Those who are most interested in a rural healthcare practice are those who grew up in and prefer a rural setting.
With the need for rural practitioners critical, the most effective way for rural hospitals and health systems to adequately staff for nurses and nurse practitioners is to grow their own, says nurse educator and practicing clinician.
Michele Reisinger, DNP, APRN, FNP-C, should know. She is a Kansas native with a decades-long clinical practice as a family nurse practitioner in her hometown of Onaga, population about 700.
She also is an assistant professor of doctoral nursing at Washburn University School of Nursing in Topeka, Kansas, where she is the primary investigator on a Health Resources & Services Administration-funded $2.4 million, four-year grant focused on the education and preparation of rural nurse practitioners for practice in medically underserved communities.
The need for advanced practice nurses (APRNs) in rural areas is great, as hospitals close and the number of physicians declines. Nearly 80% of U.S. rural counties are medical deserts, with no access to healthcare services, according to the National Rural Health Association.
"I have students that live out in western Kansas and southwestern Kansas, and these students are being recruited heavily a year before they even graduate because those rural health clinics are having to staff with long-term locums who have been present for several months to a year because they don't have enough bodies to physically fill the positions that are there," Reisinger says.
The question is whether those APRNs will stay for the long term, she says.
"You can provide incentives, such as participation with tuition reimbursement," Reisinger says, "but often what we will find happens is those entities then put in the number of years they're required to pay back their tuition reimbursement and they don't often stay sustainably in the community."
For example, the National Health Service Corps Scholarship Program essentially removes a clinician’s educational debt once they’ve fulfilled an obligation of a particular number of years to a community.
"Sometimes it works, sometimes it doesn't," Reisinger says. "Sometimes those people stay for 10 or 15 years, sometimes they stay there for three years and move on, because they've got their educational debt paid off."
But that’s not for lack of trying on Reisinger and Washburn’s part to get them to stay.
The nursing school requires students’ rotations to include a certain number of hours in rural health settings to expose them to a practice of which they might not otherwise be familiar.
"The reason for that is twofold," Reisinger says. "One is to effectively prepare them educationally, but it’s also to generate interest because it's very difficult to recruit nurse practitioners to the rural areas, so this is also a workforce type of issue."
Coming back home
Those who are most interested in a rural healthcare practice are those who grew up in and prefer a rural setting, Reisinger notes.
"In my little corner of the world, we've recruited a lot of different ways, but what really works is you have to raise them in a rural community, send them away to get educated, and hope they migrate back to the rural community because they recognize the benefit of a rural community in raising their own children or have that piece of community attachment," she says.
"It's really hard to relocate a provider who has never experienced rural living or who doesn’t have a sense of community in a rural entity," she says.
That’s why hospitals or extended-care facilities are tending to recruit locals within their own communities.
"Rather than spending those additional funds outside and trying to recruit it, if you can recruit within and then bring them back, retention is much greater, at least in my experience," Reisinger says.
Better staffing, cost savings
Eastern Maine Community College’s nursing program in Bangor, Maine, collaborates with the region’s rural hospitals to provide nursing education for students who prefer to stick close to their communities.
Northern Light Mayo Hospital in Dover-Foxcroft, Maine, graduated six students in the class in 2020 and nearly all continued working there, according to The Hechinger Report, a national nonprofit newsroom that reports on education.
Not only did that help with staffing levels, but in the first nine months after the nursing students’ graduation, the hospital saved $360,000 in travel nursing costs, according to Hechinger.
Building a pipeline
Rural and underserved citizens of Colorado have gained access to healthcare providers through the Grow-Your-Own APRN Fellowship, an innovative model that builds an advanced practice (APRN) primary care workforce and pipeline for rural and underserved areas by recruiting and developing nurses already committed to their own rural community.
The program was developed by Ingrid Johnson, DNP, MPP, RN, FAAN, president and CEO at the Colorado Center For Nursing Excellence, who recruited rural BSN nurses to return to school, earn advanced practice degrees, and transition to practice as a rural primary care APRN. The fellowship provided financial support, individualized coaching, and leadership support.
