June 2016 FNPN Newsletter

Good Morning!

We would like to bring you up to date on what's new in your own backyard of Florida.

In this newsletter you will find the following:

• FNPN Conference update
• FNPN Legislative update
• FNPN PAC Update
• Job Announcement
• Membership update
• News You Can Use

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Quote of the Month

"Do the right thing. It will gratify some people and astonish the rest."
― Mark Twain

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FNPN Conference Update

Registration is open for the FNPN conference at the beautiful Sarasota Hyatt on August 18th-20th! We are proud to be hosting a quality evidence based educational conference that will enhance quality NP practice.

Again this year we are offering four exciting, innovational workshops presented by well-respected NP experts.
There is a DOT Course, A Simulation Lab, ECG/Imaging, and Basic Procedures in Dermatology. CLICK HERE for more information on these workshops, including speaker information and CE's available.

We are especially excited about our Friday night celebratory gala that promises to hold extraordinary surprises! Special Guests include Barbara Lumpkin, Dr. Loretta Ford, Rep. Cary Pigman, and Sen. Denise Grimsley.

A must see for all.....breaking news that will be hot off the press from Joe Baker (executive director BON) & Dr. Doreen Cassarino (chairperson formulary committee) regarding the new legislation and what every NP will need to know to practice legally!

Finally, visit the exhibits hall, this is an excellent opportunity to disseminate the latest information and updates on pharmaceutical products.

Please join us to network with NP colleagues and friends from near and far! For more information on the FNPN Conference CLICK HERE

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FNPN Legislative Update

Dr. Doreen Cassarino – VP Legislation

Barbara Lumpkin Prescribing Act
Effective Date: April 14, 2016

This law impacts several components within the medical and nursing professions. Physician Assis-tants (PAs) and Advanced Registered Nurse Practitioners (ARNPs) can prescribe controlled substanc-es listed in Schedule II, Schedule III or Schedule IV as defined in s. 893.03 Florida Statutes, beginning January 1, 2017. An ARNP who is certified as a Psychiatric Nurse should refer to HB 977 regarding prescribing controlled substances. An ARNP may only prescribe or dispense a controlled substance as defined in s. 893.03 Florida Statutes if the ARNP graduated from a program with a master's or doc-toral degree in a clinical nursing specialty area with training in specialized practitioner skills. Howev-er, all ARNPs and PAs are required to complete at least three hours of continuing education on the safe and effective prescribing of controlled substances.

The law further requires PAs and ARNPs to designate themselves as controlled substance prescribers on their practitioner profile if they plan to prescribe for the treatment of chronic non-malignant pain. If treating for chronic non-malignant pain, ARNPs and PAs must meet the same standards of practice as physicians.

Under the new law, an ARNP's and PA's prescribing privileges for controlled substances listed in Schedule II are limited to a seven-day supply and do not include the prescribing of psychotropic med-ications for children under 18 years of age, unless prescribed by an ARNP who is a Psychiatric Nurse (see HB 977). The bill also clarifies that only allopathic physicians licensed under chapter 458, Florida Statutes, or osteopathic physicians licensed under chapter 459 Florida Statutes may dispense medi-cations or prescribe controlled substances in a registered pain management clinic. In addition to cur-rent exemptions, the bill adds an exemption for referral to a board-certified pain management physi-cian, an addiction medicine specialist and a mental health addiction facility for physicians who are board-eligible or board certified in pain medicine by the American Board of Interventional Pain Physi-cians the American Association of Physician Specialists.

In accordance with HB 423, the Florida Board of Nursing has established a committee to recommend a formulary of controlled substances that an ARNP may or may not prescribe for specific uses or in limited quantities. The Controlled Substances Formulary Committee must consist of three ARNPs recommended by the Board of Nursing; three physicians recommended by the Board of Medicine who are licensed under chapter 458 or 459, Florida Statutes, and have experience with ARNPs; and a pharmacist licensed under chapter 465, Florida Statutes, who holds a Doctor of Pharmacy degree and is recommended by the Board of Pharmacy. The Board must adopt, by rule, the committee's initial recommendations no later than October 31, 2016.

