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Dueling opinions: The evolving scope of practice for NPs

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Dueling opinions: The evolving scope of practice for NPs


Nearly half the states allow broad practice authority for nurse practitioners. Some of their limitations were also loosened in response to the COVID-19 pandemic.

What restrictions, if any, do you believe should be part of licensing nurse practitioners?

Sophia Thomas: We concur with state nursing laws, which specify NPs must practice within the scope of their education and certification. NP licensure should require a Bachelor of Science in nursing granted by an accredited institution; an active registered nurse license; a graduate degree from an accredited NP program and university; and evidence of passing the national NP certification exam.

Dr. Susan Bailey: Nurse practitioners should be licensed to provide care only for which they’re educated and trained. Two to three years and 500 hours of education and training is insufficient to practice independently. Patients agree. In one recent poll, 68% said it’s very important for a physician to be involved in their medical diagnosis and treatment decisions. That’s why the AMA supports physician-led teams.

Is the state-by-state system the best approach to licensing nurse practitioners?

Thomas: State-based licensure allows states to balance public protection with local oversight. One challenge is the unnecessary variation in state laws. Twenty-three states and Washington, D.C., allow patients full and direct access to NPs. In the remaining states, patient access to NPs is limited by outdated licensure laws. To fix healthcare, we must end this patchwork.

Bailey: The AMA supports state-based licensure for all healthcare professionals, recognizing the valuable and primary role of state boards in protecting the health and safety of the public. Alternatives raise serious problems related to enforcement and applicability of practice acts, and state laws related to liability, age of consent, abortion and end-of-life issues.

How do you believe the growth in nurse practitioners has affected access to healthcare services?

Thomas: Decades of studies show NP-delivered care improves outcomes, helps manage costs and improves patient engagement in their care. States with full practice authority attract more NPs, achieve better outcomes and expand care where patients need it most—from retail clinics to home visits. More accessible care can mean earlier detection, illness prevention, improved quality of life and lower costs.

Bailey: Data confirms, irrespective of state laws, the growth of nurse practitioners has not increased access to care in rural or underserved areas. We have seen a proliferation of online-only NP programs, newly graduated NPs with less RN experience, exacerbating the shortage of needed RNs without improving access to care.



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Uber, Lyft to offer free rides to COVID-19 vaccination sites

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Uber, Lyft to offer free rides to COVID-19 vaccination sites


The Biden administration plans to partner with ride-sharing companies Uber and Lyft to provide free transportation for individuals to get vaccinated, as it focuses on building and expanding community outreach.

In a virtual meeting with governors from six states on Tuesday, President Joe Biden outlined the ‘next phase’ of the vaccine rollout with a specific focus on expanding access, building greater confidence in the vaccine and ensuring equitable distribution among vulnerable communities.

As part of that effort, Uber and Lyft have agreed to provide free rides to and from vaccination sites from May 24 through July 4.

“I think that is really stepping up,” Biden said.

The administration plans to partner with community colleges to create on-campus vaccination sites for students, faculty, employees and surrounding community members.

Biden said the Federal Emergency Management Agency will provide funding to state, city and local governments to support their community vaccination outreach efforts with phone banking, door-to-door canvassing or pop-up vaccination sites at workplaces and churches.

“Governors in so many states have been essential partners in this effort,” Biden said. “They know it isn’t about politics, it’s about saving lives and livelihoods, rebuilding our economy and getting us back to our way of life.”

The governors of Utah, New Mexico, Maine, Massachusetts, Minnesota and Ohio also shared their best practices on vaccinating their populations at the White House meeting.

Maine Gov. Janet Mills said Maine’s low population density and its high proportion of seniors made vaccinating their elderly population a high priority. The vaccine soon became available to all individuals 65 and older soon after frontline healthcare personnel were eligible. By April 7, everyone over 16 were eligible to receive a shot, she said.

The state had a series of pop-up clinics and workplace vaccination sites and is working with FEMA to send mobile vaccination units to more rural parts of the state. Those efforts have led to 67% of Maine’s adult population receiving at least one vaccine dose, and 53% are fully vaccinated.

“Nearly every day, our state has led the nation in getting shots into arms,” Mills said. “But we are not dropping our guard, we’re not slowing down.”

Utah Gov. Spencer Cox said the state’s vaccination program has had to become flexible to accommodate changing levels of demand. He said the state designed a public information campaign that focuses on working with community leaders, family doctors and clinicians to talk with their vaccine-hesitant patients about the benefits of getting a shot.

“We’re finding that those trusted voices are helping with us with those next phases of people who are a little unsure or didn’t have time to get around to it,” Cox said.

Massachusetts Gov. Charlie Baker said their vaccination program has led to 74% of their adult population having received at least one dose, which ranks second highest in the country behind Vermont. Baker said the state began its rollout by concentrating on getting vaccinations to more vulnerable adult populations first. Outreach campaigns started with mobile vaccination drives at group homes housing adults with mental and developmental disabilities, elderly adults, and guests and workers within homeless shelters.

