assignment #3 pop health

Regulation for Nursing Practice Staff Development Meeting

Objectives  Describe the differences between a board of nursing and a

professional nurse association.  Describe the geographic distribution, academic credentials,

practice positions, and licensure status of members of the board for your specific region/area.

 Describe at least one federal regulation for healthcare.  Describe at least one state regulation related to general

nurse scope of practice.  Describe at least one state regulation related to Advanced

Practice Registered Nurses (APRNs).

Differences between a Board of Nursing and a Professional Nurse Association

BOARD OF NURSING (BON)

 The board of nursing for each state is a jurisdictional government agency. They are responsible for the regulation of nursing practice for each 50 sates.

 They are there to protect the public's health and welfare by overseeing and ensuring the safe practice of nursing.

 They achieve this by outlining the standards for safe nursing care and issuing licenses to practice nursing.

 Once a license is issued, they continues by monitoring licensees' compliance to jurisdictional laws and taking action against the licenses of those nurses who have exhibited unsafe nursing practice.

Professional Nurse Association

 Nursing organizations like the ANA and the National League for Nursing (NLN) have a broad focus, encompassing the entire nursing profession.

 There are more than 100 Nursing Organizations, like the ANA.

 Unlike the BON, a nursing association (also called a professional association) is a private organization whose members must pay dues to enjoy the benefits of membership. One of the primary functions of a nursing association is to represent its members in legislative, political, and practice matters. It provides a central voice for its nurse membership

 A nursing association can lobby the legislature and Governor for the interests of its members and the profession of nursing. A nursing association provides a united voice that can speak out on the issues important to a specific area of nursing practice and/or to the nursing profession as a whole. In addition, a nursing association provides leadership in other areas such as improving working conditions and benefits for nurses. A nursing association also may lead the way in developing public health policies.

 Describe the geographic distribution, academic credentials, practice positions, and licensure status of members of the

board for your specific region/area. Geographic distribution = Texas  Academic credentials= APRN, RN, LVN, MSN, BA  Practice positions = Family practice FNP, Instructor, Professor of a Vocational

Nursing Program, Consultant, Vice President of Nursing for Surgical/Procedural Services for a Doctors Hospital, Quality Management, Interim Dean of Health and Human Services/Director of Nursing for an associate degree nursing program, Director of Public Policy, Quality Assurance hospital nurse, Lead faculty for a bachelor of science program, Pediatric Nurse with Cook Children’s Medical, Vice President at First Community Bank in Corpus Christi. A chairman of the Port Aransas Recreational Development Corporation, and Licensed Vocational Nurse in the Primary Care Outpatient Clinic at West Texas Veteran’s Health Administration.

Licensure status= As listed above and current in the state of Texas, with the exception of the two BA’s on the board.

Distribution, Credentials, & Licensure status

 Who is on the board?  Kathy Shipp, President, APRN Practice, MSN, RN, FNP-Lubbock  David Saucedo, II Vice President, Consumer member  Nina Almasy, DNP, RN, CNE- Representing LVN Education  Patricia "Patti" Clapp, BA-Consumer Member  Laura Disque, MN, RN-Representing RN Practice  Diana Flores, MN, RN-Representing RN Practice – Helotes  Doris Jackson, DHA, MSN, RN, Representing ADN Education – Pearland  Mazie Mathews Jamison, BA, MA, Consumer Member – Dallas  Kathy Leader-Horn, LVN-Represents LVN Practice – Granbury  Allison Porter-Edwards, DrPH, MS, RN, CNE-Representing BSN Education Bellaire  Melissa Schat, LVN-Representing LVN Practice – Granbury  Francis Stokes, BA, Consumer Member – Port Aransas  Kimberly “Kim” Wright, LVN- Representing LVN Practice – Big Spring

