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Free these nurses to improve care


Publication: The Day

Published February 19. 2014 4:00AM

The aptly named bill, "To Improve Health Care Access," would do just that by allowing advanced practice registered nurses (APRN), also commonly known as nurse practitioners (NP) or clinical nurse specialists (CNS), to practice alone, ending the requirement that they can only work in a legally binding collaraboration with a physician. Allowing these highly trained professionals to more freely do their jobs will boost their productivity and improve care.

Existing law requires APRNs to have "collaboration" (a mutually agreed upon relationship) and a written contract with a physician. At a minimum the contract must state: the way the APRN role is disclosed to patients; level of prescriptive authority; and description of care and consultation limits.

As an NP for too many years to admit, I applaud this proposal for common-sense change ending these requirements.

I have a subspecialty private practice in the region diagnosing and treating dementia and cognitively impaired patients. I collaborate with the patients' entire health care team. I would be more productive, treat more patients, and have more time to improve dementia care in our community under the new legislation. The present requirement and contract causes headaches and significant time loss every week. Turf challenges arise from local Connecticut doctors, hospitals and care facilities, and health care businesses. It is never my patients who erect roadblocks.

Clients and families know I am a nurse practitioner; and clever as they are, they know the difference between a psychologist, a chiropractor, optometrist, podiatrist, NP and a medical doctor. I render excellent dementia care in my niche practice, and provide appropriate escalation of care, referral to physicians, researchers and counselors. It is the same among my colleagues in their first-rate NP primary care centers.

By the way, I do have a doctor-collaborative agreement and written contract with a generous and expert geropsychiatric clinician. What if he leaves Connecticut? It was hard for me to get that first signed contract, let alone convince another New London doctor to sign on that dotted line. I would consider relocating my practice to Rhode Island, Vermont, New Hampshire or Maine, where there is already independent practice for NPs, but I am closely tied to family and neighborhood.

This bill is sure to face oppostion from doctors over training, education and turf. Read the report submitted to Gov. Dannel P. Malloy by Dr. Jewel Mullen, commissioner of the Connecticut Department of Public Health. It offers support of APRN independent practice. The report is a critical analysis of scientific reports and research of APRN practice and its role meeting the health care requirements of the future.

APRNs are expertly educated and clinically competent; they pass certification boards, must have malpractice coverage, are periodically recertified, and require continuing education hours, including meeting changing pharmacology standards.

The outcomes for primary-care APRNs are as good or exceed those of doctors (2010 Institute of Medicine report: "The Future of Nursing"; and 2012 National Governor's Association report: "The Role of Nurse Practitioners in Meeting Increasing Demands for Primary Care"). APRNs practice both medical and nursing models, including holism, care and cure; and we are especially nuanced to listen. We know boundaries, as the same litigious culture that measures doctors, also judges NPs. The contract requirement is redundant; not so the physician collaboration we already integrate into our practice along with the entire health care team, patient and family.

There are plenty of patients for all of us, especially me, considering one out of six people reading this opinion will be diagnosed with Alzheimer's disease during their lives. Support this bill for APRN independent practice. All APRNs are nurses, the most trusted professionals in the United States.

Elena Schjavland is a board certified Adult and Geriatric Nurse Practitioner. She lives in Mystic.

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