model. The Consensus Model provides uniformity in the regulation of licensure, accreditation, certification, and education of APRN roles in states that adopt it. DNA applauds members of the Legislative Assembly for passing these bills.

Senate Bill 57 w/SA 1changes the title of Advanced Practice Nurse (APN) to Advanced Practice Registered Nurse (APRN), updates the renewal and reinstatement requirements for advanced practice nursing licensure, and clarifies prescription requirements.

SS 1 for SB 101 creates a new Board of Nursing Advanced Practice Registered Nurse (APRN) Committee to include four APRNs in the four population foci to be consistent with the Consensus Model, four medical doctors and one pharmacist. Also included is the provision for full practice authority for APRNs that extends to ordering and prescribing non-pharmacological interventions such as medical devices, durable equipment, diagnostic and supportive services and to sign death certificates.

The bill eliminates collaborative agreements for licensure for APRNs already practicing with a collaborative agreement as of July 1, 2015. All new APRN graduates and those nurses seeking to obtain independent practice must practice under a collaborative agreement for 2 years and a minimum of 4,000 full-time hours.


The Delaware Nurses Association is the ONLY state nurses association that supports and advocates for all professional nurses regardless of nursing specialty or practice setting. For more information, please visit us online atwww.denurses.org


Kind Regards,

Sharon Brown, MSN, APRN, BC

DCNP President

New Law Makes Maryland the 21st State to Grant Patients Full and Direct Access to Nurse Practitioner-Provided Care

AUSTIN, TX (May 12, 2015) – The American Association of Nurse Practitioners (AANP) praised Governor Larry Hogan and the legislators of Maryland for adopting a new full-practice authority law that allows patients in all areas of the state to directly receive the full scope of services that nurse practitioners are educated and clinically trained to deliver. The law expands patient access to high-quality health care and promotes a wider geographic distribution of the state's health care workforce.

The legislation retires the mandate that Maryland nurse practitioners maintain "attestation agreements" with physicians as a pre-condition of licensure and practice, which had previously discouraged nurse practitioners from practicing in rural and unserved areas of the state, according to AANP.

Governor Hogan signed the bill (HB 999/SB 723) into law on May 12th, making Maryland the 21st full-practice authority state, and the seventh state to right-size regulations affecting nurse practitioner patients in the last four years. The move closely follows actions undertaken in Nebraska, which similarly eased nurse practitioner restrictions in March.

"The legislative leadership we've seen in states like Maryland illustrates how lawmakers are increasingly rallying behind nurse practitioners as essential providers, especially equipped to meet the health care needs of constituents," said AANP president Ken Miller, PhD, RN, CFNP, FAAN, FAANP. "We urge all states considering similar legislation to champion this tried-and-true, no-cost health care solution that is gaining momentum all throughout the nation."

According to AANP, the new law will not only improve access to care and provider choice among patients in Maryland, but also enhance the state's ability to recruit nurse practitioners from its neighbors, which have yet to right-size nurse practitioner laws with the exception of Washington, D.C. Independent research has shown nurse practitioners are more likely to move to and work in states where they can serve patients with full-practice authority, a significant issue as the U.S. contends with rising demand for health services nationwide.

Leading policy groups like the Institute of Medicine have long recommended that states take legislative action similar to Maryland to improve health care access. They cite extensive data showing nurse practitioners, including those with full-practice authority, have outcomes that are equivalent to those of physicians, and also offer patients a much-needed approach that is highly focused on health promotion and disease prevention.

AANP Press Release 

AANP Thanks President Obama, the Senate and House of Representatives for Medicare Reform

AUSTIN, TX (April 17, 2015) – The American Association of Nurse Practitioners (AANP), the largest professional membership organization for nurse practitioners in the country, today praised President Obama for signing into law the historic Medicare reform measure championed by bi-partisan leaders in the U.S. Senate and House of Representatives.

"Working together, our congressional and executive leaders have taken a strong stand, exemplifying the nation's unwavering commitment to preserving high-quality, cost-effective senior care," said Dave Hebert, Chief Executive Officer of AANP. "The national nurse practitioner community offers its thanks and gratitude on behalf of senior patients everywhere."

According to AANP, the law is more than a "doc fix," as sometimes called. It is also imperative to the growing ranks of nurse practitioners, highly educated and clinically trained health care providers who deliver vital services to diverse patient populations, including seniors.