“The model significantly reduces financial and continuity-of-care costs related to recruiting and turnover of providers that have no interest in living long-term in rural areas and often leave after loan-forgiveness obligations are met,” according to the center of excellence.
The $70 million, 90,000-square-foot building also will expand the college’s capacity to educate future nursing faculty members, according to the university.
UCF graduates about 260 nurses annually, though last year it added 100 students beyond its usual enrollment in response to the state’s demand for new nurses. The expansion will enable the college to increase enrollment by at least 50%, significantly boosting Florida’s nursing workforce. Indeed, 85% of the school’s 16,000 nursing alumni live and work in Florida.
Alliances between hospitals or health systems and colleges are becoming more common as healthcare leaders search for creative ways to bolster the number of nursing students, and thus, their nursing pipeline.
"Ensuring we have well-educated, highly trained, and skilled nurses to meet Florida’s growing healthcare needs is a pressing challenge for the entire healthcare sector," says Randy Haffner, CEO of AdventHealth Florida. "Partnering with leading educational institutions such as UCF is absolutely vital to ensuring these efforts are successful."
"We are excited about our long-term partnership with UCF as we continue to strategically plan nursing workforce opportunities for the future," says Karen Frenier, senior vice president, human resources and chief nurse executive, Orlando Health.
Each hospital’s gift, in addition to contributing to the new building, will support students with the creation of a scholars’ program named in their honor. Each of those programs will provide tuition assistance to 10 senior BSN students annually and establish a paid summer internship program for an additional 10-15 students annually.
UCF continues to seek philanthropic investments in the new building, as it nears the goal of raising $70 million needed to break ground. To date, more than $26 million has been raised through philanthropy, which will be combined with $43.7 million committed by the State of Florida.
"AdventHealth and Orlando Health have been valued, transformative partners to UCF as we collaborate to support the health and well-being of our community," says Alexander N. Cartwright, UCF president. "Their continued partnership and generous investment in UCF’s College of Nursing will make a difference in our region for generations to come."
Your current method of rounding isn't one of them.
One of the most common practices among nurse leaders to improve retention is employee rounding—so much so that the time-consuming practice has been “hard-wired” into leadership routines.
That was one of the findings in the study, Connection is Retention: Lessons from Leaders with Unusually High Nurse Retention, conducted in March 2023 by AONL and Crucial Learning. The research studied 1,559 nurse managers and 562 clinical staff at hundreds of U.S. hospitals to discern the drivers behind high levels of nurse turnover.
“The first surprise was that employee rounding—a practice intended to connect clinical staff to their managers with regularity and purpose—had no effect on whether nurses were likely to quit their jobs within the next three years,” the report states. “In fact, employee rounding seemed so irrelevant that employees often didn’t seem to know it had happened.”
Indeed, while 81% of managers in the study reported that they round regularly, only 36% of clinicians say their managers round regularly.
"As we dug into this curious and concerning inconsistency, we concluded that the most likely explanation for the gap is that rounding is being done in a way that is meaningless to the real concerns of frontline nurses," says Joseph Grenny, lead researcher and Crucial Learning co-founder.
Instead, the study found that nurse managers with surprisingly high retention of their staff were “preternaturally effective” at creating connection with their nurses by offering three things:
Care: I feel a sense of belonging and believe my manager cares about me as a person.
Growth: My manager takes an active interest in my personal and professional growth.
Help: My manager steps in to help when I need it.
Nurses who reported that their nurse managers offered care, growth, and help were more than 80% likely to intend to continue with their work indefinitely, the research indicates.
“One common argument for employee rounding is that frequent structured contact should help nurses know leadership cares about them, is there to help, and invests in their growth. But once again the study found no relationship between consistent reported rounding and perceptions of care, growth, and help,” the report notes.
How to connect
As researchers reviewed nurse experiences that led to both connection and disconnection, four manager best practices emerged, according to the report.
1. Connection is about feeling not frequency. Connection is not made from a certain frequency of interaction. Rather, what created connection was some meaningful moment—an interaction that showed presence, planning, personalization, or follow-up—in a way that made it stand out.