The Board

 A person is not eligible for appointment as a public member of the board if the person or the person's spouse:  (1) is registered, certified, or licensed by an occupational regulatory agency in the field of

health care;  (2) is employed by or participates in the management of a business entity or other

organization that:  (A) provides health care services;  (B) sells, manufactures, or distributes health care supplies or equipment; or  (C) is regulated by or receives money from the board;

 (3) owns or controls, directly or indirectly, more than a 10 percent interest in a business entity or other organization that:  (A) provides health care services;  (B) sells, manufactures, or distributes health care supplies or equipment; or  (C) is regulated by or receives money from the board; or

 (4) uses or receives a substantial amount of tangible goods, services, or funds from the board, other than compensation or reimbursement authorized by law for board membership, attendance, or expenses.

Becoming a Board Member

 One Federal Regulation for Healthcare is the; Readmissions reduction program.  How does this regulation influence delivery, cost, and access to healthcare (e.g.,

CMS, OSHA, and EPA)?

 It’s the main goal of healthcare facilities to treat their patients and send them home healthy. Readmissions occur when complications require a patient to return to the hospital for further treatment. The readmissions reduction program was recently established by the CMS “to encourage hospitals to manage their patients in a fashion that reduces and/or eliminates readmissions to inpatient hospital care,” VanFleet says.

 The CMS gathers data from the program to reward hospitals with low readmissions rates and penalize those with high readmissions rates. “The data allows CMS and hospitals to tie outcomes to staffing,” says Young. That means you’ll be directly helping your hospital and yourself if you pay careful attention to patient outcomes.

Federal Regulation

 Has there been any change to the regulation within the past 5 years? Explain.

 Section 3025 of the Affordable Care Act requires the Secretary of the Department of Health and Human Services (HHS) to establish HRRP and reduce payments to Inpatient Prospective Payment System (IPPS) hospitals for excess readmissions beginning October 1, 2012

 CMS uses excess readmission ratios (ERR) to measure performance for each of the six conditions/procedures in the program:

• Acute Myocardial Infarction (AMI) • Chronic Obstructive Pulmonary Disease (COPD) • Heart Failure (HF) • Pneumonia • Coronary Artery Bypass Graft (CABG) Surgery • Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty.

Federal Regulation continued

 In the FY 2014 IPPS final rule, CMS finalized the following policies:  Adopted the application of an algorithm to account for planned readmissions to the

readmissions measures.  Expanded the applicable conditions beginning with the FY 2015 program to include: (1) patients

admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD); and (2) patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).

 In the FY 2015 IPPS final rule, CMS finalized the following policies  Expanded the applicable conditions beginning with the FY 2017 program to include patients

admitted for coronary artery bypass graft (CABG) surgery.

 In the FY 2016 IPPS final rule, CMS finalized the following policies:  Adopted an extraordinary circumstance exception (ECE) policy allowing hospitals that

experience an extraordinary circumstance (such as a hurricane or flood) to request an exception.  Refined the pneumonia readmission measure by expanding the measure cohort to include

additional pneumonia diagnoses: (i) patients with aspiration pneumonia; and (ii) sepsis patients coded with pneumonia present on admission (but not including severe sepsis) beginning with the FY 2017 program.

Federal Regulation changes

 In the FY 2017 IPPS final rule, CMS finalized the following policy:  Revised the date for publicly reporting hospitals’ excess readmission ratio on the

Hospital Compare website to allow for the posting of data as soon as possible following the review period.

 In the FY 2018 IPPS final rule, CMS finalized the following policy:

 Changed the methodology to calculate the payment adjustment factor in accordance with the 21st Century Cures Act to assess penalties based on a hospital’s performance relative to other hospitals treating a similar proportion of Medicare patients who are also eligible for full Medicaid benefits (i.e. dual eligible) beginning with the FY 2019 program.

 Updated the ECE policy to allow facilities or hospitals to submit a form signed by the facility or hospital’s CEO or designated personnel and to allow CMS to grant ECEs due to CMS data system issues which affect data submission.

