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In order to prescribe drugs, advanced practice registered nurses (APRNs) in Kansas and Ohio must first enter into a contract with a physician. That could change, and the Federal Trade Commission (FTC) is hoping it does.

The agency issued letters earlier this month telling lawmakers in Kansas and Ohio that the FTC supports bills before their legislatures that would modernize APRN scope of practice, allowing the clinicians to practice to the top of their education and training. The Kansas bill, H.B. 2412, would remove the need for APRNs to have a contract with a physician in order to prescribe drugs. The Ohio bill, H.B. 177, would do the same. Why does the FTC care?

The agency argues that requiring physicians to supervise APRNs raises competition concerns because it “effectively give[s] one group of health care professionals the ability to restrict access to the market by another, competing group of health care professionals.” In a 2014 policy paper, the FTC urged policymakers to view “competition and consumer safety as complementary objectives,” and it concluded that removing barriers to APRN practice is “good for competition and American consumers.”

In its recent letters, the agency said its support for the state bills also rests on a body of evidence: research indicating that APRNs provide safe and effective care and have prescribing patterns comparable to those of physicians. “APRNs should be able to evaluate patients and prescribe medications as needed, as long as they do so within the limits of their education and training,” the Ohio letter stated.

“Modernizing public policies related to APRN practice would help improve consumers’ access to care and provide support for family caregivers,” says Winifred Quinn, director of Advocacy and Consumer Affairs at the Center to Champion Nursing in America, an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation. “The FTC letters help advance that effort and provide further evidence that APRNs provide high-quality care.”

Twenty-two states and the District of Columbia currently permit fully independent prescribing by APRNs. States considering changes to their APRN practice laws and regulations may want to seek advice from the FTC. As part of the agency’s competition advocacy program, the Commission and its staff often respond to requests, from state legislators and regulators, to identify and analyze specific restrictions that may harm competition without offering countervailing consumer benefits. Action Coalitions seeking input on the likely competitive effects of a bill or a proposed regulation should have the legislation sponsor or state agency  contact Bilal Sayyed, Director, Federal Trade Commission Office of Policy Planning, at bsayyed@ftc.gov.

Want to learn more?

Read about removing barriers to practice and care.

Read the FTC’s letters to lawmakers in Kansas and Ohio.

Read the agency’s 2014 policy paper Competition and the Regulation of Advanced Practice Nurses.

Read a Charting Nursing’s Future policy brief that explains The Case for Removing Barriers to APRN Practice.

Access Campaign for Action resources on Improving Access to Care.

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• Complete a gap analysis of the federal Office of Minority Health’s national standards for culturally and linguistically appropriate services (CLAS) in health and health care to identify gaps between the workforce and communities served.
• Meet with executive leadership to create awareness about CLAS standards and areas of responsibility and present needs and initiatives to reflect communities served.
• Require collaboration with all levels of the organization to engage in diverse strategies.

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1. Summer and Bridge Programs: pre-admission workshops in secondary school to boost college admission test scores.
2. Mentorship: establish relationships to promote academic and professional success.
3. Leadership Development: provide tools to prospective leaders.
4. Public Awareness: promote diversity awareness among students and staff in order to enhance cultural competence.
5. Financial Counseling: discuss financial expectations (tuition, books, fees) as well as available resources (scholarships and grants).
6. Scholarships or Grants: increase awareness on scholarship and grant opportunities.

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Education Diversity Toolkit

Practice Diversity Toolkit

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The Future of Nursing: Campaign for Action is excited to announce nine of its state-based Action Coalitions have each been selected to receive up to $25,000 for innovative ideas to advance nursing and build a Culture of Health. The winners were chosen based on their submission of replicable plans to continue working to implement at least one recommendation from the Institute of Medicine (IOM) report on the future of nursing, while also contributing to building a healthier America through nursing.

The winners are:

Colorado

The Colorado Action Coalition’s project seeks to advance nursing leadership by supporting the expansion of a nurse-led health care model to federally qualified health centers in the state. Nurse leaders interested in implementing this RN-based model will be offered a two-day workshop and team-based coaching. The project is called Nurses Leading the Transformation of the Practice Environment.