2. Always Be Collecting Dots (ABCD). The report referenced hospitality guru Danny Meyer, who creates connection with his hundreds of thousands of daily guests by advising his employees to always be collecting dots.
“Every time you interact with anyone, they generate dots of information about what’s going on in their life,” he says. “Your job is to collect these and connect them in how you respond to customers to create a special experience for them.”
Great nurse managers do the same, the study says, by taking note of conversations with their nurses about family, interests, or work challenges.
“These dots are leadership gold, if the manager records them, reflects on them, and uses them to inform ways they can show care, facilitate growth opportunities, and offer help,” the researchers write.
3. Connection = Sacrifice. People perceive you value them when you show you’re willing to sacrifice things valuable to you, such as time, money, or other priorities. It doesn’t require a vast amount of sacrifice; just enough to show you value care, growth, and help.
4. Don’t make promises you can’t keep. Keep the promises you make. “Even the smallest broken promises damage perceptions of care, growth, and help far faster than equivalent promises kept,” the authors write. “Better managers are crystal clear about commitments made and impeccable about keeping them. When, on rare occasions they break them, they quickly acknowledge the transgression and find ways to make amends—without waiting to be confronted.”
These recommendations should help overloaded nurse managers create teams of engaged and satisfied nurses, says Robyn Begley, DNP, RN, NEA-BC, FAAN, one of the report’s authors and CEO of AONL.
"We recognize these recommendations might sound daunting to already overwhelmed nurse managers. They should not," Begley says. "The first two don't require time; they simply require thought.”
“In fact, the first—connection is about feeling not frequency—suggests that time spent today in ritualistic employee rounding might be recovered and repurposed. Our study suggests that replacing any recovered time with the second two activities will yield dramatically different results in engagement and retention,” she says. “These are things managers are doing consistently and successfully in units just like yours and if replicated, will make a difference in your team."
Schools of Nursing are ramping up their efforts to accommodate nursing students.
Healthcare educators are taking decisive steps in growing and strengthening the U.S. nursing workforce, with efforts ranging from simplifying the transfer of credits between higher education institutions to creating alliances with hospitals or health systems to building more nursing schools.
Just within the last two weeks, new nursing schools have opened their doors, greatly expanded, or have broken ground for construction. Here are three of the newest:
Galen College of Nursing
With a new campus in Roanoke, Virginia, Galen College of Nursing, one of the nation’s largest private nursing schools, has expanded to 19 campuses nationwide, plus an online program. It’s the second campus in Virginia—the first being in Richmond.
The Roanoke campus will feature the latest resources—from advanced patient simulation labs to classroom environments designed to encourage practice-based learning—to provide nursing students with a hands-on learning experience.
It initially will offer a two-year Associate Degree in Nursing program and a Licensed Practical/Vocational Nurse to Associate Degree in Nursing Bridge.
“This new endeavor will help us continue to attract the next generation of nurses and help support the delivery of quality care in the state,” said Mark Vogt, Galen’s CEO. “With over 30 years of experience exclusively educating nurses, Galen is well-positioned to help expand the pipeline of practice-ready nurses in the Roanoke area.”
Illinois State University Mennonite College of Nursing
“As we break ground today for the Nursing Simulation Center, we are moving closer to meeting the ongoing need for highly qualified nurses in this state and across the nation,” Aondover Tarhule, the university’s interim president, said at the groundbreaking ceremony.
The new building will wrap around the college’s existing simulation center and will feature an enhanced clinical education setting with virtual reality technology.
Scheduled to open in fall 2024, the new simulation center, nearly a decade in the making, will include space for interdisciplinary collaboration, additional student support, and increased research capabilities.
“It allows us to educate more exceptionally well-prepared nurses,” said Judy Neubrander, EdD, FNP-BC, nursing college dean, “who will be a part of improving the health and well-being of our community and state.”