Federal Regulation changes

 All licensed nurses practicing in Texas are required to “know and comply” with the Nursing Practice Act (NPA) and Board Rules. 22 TAC §217.11(1)(B) requires the nurse to “promote a safe environment for clients and others.” This standard establishes the nurse’s duty to the patient/client, which supersedes any physician order or any facility policy. This “duty” to the patient requires the nurse to use informed professional judgment when choosing to assist or engage in a given procedure.

 This regulation influences the nurse's role in many ways. One way is that as nurses', we are always told to follow through with a physician’s order. However, a professional nurse must act as a prudent nurse. This means that if an order is given for a medication, procedure, etc. that the nurse may deem unsafe or cause harm to the patient, that nurse has the obligation and duty to be the advocate for the patient and if need be, can refuse to administer a medication or perform the procedure ordered, despite what the physician says or how they react.

 This regulation can influence the delivery, cost, and access to healthcare in so many ways. If the nurse is in a situation in which they refuse to administer a medication that they deem inappropriate for a patient could possibly avoid a patient going to the hospital, which reduces the cost of healthcare, and provides the patient with a overall better outcome. The delivery of care is affected in which one has to question why a prudent nurse would have to question a physicians order. A nurse takes an oath to provide care for a patient by using their own professional judgement and this must always be followed to the fullest extent to ensure quality outcomes.

State Regulation

 Prescription Monitoring Program (PMP)  Board of Nursing, 222.8. Authority to Order and Prescribe Controlled Substances (ADOPTED 11/9/18)

This rule was amended by the BON to implement Prescription Monitoring Program rules, as required by legislation from the 85th Session. The rules state that an APRN must check the PMP, and document that check, prior to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol, unless the patient is receiving hospice care or is diagnosed with cancer. An APRN is not subject to discipline if the APRN makes a good faith attempt to review the PMP but is unable to, and documents that attempt. The APRN Alliance submitted comments, arguing that the BON should not discipline for failing to document, that they should clarify the meaning of a “prescription record,” as used in the amendment, and that they should include an effective date, which by law is September 1, 2019. In its adoption, the BON provided clarifications on the second point and accepted the third.

 As a RN moving into an APRN role, this completely changes their scope of practice. Of course RN’s do not having prescribing medication abilities. Also, with so much focus on the opioid epidemic right now, APRN’s must be very diligent in ensuring they have met the proper guidelines prior to prescribing medications.

 This regulation influences delivery, cost and access to healthcare in so many ways. Having APRNs with the ability to prescribe medications and treat patients is a game changer in healthcare itself. This can and has shown to significantly lower the cost of healthcare as opposed to patients being restricted to only being seen by a physician, especially in rural areas. On the other hand, there must still be policies in place to ensure that APRN’s are followed closely by a physician. Physicians in Texas are still required to sign off on all APRN’s treatment orders. This is a safety issue as physicians have more extensive training than APRN’s

State Regulations for APRN

 American Nurses Association [ANA]. (2010). Nursing Professional Development: Scope and Standards of Practice. Silver Spring, Maryland: Nurses Books.org.

 About U.S. Boards of Nursing. (n.d.). Retrieved July 03, 2019, from https://www.ncsbn.org/

 The American Association of Nurse Practitioners. (2017). State advocacy. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment

 Texas Board of Nursing (n. d.). Nurse practice act. Retrieved July 2, 2019, from https:// www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp

 About U.S. Boards of Nursing. (n.d.). Retrieved July 5, 2019, from National Council of State Boards of Nursing: https://www.ncsbn.org/about-boards-of-nursing.htm

 Readmissions-Reduction-Program. (2019, January 16). Retrieved from https:// www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissio ns-reduction-program.html

 Hospital Readmissions. (n.d.). Retrieved from http://www.aarc.org/advocacy/federal-policies-affecting-rts/hospital-readmissions/

References