Massachusetts

The Massachusetts Action Coalition’s project, Promoting Health Literacy to Influence Health and Wellness of Students in the Community, aims to develop a health literacy initiative for students in select communities. The initiative will encourage nurses to become leaders and participants in existing school wellness committees. Participating nurses will receive population health training and access to resources from partners so they can be better positioned to shape school policies concerning school nutrition, physical activity, and other student health issues.

Michigan

The Michigan Action Coalition will create a networking platform featuring social and professional networking, as well as online education opportunities.    The aim of Nurses Connect is to  increase professional development opportunities and strengthen connections among nurses to increase job satisfaction, improve retention, and promote lifelong learning. The platform will include leadership development, mentoring, and Culture of Health components.

Nebraska

The Nebraska Action Coalition will involve nurses on an interprofessional committee whose purpose is to increase access to care by promoting the involvement of community health workers on interdisciplinary teams. The Nebraska Action Coalition will also participate in events that promote the importance of nurses leading in their communities to help build a Culture of Health. Such activity includes hosting regional conferences using the Robert Wood Johnson Foundation Culture of Health framework and other tools to assist communities in creating their Community Health Improvement Plans (CHIP). The information gathered will contribute to the development of a national CHIP model for other communities to use as they create their own plans.

Ohio

In an effort to promote nursing leadership and address local health-related issues, the Ohio Action Coalition will partner with Court Appointed Special Advocates (CASA) to encourage nurse participation in CASA’s efforts to train volunteers to advocate in court for the interests of an abused or neglected child.

Pennsylvania

The Pennsylvania Action Coalition project, a podcast series titled “At the Core of Care,” is an effort to showcase the stories of patients, families, and communities, and the creative efforts of nurses and other partners to better meet their health and health care needs. These podcasts will view a health care need through the lens of the consumer and highlight the ways that nurses and other organizations are intervening and partnering to transform the health care system.

Rhode Island

The Rhode Island Action Coalition seeks to improve its state’s health care system by creating a nursing curriculum, competency assessment, and development program to prepare nurses to become primary care providers in high-demand communities. Additionally, the state will develop a campaign to promote interprofessional practices among diverse organizations to foster collaboration within the health care environment.

Utah

The Utah Action Coalition aims to increase diversity in nursing by implementing strategies that include outreach to middle and high school counselors. The goal is to recruit students from underrepresented communities and backgrounds for nursing schools. To support diversity in nursing students’ academic progression and leadership, the Action Coalition will implement mentoring and support programs featuring mentors who represent a diversity of racial, ethnic, age, gender, and socioeconomic backgrounds.

West Virginia

The West Virginia Action Coalition will focus on nurse entrepreneurship, offering webinars and online training to teach skills and build a community for nurses to learn about becoming entrepreneurs. This project is based on the belief that nurses could have a large economic impact in the state and in their communities if they were more knowledgeable about business opportunities.

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In Collaboration with: DeAnna Hawkins, MSN, RN, NEA-BC, Jane Mahowald, MA, RN, ANEF, and Carol Drennen, MSN, MS, RN

Problem Statement:  Research shows that a person’s health is affected 20% by clinical care and 80% by opportunities where one lives, works and plays.  These opportunities (or lack thereof) such as healthy food, housing, utilities, are referred to as the Social Determinants of Health (SDH’s).  Gaps in achieving SDH’s traditionally affect vulnerable populations, often impacting people’s ability to attain or maintain health.  Despite nurses’ best intentions to help clients be healthy, nurses have not traditionally been taught about the impact of SDH’s on their patients’ health outcomes or how to assess for SDH’s. The current and future nursing workforce (nurses in practice and nursing students) therefore have a need for basic SDH education and standardization in assessing for SDH’s as a basic component of a nursing assessment in order to advance their clients’ health.

Approach:  A baseline survey was conducted among hospitals, health departments and nursing academic institutions in Ohio to assess for SDH education and assessment among nurses.  Survey results revealed that nurses across the state were not assessing for basic SDH’s.  A standardized SDH screening based on CMS’ core SDH’s was developed and piloted along with an educational module for nurses as part of a basic nursing assessment.

Products/Outcome:  SDH assessment “tool;” accompanying educational module; pre- and post-surveys regarding Ohio nurses assessing clients for SDH’s

Implications:  A basic nursing SDH assessment administered consistently will allow clients to be referred for services to meet basic SDH’s, promoting healthier clients and a healthier population overall.

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