The new school will consist of about 78,000 square feet of new construction, along with the 28,000-square-foot University Rehabilitation Center, which will be renovated to house simulation and skills laboratories. New construction will feature a 200-seat auditorium, classrooms, group study rooms, offices, meeting rooms, research laboratories, a courtyard, and small amphitheater.
Cost of the new School of Nursing is covered by $55 million in COVID-19 state and local recovery funds, along with $12 million from the medical center.
Mississippi’s nursing shortage makes this project particularly vital, Lt. Gov. Delbert Hosemann said at the groundbreaking ceremony.
“We need nurses,” he said, “and what better to have them educated than at the University of Mississippi Medical Center?”
The collaboration creates a pathway for students admitted to the U of M School of Nursing’s Doctor of Nursing Practice program to complete about 1,000 hours of required clinical training at Mayo Clinic hospitals in Minnesota and Wisconsin. The program begins in fall 2024.
"The U.S. is facing a maternal mortality and morbidity crisis that is particularly affecting rural areas," says Judith Pechanek, DNP, RN, CENP, assistant dean of the Doctor of Nursing Program at U of M. "Through this collaboration, we will educate and train nurse-midwives to meet the reproductive needs of women both regionally and across the nation."
Indeed, areas where there is low or no access to maternal care affects nearly 7 million women across the United States, according to the March of Dimes’ 2022 report on U.S. maternity care deserts. This unavailability is growing, with a 2% increase in counties that are maternity care deserts since the organization’s 2020 report.
"Mayo Clinic expects a significant expansion of midwifery services across the Midwest over the next decade," says Miri Levi, DNP, CNM, MBA, director of midwifery services at Mayo Clinic in Rochester, Minnesota. "This collaboration with the University of Minnesota facilitates the recruitment, training and hiring of the next generation of midwives across rural Minnesota and Wisconsin."
Courses will be taught by U of M faculty as well as Mayo Clinic-certified nurse-midwives, who hold adjunct faculty positions with the School of Nursing. The program’s hybrid structure is designed to maximize education while offering flexibility.
Collaboration between U of M and Mayo Clinic nursing dates to 2002 when the school first began educating Bachelor of Science in Nursing students in Rochester.
"We are seeking new ways to engage learners to build the workforce of the future," says Leah McCoy, DNP, CNM, incoming nurse-midwifery program director at Mayo Clinic School of Health Sciences.
"This collaboration will offer an innovative pathway for nurses interested in pursuing a career as a midwife," she says, "especially if they would like to practice in more rural areas of Minnesota and Wisconsin."
'Increasing the proportion of nurses with a baccalaureate or higher degree will significantly impact healthcare in South Dakota.'
Nursing education in South Dakota is getting a boost with two wide-reaching initiatives designed to grow the state’s healthcare workforce.
The first creates a statewide nursing agreement to simplify the process of transferring credits between higher education institutions for nursing students, according to the South Dakota Board of Regents, which authorized both moves.
For more than a year, the board of regents has met with the Board of Technical Education (BOTE) academic programming staff to explore ways to enhance their partnership and decided to implement a statewide nursing agreement.
The agreement enables nursing students to seamlessly transfer credits from technical and community colleges to South Dakota State University and the University of South Dakota where they can obtain a bachelor’s degree.
"The goal is to promote workforce development in healthcare, specifically for registered nursing and the Bachelor of Science in Nursing, which are critical for South Dakota's economic growth," according to the board of regents.
"We should applaud the technical colleges, university staff, and their administrations for their dedication to workforce development in our state," said Janice Minder, EdD, system vice president of academic affairs. "Increasing the proportion of nurses with a baccalaureate or higher degree will significantly impact healthcare in South Dakota."
The move also will expand consumer access to primary care through an increased number of advanced practice nurses and increase the critical faculty pipeline to prepare an adequate nursing workforce for the future, the board of regents noted.
New NSU nursing program
NSU will add nursing education to its offerings beginning in fall 2024 with a Bachelor of Science in Nursing degree.
The move will offset the loss of a previous nursing program in Aberdeen—a region already experiencing a shortage of nurses—with the closing earlier this year of Presentation College, which specialized in nursing, healthcare, and liberal arts programs.