While the law repeals the flawed "sustainable growth rate" (SGR) formula for Medicare Part B – eliminating serious cuts in reimbursement that would have grave consequences for both Medicare recipients and providers, such as nurse practitioners – it also improves health care delivery in ways specific to nurse practitioner patients, including:

• Authorizing nurse practitioners to document evaluations for durable medical equipment
• Including nurse practitioners in the first year of the Merit-based Incentive Payment System (MIPS)
• Ensuring that nurse practitioner-led Patient Centered Medical Homes are eligible to receive incentive payments for the management of patients with chronic disease
• Reauthorizing the Children’s Health Insurance Program (CHIP) which will ensure access to care is preserved for millions of children, including those who receive needed services from nurse practitioners
• Extending funding for Community Health Centers and the National Health Service Corp, programs that are vital to the preparation and inclusion of clinicians such as nurse practitioners in the provision of care to the nation’s vulnerable and underserved populations.

Nurse practitioners serve as primary, acute and specialty care providers across the country. They assess, order, perform and interpret diagnostic and laboratory tests; make diagnoses; initiate and manage treatment; prescribe medications and non-pharmacologic treatments; and counsel patients, their families and communities. More than 50 years of peer-reviewed, independent research has shown nurse practitioners to be safe and cost-effective clinicians with patient outcomes that are similar and sometimes better than those of physicians.

Early this year, AANP released data showing that the number of nurse practitioners licensed in the United States has nearly doubled over the past ten years, rising from approximately 106,000 in 2004 to 205,000 as of December 31, 2014.

March 5th marks the day when Governor Ricketts and the Nebraska Senate passed Legislative Bill 107, granting full-practice authority to Nebraska's Advanced practice nursing workforce. By adopting the law, Nebraska becomes the twentieth state to authorize nurse practitioners to provide the full scope of services they're educated and clinically trained to deliver, significantly expanding patient access to high-quality health care.

According to AANP, the move makes right last year's turn of events, in which the former Nebraska governor vetoed a similar nurse practitioner bill. He did so on the last day of the 2014 legislative session, thus preventing Nebraska lawmakers from overriding the veto after they unanimously voted to adopt the legislation.

"After a year's delay, Nebraskans will now benefit from a 21st century health care delivery model that has been shown to improve access, reduce wait times and control costs, particularly in rural and underserved communities," said AANP president Ken Miller, PhD, RN, CFNP, FAAN, FAANP. "We urge lawmakers in states considering similar legislation to follow Nebraska's example and move into closer alignment with national recommendations that prioritize the health care needs of patients."

Signed into law on March 5, the new Nebraska measure retires the requirement that nurse practitioners maintain career-long "collaborative agreements" with physicians as a condition of nurse practitioner practice, a mandate that had created obstacles and delayed patient care.

Leading policy groups like the Institute of Medicine have long recommended that states adopt such legislation to improve health care access. They cite extensive data showing nurse practitioners, including those with full-practice authority, have outcomes that are equivalent to those of physicians, and also offer patients a much-needed approach that is highly focused on health promotion and disease prevention.

Independent research further shows nurse practitioners are more likely to live and work where they can serve patients with full-practice authority, a significant issue as the U.S. contends with rising demand for health services nationwide. This has prompted some lawmakers to launch campaigns recruiting nurse practitioners from neighboring states that have yet to eliminate collaborative agreements, a trend that has enormous public health implications as competition grows for high-quality health providers.

Source: AANP

On October 30, 2014,  the New Jersey Motor Vehicle Commission adopted a regulation (NJAC 13:21-8.23, -16.4) which establishes protocol for indicating insulin dependence on driver licenses and IDs for nondrivers. It states that “The applicant shall submit a completed driver license application; an executed Request for Insulin Dependent Designation form provided by the Commission; and a prescription from a physician, PA, or nurse practitioner licensed in this State or a bordering state, or a physician stationed at a military or naval installation located in this State who is licensed to practice in any state, stating that the applicant is an insulin dependent diabetic. The prescription must be signed and dated within the immediately preceding 60 days.”

Today U.S.Senators Collins (R-ME) and Schumer (D-NY) introduced S.578, the Home Health Care Planning and Improvement Act of 2015. This legislation, once enacted, will have an immediate impact on the quality of life and timeliness of care for Medicare patients by allowing NPs to certify home health care orders.

APNs play an important role in managing and delivering health care to in the United States, especially as the Medicare population increases. Under current law, APNs with patients who need home health care services must locate a physician who will document the APN's assessment for this care.

Enactment of the S. 578 Home Health Care Planning and Improvement Act of 2015 will make it possible for APNs to provide the required certification for Medicare patients under their care. Passage of this legislation will reduce Medicare spending by eliminating duplicative services while also improving the quality and timeliness of care for beneficiaries who need home health care services.

The Bill was introduced and referred to the Senate Finance Committee.