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Medscape
2 days ago
- Health
- Medscape
Regulatory Challenges for NPs, PAs — How to Keep Up
A roadside rest stop isn't the typical place to meet up with your patient. But it worked for Johnny L. Rollins, MSN, APRN, ANP-C, a nurse practitioner (NP) and associate director of the Advanced Practice Provider Programs — survivorship at the University of Texas MD Anderson Cancer Center, Houston — and his patient who lived in Louisiana. As a licensed provider in Texas, he can't practice medicine in another state unless licensed there as well. Rollins said his patient needed a telemedicine visit. 'A telemedicine visit is technically a billable clinic visit,' Rollins told Medscape Medical News, 'and compliance with state and federal telemedicine law is required.' As a result, he said, this patient and some others from Louisiana, have driven across the Louisiana-Texas state line, parked at a welcome area rest stop, and then started the video clinic visit to meet compliance requirements. Rollins' story illustrated how keeping up with regulations is necessary — but also a challenge, not only for physicians but also for the 280,140 NPs and the 152,103 physician assistants/associates (PAs) practicing in the US. Changes regulating both NP and PA practices, some said, have increased in recent years, sometimes spurred by COVID-related changes. Staying up to date is crucial, as not paying attention could jeopardize a healthcare worker's practice. Despite the challenge, many sources of information can help NPs and PAs stay up to date. Who Regulates? Beyond federal and state legislation regulating how NPs and PAs practice, healthcare organizations may have additional policies, so it's crucial to be aware of all of them, experts said. For PAs, while there is some variation in state law, 'the majority of states have abandoned the concept that a medical board or other regulatory agency should make decisions about scope of practice details for individual PAs,' according to the American Academy of Physician Associates, Alexandria, Virginia. Rather, most states allow the scope of practice details to be decided at the practice level. For NPs, the American Association of Nurse Practitioners, Austin, Texas, offered state-by-state practice information, with information on the regulatory structure (full practice, restricted, and reduced), regulatory agency, continuing education hours needed for licensure, signature authority, and other requirements. Changes, Fast and Varied Staying up to date on regulatory changes and requirements is more difficult these days, said Susan S. VanBeuge, DNP, APRN, FNP-BC, a professor in residence at the University of Nevada, Reno, and a practicing NP. She cited more changes in requirements on both the state and national level in recent years than in the past. Deborah Busch, DNP, RN, CRNP, CPNP-PC, IBCLC, CNE, FAANP 'One of the biggest challenges for NPs is the variation in state law,' said Deborah Busch, DNP, RN, CRNP, CPNP-PC, IBCLC, CNE, FAANP, an NP and associate professor at Johns Hopkins School of Nursing, Baltimore. The regulatory environment has been 'more of a moving target the last 5 years or so,' she said. She cited COVID-19 as one reason, explaining it was accompanied by the expansion of some services, but now, as some are going away, close attention is needed to know what stays and what goes. 'The rapid pace of regulatory change in the current environment can be complex,' agreed Todd Pickard, DMSc, PA-C, a PA at the MD Anderson Cancer Center, who cares for patients and also serves as executive director of Advanced Practice at the Cancer Center. As complex as these regulatory shifts can be, Jennifer Orozco-Kolb, DMSc, PA-C, chief medical officer at the American Acad emy of Physician Associates, pointed out that one of the core competencies for every PA is staying informed about evolving laws and regulations. 'The volume of regulatory changes impacts the entire healthcare team,' she said. So, a change in, for instance, a fee schedule will affect all providers who offer that care, she said. Primary Issues What regulatory issues most concern NPs and PAs? 