Graduates of Northern's BSN will be able to practice as generalists who can provide safe and effective patient-centered nursing care. The program also specializes in telehealth and gerontology.
"Rural areas of South Dakota help drive our economy and we recognize the importance of providing quality healthcare in those communities for the continued growth of our state," said Tim Rave, board of regents president. "Expanding this program is another opportunity for our public universities to help fill this essential workforce need."
Ferrara is an actively practicing nurse practitioner (NP) with years of clinical and health policy development experience, from which he drew to help secure full and direct access to NP-delivered care for patients in the state of New York in April 2022. New York joined 24 other states and Washington, D.C., at the time in granting nurse practitioners full practice authority (FPA).
"Dr. Ferrara is widely known and respected," said AANP’s CEO Jon Fanning, MS, CAE, CNED. "As an AANP board of directors member over the past seven years, he has played an instrumental role in developing strategies to raise awareness of the high-quality, patient-centered care provided by NPs, while also advocating for full practice authority. We look forward to his leadership as more and more patients choose nurse practitioners as their healthcare provider."
In his role at Columbia, Ferrara is responsible for overseeing the NP primary care faculty practice located in New York City, where he teaches health policy in the Doctor of Nursing Practice program.
Ferrara is particularly interested in health information technology and the integration of evidence-based practice into daily practice. His doctoral work examined the impact of group health visits on the health of Type 2 diabetes patients and the extent that this intervention led to better health outcomes.
"I am proud to represent the voices of more than 355,000 licensed NPs nationwide and the lifesaving care we deliver in countless patient visits each year," Ferrara said. "As nurse practitioners, we play a vital role in healthcare delivery, and I am committed to fostering professional growth, advocating for our interests, and promoting our invaluable contributions to patient outcomes."
Ferrara has been honored with the AANP New York NP State Award for Excellence and inducted as a Fellow of AANP, the American Academy of Nursing, and the New York Academy of Medicine.
The challenge to effectively train nurses without enough preceptors led Singing River Health System to turn to technology to get the job done.
Singing River Health, a community-based, not-for-profit healthcare provider for the Mississippi Gulf Coast, piloted the customized Elemeno Health workforce empowerment app at its Pascagoula hospital a little more than a year ago for nurse training and orientation and recently deployed it in numerous departments throughout its entire health system, says Susan Russell, MSN, RN CCRN-CSC, the health system’s chief nursing officer.
The platform provides nurses with a resource hub they can consult for bedside care by delivering hospital best practices in readily digestible resource formats such as interactive guides, how-to video clips, concise updates, and intuitive checklists.
HealthLeaders spoke with Russell about how the technology is benefiting Singing River’s nurses.
This transcript has been lightly edited for brevity and clarity.
Susan Russell, CNO, Singing River Health System / Photo courtesy of Singing River Health System
HealthLeaders: Please explain what the technology does for your nurses.
Susan Russell: With high turnover rates, it's been an enormous challenge to get people in and get them trained because we have less people with experience to help train new nurses. Elemeno fits in electronically to meet the need of not having as many preceptors as needed—not having preceptors around the clock.
With the app, we’re able to replicate the best preceptor you ever had and have them available as many times or anytime you need it. Say I am that less-experienced nurse on night shift and I'm not familiar with gastric tubes. I learned virtually in school but maybe I just haven't seen it. Theoretically, you would have a preceptor, an expert clinician, who is there to walk you through every step of what you need to know, what you need to do, what you need to look out for, and what needs further action.
That's what we're able to get with this Elemeno product. Where we used to lean on human resources is now available in electronic format. It really does support our frontline staff on ongoing knowledge and the best evidence-based practice.
HL: How do you ensure that the nurses know how to use it?
Russell: It is so simple. They just hit the icon and anything they need to know is available. They put in the search word—gastric tubes—and it immediately takes them to the lesson for the training or the education that has been built around gastric tubes. It’s also not what you see in a prebuilt platform; it’s our gastric tubes that we use, it’s our equipment, and our supplies. So, it looks very much like what you would expect it to look like if there was a trainer there showing them the ropes and how to use things.
