APP execs discuss what’s keeping them awake at night

Presidents of 5 Advanced Practice Provider Associations (APPs) highlighted strategies to increase the healthcare workforce, key bills that could change the landscape of practice, how to create greater diversity among practitioners and what keeps them awake at night during an online panel discussion held in honor of APP’s second annual National Week.

The presidents have all noted problems of access to care, 96 million Americans do not have access to adequate primary care and 155 million lack of access to mental health. They also discussed the high levels of burnout among all APPs and the need to modify educational programs to help build resilience and recruit a more diverse student body and faculty. The 5 associations included the American Association of Nurse Anesthesiology (AANA), the American Association of Nurse Practitioners (AANP), the American Academy of Physician Associates (AAPA), the American College of Nurse-Midwives (ACNM) and the National Association of Clinical Nurse Specialists. (NACNS).

Access to care issues for clinical nurse specialists and midwives

Clinical nurse specialists (CNS) are trained to diagnose, treat, and prescribe, but their ability to practice is severely limited in many states, including a few states where these CPAs do not have prescribing authority. “This impacts access to care for some of the most vulnerable patients, including mental health and women’s health such as perinatal care,” said Phyllis Whitehead, PhD, APRN/CNS, ACHPN, PMGT -BC, FNAP, FAAN, President of NACNS. Some states also do not offer title protection, which means that the CNS title cannot be used by anyone who does not meet the criteria for that title.


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Questions of access to care were taken up by the other panelists. Access to certified nurse midwives (CNMs) and certified midwives (CMs) is particularly lacking, with only 13,000 of these clinicians currently practicing, explained Heather Clarke, DNP, CNM, LM, APRN, FACNM , President of the ACNM. Data shows that CNMs/CMs attended approximately 10% of births in the United States in 2020.

Studies show an inverse relationship between midwifery practice and birth outcomes, with countries that have a high proportion of midwives per birth consistently showing lower mortality rates; in contrast, the United States has one of the lowest rates of midwifery utilization and one of the highest rates maternal mortality compared to other developed countries. Additionally, many urban areas with a high proportion of minority and marginalized patients do not have access to racially congruent midwifery care.

“As a result, we are seeing unacceptable disparities in maternal mortality and morbidity,” Dr Clarke said. In rural settings, such as those in Georgia and Alabama, which have the highest rates of maternal morbidity and mortality, many counties do not have obstetrical providers and midwives cannot provide the necessary care because they cannot fully exercise their authority unless they work with a supervisor. obstetrician.

The ACNM supports 2 bills that will help solve these access problems:

  • Midwives for mothers Law (HR 3352/S 1697): will establish 2 new sources of funding for accredited midwifery education, one in Title VII health professions education programs and one in workforce development programs title VIII nursing work. Additionally, the bill will address the significant lack of diversity in the maternity care workforce by prioritizing racial and ethnic students and students from disadvantaged backgrounds.
  • Access to birth benefiting from improved essential services (BABIES) Law (HR 3337/S 1716): will provide grants to states to develop and advance innovative payment models for free-standing birthing centers

Greater diversity is needed in APP professions

NACNS is also working to create a more diverse and equitable workforce, Dr. Whitehead said. The organization established a committee to embed the principles of Diversity, Equity, and Inclusion (DEI) into the government structure and membership of NACNS and to understand the role of ICS in diverse communities.

Dr. Jennifer Orozco

Other associations have also set up DEI initiatives. “We know patients of color who see a provider of color do better. There is proven research. But we need to work on that in our AP and APRN professions,” said Jennifer M. Orozco, DMSc, PA-C, DFAAPA, AAPA President. Greater diversity among clinicians will drive some of the changes needed in health care and patient outcomes, she said.

Building Resilience for Certified Registered Nurse Anesthetists

Angela Mund, DNP, CRNA, President of AANA, noted that the COVID-19 pandemic has had a marked effect on the mental health of current resident anesthesia nurses, many of whom were critical care nurses and witnessed of the devastation that has occurred in intensive care units. during the first wave of COVID-19.

“As an APP, we have dealt with COVID-19, but our students entering CRNA [Certified Registered Nurse Anesthetists] programs, they lived it. And we need to be mindful of building resilience in our programs to ensure these students have access to mental health resources, as they will be the providers of the future,” said Dr. Mund.

Another lesson learned from the COVID-19 pandemic is that temporary federal staff deletion of the oversight requirement for CRNAs has allowed advocacy groups to demonstrate what APPs can do if barriers to practice are removed, Dr. Mund noted.

April Kapu
Dr April Kapu

What keeps you up at night?

The nurse practitioner (NP) profession is expected to grow by 46% between 2021 and 2031, and April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, AANP President, said what keeps her up at night is thinking about how to support the education of NPs and educators.

“How do we support our preceptors and give them time to teach and train our next generation of PIs and APPs? said Dr. Kapu. “And how do you access the pipeline of all those prospective students?”

“One of my biggest concerns is trying to engage all 159,000 APs as well as our senators, representatives and other lawmakers to help everyone understand the urgency we have right now in this perfect storm.” , said Dr. Orozco. “We’re really at this tipping point in health care.”

Dr. Mund called on APPs to take leadership positions. “The only way we can have an impact on what happens at the local, state and national level is to have practitioners who are willing, in our case, to leave the operating room and take on roles in the academic leadership, C-suites, and national and national levels. state-elected offices,” Dr. Mund said. She is thinking about how best to prepare APP students to take on these roles.

The full National APP Week Roundtable can be viewed here. The event was moderated by Tamekia Hayes, MBA, PA-C, of ​​Huntsville Hospital, and hosted by Stanford Health Care.

About Stuart M. McFarland

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