'The primary issues concern reimbursement, patient eligibility, and care modalities, as well as assisting patients in navigating their coverage,' Pickard said. Regulatory compliance in telehealth was important, as Rollins, the NP who has had rest area telehealth visits, knew. In most cases, he said, other communication with the patient can be handled by HER platform messaging; it's the telehealth visit with an out-of-state resident that's the logistical challenge. Susan S. VanBeuge, DNP, APRN, FNP-BC Continuing education requirements could also change, as VanBuege knew. In Nevada, for instance, the state nursing board requirements for continuing education in cultural competency changed recently. 'It went from 2 hours at regular intervals to now 4 hours of continuing education [in cultural competency],' VanBeuge said. A delay in license renewal might occur if an NP applied for renewal without those required 4 hours included in the continuing education, she said. That's why it's so important to keep an eye on the legislative proceedings in the state that an NP or PA practices in, she said. 'Our legislature meets every 2 years,' she said of Nevada. 'During that time, anything can happen within those 2 years.' Changes often do occur that affect healthcare providers, she said. Changes in guidelines for the COVID vaccine, issued in late May, are another example of the need to stay current on policy changes, Orozco-Kolb said. Those changes are dramatic, going from recommending everyone 6 months or older get vaccinated to limiting access to those older than 65 years or younger people with a risk factor for severe COVID. It's important to know the policy of a hospital network, Busch said. For instance, 'a state board of nursing may allow [NPs] to do a certain procedure, but a hospital network may have an internal policy restricting it.' The limitation isn't always about ability, she added. Rather, a hospital may already have a team in place that provides that procedure, she said. Sources of Help Policy courses are part of the education, said George Zangaro, PhD, RN, associate director of the DNP Executive Track at the Johns Hopkins School of Nursing. So, he said, simulations of regulatory cases are to prepare for the real world. 'We put a heavy emphasis on clinical, ethical, and legal responsibilities that NPs have in practice.' How to keep current on regulations in the most efficient way? 'I turn to my practice leadership, financial teams, my colleagues, and, in many cases, professional associations such as the American Society of Clinical Oncology (ASCO),' Pickard said. He acknowledged how time-consuming it is, taking time away from other responsibilities, but also noted how critical it is to both his patients and his practice. Likewise, Rollins said, he turns to colleagues and consults the legal and compliance teams at the MD Anderson Cancer Center. George Zangaro, PhD, RN 'Once out of school, to keep up, continuing education is important,' Zangaro said, beyond the required hours. He encourages graduates to attend conferences regularly. 'Most conferences have a regulatory session included in them, depending on the current hot issues.' Membership in the NP and PA organizations has built-in tools to help, the organizers pointed out. The American Association of Nurse Practitioners offers information on frequently asked questions about government policy, additional information on policy tracking, and a government affairs update newsletter that is for members only. The American Academy of Physician Associates offers insight on requirements, certification, state licensing, and maintaining certification. (While the organization, the American Academy of Physician Associates, uses only 'associates,' not 'assistants,' Oregon is so far the only state to adopt the title change to associate, effective June 6, 2024.) Turn to 'trusted sources,' Zangaro said, such as the National Council of State Boards of Nursing, the Centers for Medicare & Medicaid Services, and national associations such as the American Nurses Association. While many sources of help are available for staying current with regulations, VanBeuge emphasized that the responsibility is on the shoulders of the healthcare practitioner. 'It's on you as the license holder to be responsible to know what is happening, and not the regulatory body's responsibility to tell you.'