HL: How did you determine what information to include in the app?
Russell: What we're seeing is many staff members who recently graduated or have been hired since COVID did not get trained as well, whether it was in school or after they got out and came into the healthcare system, so we're going back to the drawing board with some of the things that we take for granted that nurses would know, but they don’t; they don’t have the experience that previous nursing generations had.
HL: How did Singing River pilot it before making it available to the entire health system?
Russell: During COVID, there wasn’t as much surgery to do—everybody is aware that many surgeries were completely curtailed during the pandemic—so that seemed like a good place to start because there are so many specific things to train somebody on in surgery.
Every single nurse needs to be trained when they come into a new health system. Say I’m a 20-year nurse; I’m still going to have to have orientation, and some areas take a lot more orientation and surgery is one of them. Our surgery department embarked on having that training placed into an electronic platform so that it can be used 1,000 different times.
They got it up and built about 1½ years ago, and with the platform, they were able to address some of the things that come up in surgery that you don’t see that often along with some of the things that are fundamental that you need to go over time and time again.
We’re also able to give ongoing assignments. Say you’re six months into your nurse training, there will be additional assignments for you to build on, and then I'm going to teach you more things over those six months. This allows you to continue to grow and develop while you’re on orientation or even if you're not on orientation. If there's a new product that comes out or something that we’re seeing as a system that people are missing or not doing correctly, we can send a lesson assignment out. We're going to go step by step and give them everything they need for clarity and consistency.
HL: How have the nurses responded to it?
Russell: Well, they don’t have to go to class Wednesday morning at nine o'clock after they’ve worked the night shift or if they’re off that day. This is available 24/7.
We used to have workshops and seminars, but the GenXers don't really like that as much. They prefer social media and electronics—that's what they grew up with. They want to be in control of their environment and their home environment, so they don't want to come in for mandatory in-service: "Tell me what I need to know and send it to me so I can look at it when I want to look at it. And if I want to break it up into two different viewings, let me break it up into two different viewings. Don't tell me how to learn; let me decide how I want to learn."
What we're hearing from them is it allows them to reinforce some of the information they got during orientation. Orientation can be overwhelming and maybe someone didn't exactly understand the section on central lines; it allows them to go back and find all the unique parts and pieces of central lines. They can do it when they need that information. If you tell them during orientation, they’re not actually doing so it doesn't gel as much, but if they look at that information and they’re about to use it, the information really is going to be more hardwired.
The goal of the partnership is twofold: to retain RNs at Duke by granting them more opportunities to instruct at the bedside and to recruit more nursing students to DUHS.
Alliances between hospitals or health systems and colleges are becoming more common as healthcare leaders search for creative ways to bolster the number of nursing students, and thus, their nursing pipeline.
Duke nurses will provide clinical instruction at Durham Technical beginning July 1, and the health system will equip the college with funding, simulation, and nurse aide training resources.
This agreement comes at a critical time. North Carolina is one of 21 states that will fall short of filling the demand for qualified registered nurses by at least 1,000 nurses by 2026, a Mercer Report study found. The state currently has a shortage of 13,112 RNs.
"We see this collaboration as an opportunity to advance greater economic stability and economic mobility within the communities we serve," said Craig Albanese, MD, CEO of Duke University Health System. "The agreement will promote career awareness, career readiness, and education as well as increase the number of registered nurses, licensed practical nurses, and certified nurse aides entering the workforce at DUHS."
Duke nurses will prepare students by teaching advanced classes, providing mentorship, and sharing feedback and support.
"We are fortunate to have a strong community partner in Duke that helps create outstanding career pathways for our students," said J.B. Buxton, president of DTCC. "We are proud of the work we do to develop robust talent pipelines for employers in our community, and this new collaboration showcases just how well we can do that to benefit the region."
'The AMA is again adopting policies encouraging laws and regulations that impede competition and help their bottom line.'
Nursing groups are denouncing the American Medical Association's recent policy amendment calling for advanced practice RNs (APRNs) to be licensed and regulated jointly by the state medical and nursing boards.
