Author: Moore on Health

As a Nurse Practitioner I am delivering healthcare services, namely, providing evidenced based health promotion, primary prevention, disease and medical practice management.

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AB 890 (Woods) Nurse Practitioner bill will remove standardized procedure and provide a scope of practice definition for Nurse Practitioner. In addition, AB 890 will also – as written February 2020 – do the following and more:

  1. Create a NEW – Advance Practice Registered Nursing Board with 3 MDs +/- surgeons, 4 NPs and 2 members of the public. 
  2. Established a transition to practice (TTP) of 3 years or 4600 hours
  3. Require National Board Certification 
  4. Require NPs to use an identified standard Spanish phrase to describe the NP
  5. Require an addition 3 years added to the 3 year TTP for NPs practicing outside the identified settings (i.e., hospital, health facility, clinic, and-or medical corporation)

It is very important that you READ the bill for yourself before discussing it with other NPs and/or your local elected officials. The bill passed out of the Assembly this month. You should reach out to your local elected Senator when you are ready to discuss the bill. If you don’t know who your elected official is go to – http://findyourrep.legislature.ca.gov 

To read AB 890 click here – https://leginfo.legislature.ca.gov/fa…/billTextClient.xhtml…

Currently, 22 states and the District of Columbia allow NPs to diagnose, treat patients and prescribe medications without a physician’s supervision. NPs practice in a variety of health care settings, including hospitals, nursing facilities, clinics and private practices. State law determines the extent to which NPs can work independent of a physician.

Almost 80 percent of NPs in the U.S. – 204,000 out of 262,000 – practice primary care, compared to 33 percent of physicians (Health Affairs – online September 4, 2018). In 2016, the US Department of Veterans Affairs announced new regulations permitting full practice authority for the nearly 6,000 advanced practice nurses in its workforce. The VA made this change in policy due to an acute provider shortage within its system, resulting in delays in care. The regulations allow NPs working in a VA facility “to practice to the full extent of their education, training, and certification, regardless of state restrictions that limit such full practice authority.” 

Moore On Health believes in increasing #DirectAccessToCare for the people of California by allowing #NursePractitioners to gain #FullPracticeAuthority. #AB890 has several areas of concern and although there is not such thing as a perfect bill we must not set forth precedents that will negatively impact our profession and other States seeking #FPA. 

 

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SDOH1

In 1994, President Clinton signed into law Executive Order #12898 that required the following: 

“Each Federal agency shall make achieving environmental justice part of its mission by identifying and addressing, as appropriate, disproportionately high and adverse human health or environmental effects of its programs, policies, and activities on minority populations and low-income populations.”

It has been proven that we cannot address environment justice unless we tactical social justice. This form of social injustice clearly obvious when you look at the locations of various environmental destruction throughout history caused by mankind.

Recently, we experienced the Thomas Fire in Santa Barbara county and there was an issue about the emergency evacuation information not being delivered in Spanish. This issue was addressed by Santa Barbara’s Assemblymember Monique Limon in September 2018 with the introduction of AB 1877 (Limón) Office of Emergency Services: 15320communications: notifications: translation. This bill was signed into law by Governor Brown on September 21, 2018. This bill would require the Office of Emergency Services to create a library of translated emergency notifications and a translation style guide, as specified, and would require designated alerting authorities, as defined, to consider using the library and translation style guide that may be used by designated alerting authorities when issuing emergency notifications to the public. The bill would authorize the office to require a city, county, or city and county to translate emergency notifications as a condition of approving its application to receive any voluntary grant funds with a nexus to emergency management performance.

SDOHAccording to Health People 2020, “ the importance of addressing the social determinants of health by including “Create social and physical environments that promote good health for all” as one of the four overarching goals for the decade. The Social Determinants of Health topic area within Healthy People 2020 is designed to identify ways to create social and physical environments that promote good health for all. All Americans deserve an equal opportunity to make the choices that lead to good health. But to ensure that all Americans have that opportunity, advances are needed not only in health care but also in fields such as education, childcare, housing, business, law, media, community planning, transportation, and agriculture.”

Examples of social determinants include:

  • Availability of resources to meet daily needs (e.g., safe housing and local food markets)
  • Access to educational, economic, and job opportunities
  • Access to health care services
  • Quality of education and job training
  • Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
  • Transportation options
  • Public safety
  • Social support
  • Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
  • Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
  • Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
  • Residential segregation
  • Language/Literacy
  • Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
  • Culture

As a member of the health care profession social determinates are a growing number of issues within and outside of the health care system. Outside of the health care system, initiatives seek to shape policies and practices in non-health sectors in ways that promote health and health equity. Inside the health care system,there are multi-payer federal and state initiatives as well as Medicaid-specific initiatives focused on addressing social needs.

Sources:
https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

 

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On February 3-5 – Moore On Health had the pleasure to join over 300 other Nurse Practitioners in Washington D.C at the 2019 AANP Health Policy Conference. During the conference we heard from policy and legislative strategy experts on issues limiting access to care. Every day, we should be working to create positive changes to the health care system, eradicating antiquated regulatory process and increasing direct access to care for the community at large.

Presently our federal legislative policy priorities are:

  • Authorize NPs to Certify Patient Eligibility for Medicare and Medicare Home Health Services
  • Authorize the assignment of NP patients to Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs)
  • Ensure Patients with Diabetes Have Timely Access to Therapeutic Shoes
  • Authorize NPs to Certify Medicare Patients for Hospice Care
  • Authorize NPs to Perform Admitting Examinations and All Required Patients Assessments in Skilled Nursing Facilities (SNFs)

AANP supports legislation and regulatory changes which removes barriers to practice so that NPs can practice to their full scope, ensuring that patients have access to these much needed high quality, cost effective, health care services. NPs are a critical part of the solution to our nation’s health care needs.

Question: How are our advocating to strength the NP profession and increases full and direct access to care?

If you did not attend the 2019 AANP Health Policy Conference you can still participate and help eradicate antiquated process that creates barriers to practice.

  • Ask your Senators to cosponsor Home Health Care Planning Improvement Act (S. 296) – Click HERE
  • Ask your Members of Congress cosponsor S. 237/H.R. 808 which would authorize nurse practitioners (NPs) to certify their patient’s need for therapeutic shoes. – Click HERE
  • Encourage Members of Congress to Cosponsor H.R. 900 to Allow NP Patients to be Counted in ACOs – Click HERE

As nurse leaders, NPs must be involved in health policy. The NPs who advocate for major health policies can influence countless people throughout their state and the nation, depending on the level of the health policy.

Involvement in health policy is the most important role an NP can have in impacting positive change in health care that will benefit multiple generations of patients across institutions, states, the nation, and even globally.