Yahoo
25-05-2025
- Health
- Yahoo
Illinois General Assembly passes bills aimed at helping new mothers
Illinois lawmakers passed two bills this week that aim to support mothers in the state. One bill requires employers to give paid time off to employees who pump breastmilk at work. The second allows midwives to help with home births, which is the latest attempt by Illinois lawmakers to restore access to maternal health care in the state's maternity care deserts. House Bill 2688, sponsored by Rep. Anna Moeller, D-Elgin, would allow certified nurse midwives to enter a written agreement with a physician to provide or assist with home births. In designated maternity care deserts, they can enter into such an agreement even if the local physicians don't provide home births. The bill only applies to certified nurse midwives, who must be a licensed advanced practice registered nurse, or APRN, and have at least a graduate degree in midwifery. It does not give the same privileges to certified midwives, who are required to have a graduate degree in midwifery. In recent years, the number of home births across the nation has been steadily rising. The CDC reported that 51,642 home births took place across the country in 2021. That number was a 12% increase from the number of home births in 2020, which the CDC said was the largest increase since at least 1990. The rise in home births in Illinois is often attributed to the rise in the state's maternity care deserts, which are counties without a single hospital, birth center, or licensed health care professional who offers obstetric care. According to a report from March of Dimes, a nonprofit focused on improving maternal health care across the U.S., about 34% of Illinois counties are labeled maternity care deserts. The nationwide average is about 32% of all U.S. counties. The CDC reported that nearly 35% of women living rural areas that are of reproductive age did not live within 30 minutes of a birthing hospital in 2023. March of Dimes reported that women living in counties with the highest travel times to a birthing hospital had to travel anywhere between 47 and 59 miles. They also found that women living in maternity care deserts had to travel a little more than 5 times as far as women living in areas of the state with adequate access to maternity care. 'This bill addresses the maternity care deserts that exist in our state to give certified nurse midwives the ability to collaborate with other nurse midwives and APRNs to provide such care,' Moeller said during a House committee hearing on the bill in March. Illinois' recent history around the legality of midwives also played a role in the recent increase of maternity care deserts in the state. Although midwives have been used and recognized as health care professionals for centuries, when hospitals began to be recognized as the safest health care settings in the late 1900s, many states stopped licensing midwives and even outlawed the practice altogether. In Illinois, state officials stopped licensing midwives in the mid-1960s and outlawed the practice in 1992 – making the act a felony with punishments of fines up to $10,000 or three years in prison – according to NPR Illinois. A law passed in 2021 reversed that decision, making midwifery in the state legal and again allowing for midwives to be legally licensed. HB 2688 also allows nurse midwives, if they are APRNs, to provide birth services in a licensed birth center without a written agreement if the director of the birth center allows them to. Under the bill, physicians will not be liable for the acts or omissions of nurse midwives solely because of the agreement, unless the physician 'has reason to believe' the midwife was unprepared to perform the services or committed willful and wanton conduct. The bill passed the Senate on Thursday with a vote of 57-1, with only Sen. Jil Tracy, R-Quincy, voting no. It now awaits approval from the governor to become law. Senate Bill 212 mandates employers to compensate mothers who take breaks at work to pump breast milk for up to a year after their child is born. The bill prohibits employers from requiring employees to use paid leave time for pumping. 'I believe many employers are already doing the right thing, and, you know, we just need to compel a few of them to make sure they are also supporting mothers and babies,' Rep. Katie Stuart, D-Edwardsville, said on the House floor Wednesday. During a news conference in February, bill sponsor Sen. Laura Fine, D-Glenview, said she would have benefitted from the bill when she had children. 'I know for me, we did not have the generosity of these rules and regulations to allow me to take that break to take care of my child,' Fine said. 'So, it would be hiding in a bathroom, getting away when you possibly could and actually having to stop breastfeeding early when it couldn't work out.' The bill passed the House Wednesday on a bipartisan vote of 82-27. It now only needs approval from the governor to become law.