The policy amendment was passed by the AMA's House of Delegates (HOD), the policy-making body of the organization, during its annual meeting last week in Chicago.
The National Council of State Boards of Nursing (NCSBN) "strongly opposes" the recommendation, given that U.S. nursing regulatory bodies (NRBs) have regulated the practice of nursing for more than 100 years, the NCSBN noted in a statement.
"They have the unique experience and expertise to license, regulate, and discipline nurses at all levels of practice from licensed practical/vocational nurses, to registered nurses to APRNs," according to the NCSBN. "The Consensus Model for APRN Regulation, the nationally recognized and longstanding model for APRN regulation, calls for regulation of APRNs by NRBs."
"At a time when the healthcare industry is facing a critical workforce shortage and patients' access to care is in jeopardy, the AMA has chosen to focus on ‘fixing' a problem that does not exist," Angela Mund, DNP, CRMA, president of AANA, said.
The American Association of Nurse Practitioners (AANP) also weighed in: "The AMA has once again dusted off its old protectionist playbook and demonstrated its commitment to put profit and powerplays ahead of patients and their access to high-quality healthcare," the organization said.
Adding state medical boards into the mix could negatively affect care, said Maryann Alexander, PhD, RN, FAAN, chief officer of nursing regulation for the NCSBN.
"In the interest of public safety and protection, best practice dictates that regulation of APRNs should be within the purview of NRBs," Alexander said. "Adding the needless oversight of state medical boards does nothing to enhance patient protection but has the potential to add unnecessary bureaucracy that may actually slow down the regulatory process and impede access to care."
Additionally, research has identified that in those states with the most restrictive laws and regulations—such as this new AMA policy—access to care is adversely affected, according to the NCSBN.
"The only appropriate regulatory entities to oversee nursing licensure and practice are state boards of nursing," Fanning said. "Not only is the model proposed by the AMA flawed, but it has also been soundly rejected by 46 states and the District of Columbia. In the handful of states where NP practice is regulated outside the exclusive oversight of the board of nursing, the restrictive involvement of the board of medicine directly contributes to healthcare access challenges, resulting in continued low health care rankings, geographic disparities in care, and unnecessary regulatory cost in these states."
'Stuck in the past'
The AMA and other physician groups have long argued that collaborations are needed for patient safety, though some question their motives.
"The AMA has historically supported policies which restrict APRNs practicing to the top of their education and certification despite decades of evidence demonstrating APRNs provide safe, high-quality care," according to the NCSBN.
"The Federal Trade Commission has repeatedly cautioned against state legislative proposals that recommend regulation of APRNs by physician-controlled boards, urging lawmakers to ‘consider whether to allow independent regulatory boards dominated by medical doctors and doctors of osteopathy to regulate APRN prescribing, given the risk of bias due to professional and financial self-interest,'" the NCSBN continued.
Mund was a bit more direct.
"The AMA is again adopting policies encouraging laws and regulations that impede competition and help their bottom line," she said. "As a CRNA and a member of America's most trusted profession, I feel it's incumbent upon us as healthcare professionals to be honest and transparent about healthcare policy."
Mund charged that the AMA's proposed policies put physicians, rather than consumers, in control of patients' healthcare decisions.
"The AMA is simply stuck in the past," she said. "As frontline providers during the pandemic, CRNAs, as well as all APRNs, proved once and for all they have the training and clinical competence to provide safe, high-quality care without restrictive physician involvement."
"We urge our medical colleagues to join us in our movement to put patients first by supporting a modernized healthcare system that looks to the future, not the past."
AANP also called for the AMA to "put patients first."
"Unfortunately, the AMA's tactics are not new. AANP will continue to fight for patients," according to AANP. "AANP calls on the AMA to stop the rhetoric and resolutions that undermine patient choice, access and truly coordinated care. The AMA’s ongoing fearmongering and physician-protectionist resolutions are negatively impacting the health of our nation. It’s time the AMA retires its dated tactics and put patients first."
Editor's note: This story has been updated to include AANP comments.
