Rounds with Leadership: From Dialogue to Collaboration

Welcome to Rounds with Leadership, a new forum for AACN's Board Chair and President/CEO to offer commentary on issues and trends impacting academic nursing.

November 29, 2017 - From Dialogue to Collaboration

At the Interim Meeting of the American Medical Association (AMA) held earlier this month, members of the AMA House of Delegates passed a resolution that could threaten efforts underway to advance interprofessional collaboration and team-based care. Resolution 214 calls for the creation of a national strategy to limit the scope of practice of advanced practice registered nurses (APRNs), including opposing the Consensus Model for APRN Regulation that AACN has worked to implement on a national scale. Those advancing this resolution clearly do not understand the essential roles of APRNs in today's healthcare system or the growing body of research linking APRNs to quality patient outcomes.

To help eliminate misperceptions and answer questions about APRN education and practice, AACN has issued a letter to the AMA (see below) to initiate a national dialogue about how to foster collaboration where all members of the healthcare team are respected and valued. Strengthening ties between medicine and nursing will elevate the patient care experience and create an environment where new models of care can be effectively implemented and perfected. Together we can have a greater impact in improving access to care and elevating the nation's health.

November 28, 2017

David O. Barbe, MD, MHA, President
James L. Madara, MD, Chief Executive Officer
American Medical Association
330 N. Wabash Ave., Suite 39300
Chicago, IL 60611-5885

Dear Drs. Barbe and Madara,

As the voice for academic nursing, the American Association of Colleges of Nursing (AACN) is committed to quality education, research, and practice, which requires a strong interprofessional team where all members practice to the full extent of their education, clinical training, and certification. AACN, which represents more than 810 schools of nursing and nearly 500,000 nursing students, was one of the founding members of the Interprofessional Education Collaborative (IPEC), which aims to create real change in the delivery system by advancing core competencies among all healthcare professionals. These competencies focus on mutual respect and shared values with the goal of advancing team-based care, which includes collaboration among nurse practitioners and their physician colleagues.ⁱ We write today to share our concerns regarding AMA's recently adopted amendment to Resolution 214, as we believe it disregards the importance of key IPEC competencies, specifically related to knowledge of roles, communication, and relationship-building.

First, understanding the roles and responsibilities of all members of the healthcare team, specifically Advanced Practice Registered Nurses (APRNs), is paramount. Decades of research have shown that APRNs provide safe, high-quality, and cost-effective care. This evidence has informed state and national stakeholders who support APRNs practicing to the top of their licensure and call for removing barriers to APRN practice.^ii,iii,iv This evidence also has led authorities to identify restrictive legislation and policies impacting APRN practice as restraint of trade. The Federal Trade Commission (FTC) strongly promotes competition in the healthcare industry, which benefits consumers by helping to control costs and prices, improving quality of care, and expanding access to healthcare services. The FTC's analysis of APRN roles and responsibilities found that:

Numerous expert health care policy organizations have concluded that expanded APRN scope of practice should be a key component of our nation's strategy to deliver effective health care efficiently and, in particular, to fill gaps in primary care access. Based on our extensive knowledge of health care markets, economic principles, and competition theory, the FTC staff reaches the same conclusion: expanded APRN scope of practice is good for competition and American consumers.    

Moreover, each profession must guide the educational and practice standards of their discipline. The AMA's resolution specifically highlights and opposes the Consensus Model for APRN Regulation. AACN is the convener of the Licensure, Accreditation, Certification, and Education (LACE) network, which represents more than 30 APRN organizations that worked to develop and implement the Consensus Model. The primary goal of this model is to address gaps in healthcare and expand access to APRN services. Collaboration among these nursing organizations is purposeful, timely, and ongoing. Nursing firmly believes that we have a responsibility to work together to align our practice with the nation's most pressing healthcare needs, particularly in the areas of primary care, population health, social determinants of health, and precision health. AMA's Resolution 214 speaks against the Consensus Model, and we are concerned that APRN roles and responsibilities are not well understood, nor are the benefits provided to the patient.  

Finally, we believe communication and relationship building is needed. In a 21st century healthcare system where innovation and collaboration are the hallmarks of true progress, the intent to develop a national strategy to impede qualified professionals from increasing access to care, as your organization proposes, halts forward momentum. Together we must engage in dialogue for the benefit of the patient, family, and community. The core competency of responsible communication calls on us to listen and hear each other, allowing some space for discussion and debate. AACN believes that we must demonstrate responsible communication and welcomes the opportunity for a national discourse with the AMA and other stakeholders on how to overcome this divided path. 

We look forward to opening a dialogue with you to discuss the points raised in this letter and to clear up any misperceptions related to the APRN role. Together we can build a stronger relationship for the sake of our nation's health and the patients we both serve. 

Sincerely,

  

Juliann G. Sebastian PhD, RN, FAAN 
Chair of the Board of Directors

Deborah E. Trautman, PhD, RN, FAAN
President and Chief Executive Officer

ⁱⁱ Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. National Academies.

ⁱⁱⁱ National Governors Association. (2012). The role of nurse practitioners in meeting increasing demand for primary care.Retrieved from https://www.nga.org/cms/home/nga-center-for-best-practices/center-publications/page-health-publications/col2-content/main-content-list/the-role-of-nurse-practitioners.html

^iv Heritage Foundation. (2010). Not Enough Doctors? Too Many? Why States, Not Washington, Must Solve the Problem. Retrieved from http://www.heritage.org/health-care-reform/report/not-enough-doctors-too-many-why-states-not-washington-must-solve-the

^v Federal Trade Commission. (2014). State Legislators Should Carefully Evaluate Proposals to Limit Advanced Practice Registered Nurses' Scope of Practice. Retrieved from https://www.ftc.gov/news-events/press-releases/2014/03/ftc-staff-paper-state-legislators-should-carefully-evaluate.