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American Association of Nurse Practitioners (AANP) and more than 235 organizations sent a letter to the leaders of the U.S. House of Representatives Committee on Ways and Means and the Committee on Energy and Commerce illustrating strong support for H.R. 2713, the Improving Care and Access to Nurses (ICAN) Act.

This bipartisan legislation, which was introduced in April in the House of Representatives, would authorize nurse practitioners (NPs) to order cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, ensure NPs’ patients are represented in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities and more.

NPs provide high-quality healthcare to Medicare and Medicaid patients across all geographic areas and healthcare settings. Over 40% of Medicare beneficiaries receive care from NPs, the fastest-growing Medicare provider group. Yet, despite the high-quality healthcare NPs provide to Medicare and Medicaid beneficiaries, barriers still exist within the programs that prevent the effective and efficient delivery of care.

Daily Nurse spoke with former AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, and FAAN, about this critical legislation and how it will remove outdated barriers to practice that delay access to care for patients and move healthcare delivery forward for patients, providers, and our nation.

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Former AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, and FAAN

Talk about the Improving Care and Access to Nurses (ICAN) Act, how it strengthens patients’ access to care, and why it’s so important.

The ICAN Act is improving care and access to nursing. It’s focused on Medicare and Medicaid beneficiaries and removing barriers so that they can have timely needed care. And there are just a few things I can mention that are in the act. Nurse practitioners and advanced practice registered nurses providing access to APRN care can order and supervise cardiac and pulmonary rehab to certify when patients need therapeutic shoes and include their patients in the Medicare Shared Savings Program. There are no costs, no delays, and immediate things that can be put into place where Medicare and Medicaid beneficiaries can immediately have that much-needed care. So we’re very excited about reopening of the ICAN Act. We feel it will reduce barriers to care for Medicaid and Medicare beneficiaries, giving them full indirect access to NP care.

Please talk about APRNs, who they are, why they’re essential to nursing, and their role in healthcare.

APRNs are healthcare providers. Advanced practice nurses include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives, and all play a pivotal role in the future of healthcare. They’ve been educated and clinically trained to care for patients in a particular field of practice. They can diagnose and treat and order and interpret tests. They’re great at coordinating care and educating. They provide a comprehensive but focused health promotion and chronic disease management approach. And you know, most of the people I’ve talked to either know an NP, or they see an NP and know precisely the type of high-quality care we provide.

APRNs are stepping up, and we’re meeting these huge needs that we see in healthcare today. According to the U.S. News and World Report, for the second year in a row are the number one job in healthcare. So people want to see nurse practitioners. There are over a billion visits to nurse practitioners every year 42% of Medicare Medicaid beneficiaries are seen by nurse practitioners. That’s why this piece of legislation is so important. It removes those outdated and unnecessary barriers to providing the care we’ve been providing so well.

Let’s talk about the history leading to the ICAN Act. In 2010, The Institute of Medicine (IOM) issued The Future of Nursing: Leading Change, Advancing Health and in 2021 The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.

The Future of Nursing Report in 2021 is the Future of Nursing 2020-2030. It focuses on health equity, understanding social determinants of health, and nine key recommendations. Recommendation four is to remove unnecessary barriers to practice that all nurses should be able to practice to the full extent of their education and training. And that is just absolutely to provide access to care for everyone everywhere. Over 100 million Americans lack access to primary care, and nurses are catalysts for this care. So the Future of Nursing Report is very important and comes on the heels of that foundation. We must allow nurse practitioners to practice to the full extent of what they’ve been educated and trained to do. And this will enable more and more Americans to have access to care.

Despite recognizing the importance of APRNs to our healthcare workforce, some federal statutes and regulations and state practice acts limit APRN practice. How is this thinking detrimental to patient care?

We have over 100 million Americans that lack access to care. We have 163 million Americans that lack access to mental health services. It is very much a need that we’re all focused on as nurse practitioners. We’ve evolved over the last six decades. We provide very high-quality, safe care. We’re educated and have nationally accredited education, training, and standards of care. And so we need all of our states to update their laws. We have a workforce today that includes nurse practitioners. We have healthcare changes to absolutely demand nurse practitioners to be out there providing care. And so we need our states to update their laws so that we have the licensure authority to practice to the full extent of our education and training. Twenty-seven states and D.C. are full practice authority states. In those states, we’ve seen an improved workforce, increased access to care, and more nurse practitioners working in historically underserved areas.

How can we reach those states that have yet to allow full practice authority? What can nursing do to get things in motion?

We must get in front of the lawmakers, educate them, and provide evidence of our patient care outcomes. We have decades of evidence out there that show that we provide high-quality, very safe care. We get that information in front of the lawmakers and give examples of what’s happened to other states that have moved to full practice authority. So I’ll give you an example. Arizona moved to full practice authority in 2001. Five years later, they saw their workforce doubled. And they saw a 70% increase in nurse practitioners working in historically underserved areas. We see this in every state that moves to full practice authority. No state has gone back. They’ve only gone forward. The states associated with the best healthcare outcomes are full practice authority states. Those states at the low end of the list are restricted with outdated laws. If they can update those laws, it would be a no cost. As I said earlier, there is no cost, no delay solution to increasing access to care for the people in their state.

How can nurses and others support this legislation and have their voices heard?

We need to speak up. We need to advocate. We need to speak with our legislators. We need to send letters and emails. We need to contact our lawmakers as constituents in their area. They need to hear from us as nurses. From a professional association standpoint, many nurses are part of a professional association. The American Association of Nurse Practitioners is the largest NP association representing all specialties of nurse practitioners. And we have an excellent state and federal advocacy team that keep all of our members updated on what’s happening. And they keep us updated on the bill number so that we can immediately advocate for the legislator that legislation and we can immediately connect with our lawmakers. I think what’s important is we need to make that reach out to our lawmakers. They want to hear from us. They want to hear from nurses. There are over 4 million nurses in the U.S. There are over 355,000 nurse practitioners in the U.S., and they want to hear from us.

Renee Hewitt
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