Baker said the state’s network of community health centers have played a huge role in targeting communities of color, which has led to improved vaccination rates among Black and Latino adults.

Biden lauded the work of the governors for helping to stem the spread of the pandemic. Rates of COVID-19 cases, hospitalizations and deaths have all decreased over the past 30 days.

More than 220 million vaccine shots have been administered within the first 100 days of the Biden administration as of May 11, Biden said. More than 152 million Americans have received at least one vaccine dose, according to the Centers for Disease Control and Prevention, while more than 115 million are fully vaccinated.

Biden stressed such progress was only achievable through bipartisan collaboration to combat the pandemic that will need to continue to overcome issues with vaccine hesitancy among some that has led to recent declines in demand.

“It isn’t Democratic progress or Republican progress it’s American progress,” Biden said. “Now we have to take the next step together.”



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Amedisys to buy Visiting Nurse Association’s home health and hospice services

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Amedisys to buy Visiting Nurse Association’s home health and hospice services


Visiting Nurse Association signed an agreement to sell its home health and hospice services to Baton Rouge, La.-based Amedisys. The deal is expected to close around July 1, according to a press release.

VNA, which provides home health and hospice care in Omaha, Neb. and Council Bluffs, Iowa, said company leadership has realized they would need external investors to ensure the home health and hospice programs would remain financially strong. As a provider of home health, hospice and personal care, Amedisys fit the bill.

“As VNA reflects on its mission and long history, it has become clear that we should return to our original focus — to serve those in the community who may not have the resources for home health and hospice care services,” VNA President and CEO James Summerfelt said in a statement. “This was our original mission, and there is still tremendous need in our community. We want to ensure that the needs of individuals and families can be met with expertise and compassion well into the future.”

Through the acquisition, “Amedisys will provide additional scale and resources that will expand our opportunities to care for more patients and expand home health services to more communities across Nebraska and Iowa, especially during these unprecedented and evolving times in the healthcare industry,” Amedisys President and COO Chris Gerard said in a statement.

News of the purchase comes less than a month after Amedisys signed an agreement that gave it the right to offer home health services in and around Randolph County, North Carolina and provided access to 31,000 Medicare and Medicare Advantage enrollees. On May 5, Amedisys announced that it would open a start-up care center in the Randolph County area.

After the sale, VNA will continue to provide homeless shelter nursing services, parenting support, mother and child services flu and immunization services, school health programs and home health and hospice services through Amedisys Home Health and Amedisys’ hospice company, AseraCare, in Omaha and western Iowa, according to the release.

Amedisys has 21,000 employees in 514 care centers in 39 states and the District of Columbia and serves more than 418,000 patients and clients every year. It provides home healthcare at 320 locations in 33 states and the District of Columbia.



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Hospitals need to vet suppliers, tech to avoid medical errors

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Hospitals need to vet suppliers, tech to avoid medical errors


Hospitals and health systems need to systematically vet medical supply manufacturers and new technologies that are new to the market—two key lessons that ECRI is passing on to healthcare leaders.

The COVID-19 pandemic dramatically shifted what supplies health systems could get—in some cases providers only learned of discontinuations after placing product orders. Even with manufacturers ramping up production, many products are still going toward national stockpiles.

ECRI says the result of having to switch products quickly can end in patient safety errors, and both clinicians and hospital executives must get better at asking for both product samples and clinical evidence for new technologies, especially during crisis mode.

New suppliers now commonly offer health systems product samples, which can be used for testing to make sure it meets industry standards. Systems should also routinely test differing product lots and deliveries because quality can vary. ECRI recommends asking for referrals to other systems that currently use the brand, country and raw materials of origin information, product specifications, Food and Drug Administration registration information, product photographs and delivery terms.

“Track and monitor country of origin for as many products as possible: several years ago, providers were unaware of the volume of intravenous solutions manufactured in Puerto Rico until it was too late,” ECRI says in its report. “Monitoring triggers (e.g., weather, political disruption) in the country of origin may offer time to pivot to backup plans.”

Providers should also reevaluate their relationships with distributors and group purchasing organizations that either failed or met the needs of providers—like communication and how reliable timeless were—during the pandemic.

Likewise, systems need to take a hard look at processes in place to purchase new technologies during times of crisis. ECRI said that many infrared temperature screening programs were sold at the beginning of the pandemic to reduce infection transmission, but they mostly failed to actually deliver those outcomes.

“A health system’s staff and patients may be better served if leadership expends resources on measures known to work, like social distancing, wearing masks, controlling entry to facilities to separate those working in COVID-19 wards from those working in other patient care areas,” ECRI says, adding that one health system in California spent $20,000 on infrared technology that ended up not working as promised.



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