Appointed members include:

• Doreen Cassarino, DNP, FNP-BC, BC-ADM, FAANP (who will serve as chair of the committee)
• Vicky Stone-Gale, DNP, FNP-C, MSN
• Jim Quinlan, DNP, ARNP
• Bernardo B. Fernandez, Jr., MD, MBA, FACP
• Joshua D. Lenchus, DO, RPh, FACP, SFHM
• Eduardo C. Oliveira, MD, MBA, FCCP
• Jeffrey Mesaros, PharmD, JD

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Ordering of Medication

Effective Date: July 1, 2016

HB 1241 provides authority for an ARNP to order any medication for administration to a patient in a hospital, ambulatory surgical center, nursing home, or mobile surgical facility within the framework of an established protocol. The protocol should indicate that the ARNP is authorized to order con-trolled substances. The ARNP will not need a DEA as the medications are ordered under the super-vising physician DEA. PAs may also order any medication for administration to the supervising physi-cian's patient in a nursing home with their supervising physician's delegation.

A supervising physician may authorize a PA and ARNP to order controlled substances for administra-tion to a patient in a hospital, ambulatory surgical center, nursing home, or mobile surgical facility.

In addition, the bill expands the Florida's Emergency Treatment and Recover Act, which allows phar-macists to dispense emergency opioid antagonists to individuals based upon a non-patient-specific standing order issued for auto injection delivery systems or intranasal application delivery systems if they are appropriately labeled with instructions for use.

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Behavioral Health Workforce HB 977

Effective Date: April 14, 2016

The bill expands the behavioral health workforce and recognizes the critical need for psychiatric care throughout the state. The new law allows a Psychiatric Nurse, as defined in Section 394.455, Florida Statutes, and working within the framework of an established protocol with a Psychiatrist, to pre-scribe psychotropic controlled substances for the treatment of mental disorders. Grounds for disci-pline or denial of a license for Psychiatric Nurses are described in Section 8 of the law. Advanced Registered Nurse Practitioners are now authorized to seek certification as Psychiatric Nurses through the Board of Nursing. Existing ARNPs who hold this certification can add it to their license by writing the Board, along with a copy of the certification, at MQA.Nursing@FlHealth.gov. A revised protocol agreement with a supervising Psychiatrist will also be required unless the ARNP indicates he or she does not intend to prescribe controlled substances as indicated above. New applicants for ARNP cer-tification will submit documentation as part of the initial licensure process. The bill amends Chapter 893, Florida Statutes, by revising the term "practitioner' to include Psychiatric Nurses. The prescrib-ing of medication on the premises of a pain-management clinic is still limited to a physician licensed under Chapter 458 or 459, Florida Statutes.

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Transparency in Health Care HB 1175

Effective Date: July 1, 2016

Health care practitioners are required to provide a good faith estimate of anticipated charges to treat a condition if asked by the patient. The estimate must be provided to the patient or their proxy with-in 7 business days after receiving the request, however the practitioner is not required to adjust the estimate for any potential insurance coverage. Patients must contact their health insurer or health maintenance organization for any information relating to cost-sharing responsibilities.

While the estimate does not preclude actual charges from exceeding the estimate, failure to provide it within the required time without good cause will result in discipline against the practitioner. This includes a daily fine of $500 until the estimate is provided to the patient. Total fines may not exceed $5,000. In addition, the new law states that every pharmacy must make health information dissemi-nated by the Agency for Health Care Administration available on its website and notify customers in the store that this information is available online.

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Jury Service HB 111

Effective Date: July 1, 2016

Current law provides numerous grounds by which individuals called for jury duty can be exempt or excused from service. This bill adds that an individual who is permanently incapable of caring for himself or herself may request a permanent exemption from jury duty by submitting a written statement from a physician verifying the disability.

Full Practice Authority for the Veteran's Administration APRNs Takes the Next Step

• On May 25, the U.S. Department of Veterans Affairs proposal to amend APRN practice VA facilities was listed in the Federal Register for public comment. This is a key step toward passage of this rule.
• The proposal would authorize APRNs to provide health care services to the full extent of their educa-tion and training. Public comments will have significant impact with the comment period ending July 25. Please take this opportunity to help increase the options for care to our nation's veterans by making comments here.

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FNPN PAC Update

Dr. Laureen M. Fleck Chairperson - Political Action Committee

FNPN is seeking donations for raffle baskets and items for silent auction for the annual FNPN conference being held August 18 - 20, 2016 in Clearwater, Florida. Everyone loves to anticipate their number being the winning ticket!! Any theme and collection of items are appreciated.

The money raised from the raffle items will support the FNPN Political Action Committee. This past year PAC dollars were used to successfully support candidates and get our message heard in Tallahassee. We had a great legislative year this past session through our lobbying efforts and participation in legislative activities.

If interested in donating a raffle basket or items toward an auction, please contact Laureen Fleck at laureenfleck@yahoo.com or Tanya Miller at tanyamillerrn@embarqmail.com

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Job Announcements!

