Dr. Judith Chamberlain's 2013 SLC Presentation

Advance Practice Nurses in Maine

Independent practice

Assessing clients Synthesizing & analyzing data, understanding & applying nursing

principles at an advanced level Providing expert teaching & guidance Working effectively with clients, families, health care team Managing clients’ physical & psycho-social health-illness Utilizing research skills Analyzing multiple sources of data, differential diagnosis,

selecting appropriate treatment Independent decisions in solving complex client care problems Diagnosing, prescribing, administering & dispensing therapeutic

measures Recognizing limits of knowledge & experience,

planning for situations beyond expertise, consulting with or referring to other health care providers as appropriate

APRN Scope of Practice

NPs earned the right to practice independent of physicians in ME in the mid-1990s

NP must complete at least 24 months of supervised work

NPs can now be credentialed as participating providers

NPs can be primary care providers in managed care organizations

A new grad can be supervised by another NP who is independently licensed.

NP History in Maine

Physician supervision required Physician supervision not required

1088 NPs in ME in 2012

Most are independently licensed

Fewer than 50 practice independently

APRNs in Maine

Distribution of NPs and primary care similar Majority of NPs in ME in Primary Care From the ME NP Association web site:

◦ Overall 25% of NPs in rural areas of ME◦ In primary care about 40% rural (most in FM)

Rural distribution of NPs almost identical to FPs

NPs, PAs and Physicians are all leaving primary care at about the same rate (AHRQ and Robert Graham Center data)

Where are the APRNs?

Increasing numbers of nurse practitioners (NPs) and physician assistants (PAs) working outside of primary care in subspecialty fields

NPs PAs0

20000

40000

60000

80000

100000

120000

TOTALIN PRIMARY CARE

55,625

30,402

52%

43%

Data from 2010 National Provider Identifier File

106,0

73

70,3

83