Yahoo
15-05-2025
- Health
- Yahoo
Bill to let qualified nurses practice independently overcomes divisions
Terri Vandenhouten, a nurse practitioner in Brown County, testifies Tuesday in favor of a bill that would allow nurses with advanced credentials practice independently after a period of supervision. (Screenshot/WisEye) Legislation to allow nurses with advanced training to practice independently has overcome objections that led the measure to be vetoed twice in the last four years, the Assembly's health committee heard Tuesday. AB 257 would create a new health care professional category of Advanced Practice Registered Nurse (APRN). APRNs would include certified nurse-midwives, certified registered nurse anesthetists, clinical nurse specialists and nurse practitioners. Under the bill, an APRN would be permitted to practice on their own after working under the supervision of a medical doctor. Currently, nurse practitioners in Wisconsin must have a continuing collaboration agreement with a practicing physician. Advocates for the legislation have said such agreements shouldn't be necessary for a fully trained APRN, and that some nurse practitioners have faced barriers in enlisting a collaborating doctor despite their own qualifications. The legislation to end that requirement is a goal that organizations representing the nursing profession have been pursuing for more than a dozen years in Wisconsin. There are now 28 states that have a similar standard in place, advocates said. At Tuesday's public hearing on the bill before the Assembly Committee on Health, Aging and Long-term Care, advocates and one-time opponents of the measure alike appeared ready to see it finally enacted this year. 'Where health care providers are even more scarce, when the difference between a good outcome or a bad outcome is on the line, access to quality, dependable health care is everything,' said Rep. Tony Kurtz (R-Wonewoc), lead author of the Assembly bill, in his hearing testimony. 'Recognizing APRNs will help ease the provider shortage we feel across our state and make Wisconsin a more attractive place for these professionals to practice.' The bill 'is important to meeting the demands for health care throughout Wisconsin and in particular our rural and at-risk populations,' said Terri Vandenhouten, a nurse practitioner in Brown County. Gov. Tony Evers vetoed a version of the APRN legislation in 2022 after it passed both houses of the Legislature, and he did so again in 2024. This time around, Evers along with legislators from both parties spent time working through the objections that led to Evers' previous vetoes. 'We had very good conversations with the governor's office and came up with a compromise,' said Sen. Patrick Testin (R-Stevens Point), for whom the legislation has been a long-time goal. Testin said that 'not everyone is 100% happy' with the bill in its current form — 'which probably tells me we landed in a really good spot.' As the last version of the bill was under debate, Evers laid down markers for three elements that he required before he would sign the measure: increasing the amount of training and supervision before an APRN can practice independently; requiring additional supervision for some APRN practitioners in the field of pain treatment; and ensuring that APRN practitioners didn't use titles that might confuse patients about their credentials. The new bill addresses all three points, said Testin. Under the new bill, in order to be credentialed as an APRN, a nurse must have the equivalent of two years of practice under a doctor's supervision. The new APRN must then work for another two years under a doctor's collaborative supervision before going solo. The bill added a requirement — sought by doctors in the field of pain medicine — requiring APRN practitioners who treat pain syndrome and who use 'invasive techniques' to work in collaboration with a pain medicine physician. The bill also addresses the use of professional titles, which doctors have argued are sometimes improperly appropriated by providers without a physician's credential. For an APRN to use a title, it must be one granted under Wisconsin's nursing statutes, according to the bill. An APRN with a doctorate may use the title of 'Doctor,' but with identifying information about what field the degree is in, so patients don't misinterpret the practitioner as being a physician. Representatives for the medical profession who have opposed previous versions of the bill told lawmakers Tuesday they now were officially neutral. The Wisconsin chapter of the American College of Emergency Physicians hasn't taken a position for or against the bill, said the group's representative, Dr. Aurora Lybeck. While she praised the 'significant strides' in adding experience requirements, provider title protection and restrictions on pain practice, Lybeck said Wisconsin should institute specific requirements to staff emergency rooms with doctors. Mark Grapentine, the Wisconsin Medical Society's policy advocate, also testified that the doctors' organization was now neutral on the measure after having opposed it. His remarks all but conceded that the arguments of the bill were now over. 'We are grateful that so many bipartisan members of the Legislature and that Gov. Evers listened to the concerns that physician groups brought forward and were able to include three of those important elements in the bill that you have before you,' he said. Rep. Lisa Subeck (D-Madison), the health committee's ranking Democrat, told the Wisconsin Examiner that years of working on the bill as well as Evers' role in encouraging a resolution helped the legislation reach a point where its enactment now seems likely. 'This was a good example of a bill where there was both bipartisan support and bipartisan opposition,' Subeck said. 'It felt like we were a long way from getting it done, and I think the governor has really helped to get this bill moving forward.'