There have been many new job postings around the state on our website at www.fnpn.org for those of you that may have an interest. On our new website, the most recent postings are on the front page. A new feature will allow postings to be visible for 90 days. Please feel free to pass this along to your colleagues who may be interested in it as well, or who may have an interest in finding out more about our network. For those of you that have found jobs on our website, please be sure to let us know!

Do you know an employer who might find the FNPN Job posting a worthwhile site? If so, please be sure to tell them about the website and the fact that on average 20 or more jobs are posted each month. The traffic to our website is incredible and we have more and more folks seeking employment through this site than ever before. Let them know you saw it on the FNPN Website!

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Membership Update

Dr. Cindy Parsons-Membership Chair

As we recognize Heart Health this month and celebrate our advanced practice contributions to in-creasing public awareness, promoting preventative efforts and managing with our patients their car-diovascular health, we need to remember that this is the outcome of shared vision, concerted effort and advocacy. It is amazing what the strength of groups can accomplish. We are asking you to join or renew your membership in FNPN and help us to grow and strengthen our association.

One may ask, "Why is membership in FNPN so important?" The FNPN membership is shaping nurse practitioner practice in Florida and we need the support of every licensed nurse practitioner in this state to further our mission. FNPN has been involved in every legislative accomplishment for nurse practitioners in Florida since 2002. Much work lies ahead of us in 2016 and we will continue an ag-gressive legislative push to further reduce arbitrary barriers to NP practice.

The benefits of membership in FNPN include:

• Legislative Advocacy: FNPN is the statewide association working to advance and protect your practice in Florida. Through our national affiliations we help resolve federal barriers to practice. Your membership will help you to protect your practice and your profession.
• Education & Networking: There are eight regions and twenty-seven local groups that serve our members. These groups are managed by nurse practitioner members who volunteer their time to provide leadership, education, meetings, teaching events and more. They offer you the best opportunity to network and collaborate with NPs in your local area. Your col-leagues are often your best source of insight and a range of expertise. FNPN serves as a re-source for these leaders and supports them as they strive to keep members up to date about state and federal legislation that affects NPs. FNPN provides you the opportunity to connect with nurse practitioners and other professionals across town and around the state. Our annu-al conference is attended by hundreds of NPs and our members receive preferred pricing. FNPN members can receive discounts on educational products through our strategic partners.

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News You Can Use

The Florida NP Network has taken the next step to keep our members informed. Keep abreast of changes in your practice around the state and around the nation. You can join us today on Facebook under Florida Nurse Practitioner and Twitter under FloridaNP. We hope to hear from you.

CE Broker

• Did you know that full members can get a discount to CE Broker? Click here to find out more

Volunteers Needed

• For the Wildflower Clinic located in Saint Augustine, FL. The clinic is a non-profit organization offering free dental and medical care for patients uninsured, below the poverty line, or homeless. We are always looking for volunteers for the clinic. If you are a Nurse Practitioners in the St. Johns county and would like to volunteer, or have any questions, please contact Kayle Davis by email kayleedavis615@gmail.com

We Need Your Voice

• As many of you know, on May 25, the Department of Veterans Affairs (VA) published a proposed rule in the Federal Register for nurse practitioners (NPs) and other advance practice registered nurses (APRNs) practicing in Veterans Health Administration Facilities. This proposal [RIN: 2900-AP44 - Proposed Rule - Advanced Practice Registered Nurses (81 Fed. Reg. 33155, May 25, 2016)] would authorize NPs to practice to the top of their education and preparation without physician supervision in all areas of practice with the exception of prescribing controlled drugs, which remains under the authority of the federal Controlled Substances Act. The American Association of Nurse Practitioners applauds this move to provide our nation's Veterans with direct access to the health care services of NPs and other APRNs.
  
  
• The VA is accepting comments on this proposal until July 25. The voice of the nurse practitioner MUST be heard loud and clear. We ask that you use our Advocacy Center to submit comments to the VA click here. We will continue to provide additional updates as this process moves forward.
  
  
• The VA proposal is facing strong opposition from organized medicine that is similar to what we've seen in states where pro-patient/pro-NP legislation has been proposed. The best way to support our veterans' access to care and move this proposal forward is your individual engagement. Please make your voice count, and submit your support comment today.

FDA Files Electronic Cig Rule:

• This rule would regulate electronic cigarettes and other tobacco products. With the new rule, the sale of e-cigarettes is banned to anyone under the age of 18. Check out this article regarding the new rule

Opioid Update:

• FDA made label change and released safety warnings for opioid medical use. You can read the FDA's announcement here