Title protection for Advanced Practice Nurses

Goal of Legislation:  Wisconsin’s Nurse Practice Act, State Statute Chapter 441, will better reflect the legal practice of Advanced Practice Nursing in Wisconsin using the agreed upon principles and terminology identified in the National Consensus Model for Advanced Practice Registered Nurses including their title, role, educational preparation, certification and licensure.

Who are Advanced Practice Nurses: APRNs are registered nurses who have acquired, through graduate-level education, advanced clinical knowledge and skills to provide direct patient care.
There are four distinct types or roles for Advanced Practice Nurses:

• Certified Nurse Midwife (CNM)
• Certified Registered Nurse Anesthetist (CRNA)
• Clinical Nurse Specialist  (CNS)
• Nurse Practitioner (NP)

Recommendation
Amend Wisconsin State Statute Chapter 441 to achieve uniformity with the National Consensus Model on Advanced Practice Registered Nurses that includes the following:

• Change the titles to Advanced Practice Registered Nurse (APRN) and Advanced Practice Registered Nurse-Prescriber (APRN-P)
• Provide title protection for
  • APRN and APRN-P
  • Certified Nurse Midwife (CNM)
  • Certified Registered Nurse Anesthetist (CRNA)
  • Clinical Nurse Specialist (CNS)
  • Nurse Practitioner (NP)
• Create licensure for APRN-CNM, APRN-CRNA, APRN-CNS and APRN-NP
• Define APRN
• Provide technical amendments to state statutes clarifying the title APNP to APRN-P

Issue: 

• Wisconsin’s Nurse Practice Act, State Statute 441, is relatively silent when it comes to defining the role and responsibility of advanced practice nurses (APNs) and advanced practice nurse prescribers (APNPs).
• Legislation granted prescriptive authority to APNs in 1995, via state statute 441.16. As their increase in the number and utilization continues to grow so has the need for greater clarity regarding their legal practice authority which will be good for consumers.

Facts About Wisconsin’s Advanced Practice Registered Nurses

• APRNs are registered nurses who have acquired, through graduate-level education, advanced clinical knowledge and skills to provide direct patient care.^[1]
• APRNs have advanced education, knowledge and skills to care for a specific population of patients, including adults, families, children and newborns.
• APRNs can also provide gender specific health care (such as women’s health) or provide psychiatric/mental health services. They are educationally prepared to assess, diagnose, and manage patient problems, including ordering tests and prescribing medications.
• APRNs work in a variety of settings, including hospitals, clinics, private offices and schools. They may provide care in places where there is a shortage of physicians and where health care is badly needed.
• In 2012 there were about 8,900 APRNs in Wisconsin.^[1]
• In Wisconsin, approximately 3,500 APRN-Ps^[1] have legal authority to prescribe medications, order   laboratory, radiography, EKGs and durable medical equipment (DME) for their patients.

Demand for APRNs is growing because:

• Hospitals throughout Wisconsin are facing serious provider shortages and need expert clinicians like Nurse Practitioners, Clinical Nurse Specialists and Nurse Anesthetists^[1].
• Increase in the use of same day surgical centers in urban and rural settings is dependent on the services of Certified Registered Nurse Anesthetists and other on-site APRNs.
• Primary care is focusing on patient-centered care coordination that will require prevention and health promotion services particularly for patients with chronic diseases that can be effectively managed by Nurse Practitioners and Nurse Midwives.
• Comprehensive women’s health care across the life-span including obstetrics is increasingly the preferred method of health care delivery which is provided by Nurse Midwives.
• The growth in Medicare eligible individuals in Wisconsin will increase from 13% (726,280) in 2005 to 22.3% (1,485,570) in 2035. This will require greater numbers of practitioners, including APNPs, to provide collaborative and coordinated team-based care in order to achieve quality health care outcomes and cost-efficiencies^[1].
• The number of businesses offering on-site primary care and occupational health services benefits will continue to increase due to timely employee access to cost-effective and high-quality care provided by APRNs and APRN-Ps.
• Health care systems can attest to the benefits of utilizing APRNs in both acute, primary and community settings.

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^[1] The Role of Nurse Practitioners in Meeting   Increasing Demand for Primary Care,   (2012), National Governor’s Association.  http://www.nga.org/files/live/sites/NGA/files/pdf/1212NursePractitionersPaper.pdf

^[2] 2012 RN Workforce Survey, At a Glance. Department of Workforce Development. http://www.wisconsincenterfornursing.org/documents/2012%20RN–2013%20LPN%20Survey–DWD.pdf

^[3]2012 RN Workforce Survey, At a Glance. Department of Workforce Development. http://www.wisconsincenterfornursing.org/documents/2012%20RN–2013%20LPN%20Survey–DWD.pdf

^[4] Report: 2013 Wisconsin’s Health Care Workforce.  Wisconsin Hospital Association.  http://www.wha.org/pubarchive/reports/2013workforcereport.pdf

^[5] Wisconsin Plan for Older People 2013-2015.  Wisconsin Department of Health Services. http://www.dhs.wisconsin.gov/publications/p0/p00373.pdf

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