New Straits Times
06-05-2025
- Business
- New Straits Times
Asean PR Excellence Award to be held in KL on July 7
KUALA LUMPUR: The Institute of Public Relations Malaysia (IPRM) and Jakarta-based Asean Public Relations Network (APRN) will jointly organise the Asean PR Excellence Award to be held in Kuala Lumpur on July 7. In a statement today, IPRM said the award is strategically aligned with the annual Kuala Lumpur International PR Conference (KLIP 7), themed 'Impactful AI, Social Media Communication and Online Education for Asean and the Global Community'. Since its inception in 2019, KLIP has been a pivotal global conference for PR and communication leaders, professionals as well as academics from Asean and beyond, fostering the sharing of the latest industry insights. The statement noted that the conference will feature presentations and discussions aimed at cultivating collaborative strategies to enhance online safety awareness and education across Asean. "Addressing the crucial imperatives of responsible digital citizenship and ethical communication practices, this event gains particular significance as Malaysia holds the Asean Chairmanship in 2025," the statement said. The statement further noted that this pivotal role underscores Malaysia's dedication to fostering regional collaboration and assuming leadership in communication and information security. In the same statement, Communications Minister Datuk Fahmi Fadzil reaffirmed Malaysia's commitment to building a future where responsible and transparent communication remains at the heart of every relationship. "As Malaysia assumes the role of the Asean Chair, we are reminded of the critical importance of leadership grounded in integrity, transparency and ethical communication. Public relations excellence is not merely about influence; it is about fostering trust, respect and meaningful connections that transcend borders. "In this pivotal moment, Malaysia is proud to lead by example, championing ethical communication as a cornerstone of our regional cooperation," he said. The statement also quoted IPRM president Jaffri Amin Osman as saying that the confluence of the Asean Excellence Award and international conference provides a unique opportunity to celebrate achievements and drive meaningful dialogue on critical issues, especially on AI, issues and crisis management, ethics, and governance in PR and communications. Reinforcing this view, IPRM Accreditation Board chairman Professor Datuk Seri Dr Syed Arabi Idid highlighted the crucial role of communication and English language mastery for an impactful Malaysian Asean Chairmanship, a point corroborated by a comprehensive International Islamic University Malaysia (IIUM) Electoral Studies Research Unit survey. He emphasised that these skills, coupled with Malaysia's considerable international experience, will be vital in Asean's global representation, perfectly complementing the objectives of the upcoming conference and awards in fostering collaboration and raising PR and communication standards across the region. Meanwhile, APRN president Prita Kemal Gani said the Asean PR Excellence Award will recognise outstanding achievements in public relations across the Asean region, celebrating innovative campaigns and impactful initiatives that have contributed to the advancement of the profession. "We are thrilled to bring the award to Kuala Lumpur this year, a testament to the growing collaboration and dynamism within the Asean PR community. This event will be a catalyst for further growth and excellence in our field," she added. KLIP will feature international, Asean as well as national keynote speakers, panel discussions and interactive sessions, providing valuable insights and networking opportunities for attendees.
Yahoo
04-03-2025
- Health
- Yahoo
Rep. Joanne Shofner introduces bill that could improve healthcare in rural East Texas
NACOGDOCHES, Texas (KETK) – Advanced Practice Registered Nurses could soon have full practice authority in rural East Texas. Rep. Joanne Shofner filed HB 2532 on Feb. 6 that would allow APRNs to practice as independent practitioners. The bill will give APRNs the ability to treat health problems and prescribe medications (including controlled substances). In order to qualify, APRN's must apply to the Texas Board of Nursing and pay an application fee. The deadline for the fee will vary by program and school. GOP pushes ahead with citizenship voting bill. Some state election officials say it's problematic Advanced Practice Registered Nurses (APRN) range from nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists. APRNs' tasks include treating and diagnosing illnesses, manages chronic disease, advising the public on health issues and engaging in ongoing education to remain ahead of any developments. APRNs have a master's degree, or higher, while a registered nurse only has standard education and licensing. The bill has not yet reached the second stage. The Texas Board of Nursing is required to adopt implementing rules by Feb. 1, 2026 with the law taking effect on Sep. 1. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
