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2015 HSR&D/QUERI National Conference Abstract

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3015 — Baseline Evaluation of Advanced Practice Registered Nurses (APRN) in the Veterans Health Administration

Lambert-Kerzner AC, Eastern Colorado Health Care System; Lucatorto M, Office of Nursing Service; Mc Creight M, Eastern Colorado Health Care System; Fagan KM, Eastern Colorado Health Care System; Fehling KB, Eastern Colorado Health Care System; Peterson J, Eastern Colorado Health Care System; Hess E, Eastern Colorado Health Care System; Plumbley R, Puget Sound Health Care System; Ladebue A, Eastern Colorado Health Care System; Battaglia C, Eastern Colorado Health Care System

Objectives:
The Veterans Health Administration's (VHA) Office of Nursing Service is proposing Advance Practice Registered Nurses' (APRNs) be licensed independent practitioners with full practice authority (FPA) to improve access to care, continuity of care delivery, and reduce costs. APRNs have education and certification in four areas: clinical nurse specialist (CNS), nurse-practitioner (NP), nurse-anesthetists (CRNA), and nurse-midwives. FPA occurs when states recognize APRNs as LIPs not requiring physician oversight. Currently 19 states and the District of Columbia have FPA. Reduced/restricted practice authority requires physician's formal collaboration or supervision. Our objective was to describe the roles of interviewed APRNs and perspectives of administrators and APRNs regarding the proposed policy change.

Methods:
A convergent parallel mixed-methods design used quantitative and qualitative data, collected simultaneously and integrated. Eighty-two APRN telephone interviews included 66 NPs, 12 CRNAs and four CNSs. Seventeen administrators were interviewed: five Chiefs of Staff, four Medical Center Directors, two Chief Medical Officers, five Nurse Executives, and one Quality Management Officer.

Results:
We identified 5,724 APRNs in various roles; 84.6% women; mean age 52.7 years. Thirty-five percent of APRNs worked in full practice states; 64.7% in reduced/restricted states. Eighty-one percent were NPs, 14% CRNAs, 5% CNSs, no nurse-midwives. Most APRNs (98%) supported the proposed policy change identifying: efficacious use of resources and decrease variability in APRN care. Most (81%) were satisfied with their practice and felt relationships with physicians would not change; however, some felt physicians may push-back. Barriers to implementation included: having appropriate support/resources throughout transition period and appropriate communication from ONS. Eighty-two percent of administrators expressed support, identifying improved access and quality of care, especially in rural areas. Concerns included: APRNs may leave the VHA and other healthcare professionals may demand a change in licensure.

Implications:
Over 80% of administrators and APRNs supported the change, believing it could standardize patient-centered care across the VHA. Moreover, by adopting the policy change, the VHA may position itself to become more competitive with the private sector attracting APRNs.

Impacts:
The supported policy change is intended to increase access to care, decrease variability throughout the healthcare system, and ensure continuity of the highest quality of care for Veterans.