January/February 2011 FNPN News Bullets
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As we move quickly into the new year, 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:
- Message from the President
- FNPN Annual Elections
- Apathy among NPs threatens another year of Legislation!
- FNPN $10 for 2010
- FNPN Shining Star
- Education Updates
- Membership Update
- Job Announcement
- From Your AANP Representative
- FNPN PAC Update
- Around the State and Around the Nation
- News You Can Use
Quote of the Month:
“Go confidently in the direction of your dreams. Live the life you have imagined."
~ Henry David Thoreau
Message from the President
Doreen Cassarino, MSN, ARNP, FNP-BC, BC-ADM
I am honored to serve as your next FNPN president and I want to thank you for your support, as well as for taking the time to vote. I also want to thank your other board members who also volunteer their time to serve the organization and I look forward to working with them. We have much work ahead of us but we have a solid base on which to continue to build. I look forward to getting started and ask that you pledge to be involved, to work together, going forward, to serve the best interest of our profession and our patients. In order to reach our goals we need to ensure that we work together as we face our challenges.
I look forward to serving you and working with you for the next two years, and again I thank all of you for this opportunity.
FNPN Annual Elections
FNPN would like to thank all those members who took the time to vote in this year’s annual election process. The following officers have officially been declared:
- President: Doreen Cassarino
- Vice President Education: Jean Aertker
- Treasurer: Denise Elswick
- Secretary: Cindy Parsons
Our goals this year will be many, and require the participation of all members both active and unsure. While our volunteer leadership takes great pride in their efforts, it requires interaction with members and community alike. Please take a moment to congratulate our new board members and wish them only success in the coming term.
Apathy among Advanced Practice Nurses threatens another year of legislative success!
By Chris Saslo, Past President, FNPN
FACT: For 16 years, a controlled substance bill has been filed; and for 16 years, the Florida Medical Association (FMA) has successfully lobbied against us. Each year, NPs angrily express their frustration at not being able to practice as we were educated and trained.
FACT: Even with the increase in legislators among the Coalition for Advanced Practice Nursing (CAPN) Members, the real gaps in visibility comes from the voices of the Advanced Practice Nurse. Amazingly, our legislators have repeatedly asked, “Who are these NPs? I don’t hear from them, and when I do, it is only a handful.” Each year, NPs voice their frustration with lobbyists NOT doing their job, but fail to recognize their responsibility in successfully passing legislation.
FACT: With nearly 15,000 APNs in the state of Florida, our legislative voice should be overwhelming. Despite this, many of our larger metropolitan areas as well as our smaller, rural colleagues have consistently ignored the power of their voices. Examples include areas like Miami-Dade County, where NPs account for nearly 1,000 NPs in the state yet have less than 5% of membership in FNPN to represent them. Conversely, Hillsboro County demonstrates nearly 900 NPs in strength and account for more than 10% membership in FNPN representing them.
FACT: Last year, an effort to launch the first annual “Rally in Tally” was achieved. Despite the more than 300 NPs and their supporters showing in Tallahassee, it was considered by legislators “too late” in the session. Once again, we were told that our voices are not consistent, not loud enough and not strong enough.
Each year we struggle to have membership raised and participation skyrocket. Despite these efforts, Nurse Practitioners from around the entire state remain represented only in small percentage. Apathy, however, seems to be an ever growing cancer that silos each Nurse Practitioner as he or she moves into the workforce. We move throughout our days, struggling with our patient load, demands from our families and responsibilities at home.
Who has time for legislative activity? There are handfuls of your colleagues who do an incredible job each year and struggle to help keep our voices heard on the capital as well as at home. These heroic men and women should be thanked for their efforts, as the majority are voluntary and work hard to balance their personal and professional lives with the commitment of volunteering their time in the professional organizations in which they belong.
So before you complain about change not coming to Florida, or that we remain only one of two states who do not allow NPs to prescribe controlled substance, ask yourself several questions. Are you content with the status quo of your professional limitation? Are you content to be apathetic, are would you prefer to see change? What changes in your own practice need to occur for you to be more successful? Do you know who your legislators even are in the house, senate and federal levels? Do you even know who to contact in your local and state organizations to find out how to be involved? Are you really ready for a change?
As the upcoming year brings time for renewal in so many organizations, we hope you will consider your impact of this growing apathy and need to be more involved, not only the Florida Nurse Practitioner Network, but to your local organizations as well. This commitment is essential not only for support of the lobbyists, media campaigns and educational opportunities. Renewal and memberships are your promise to remain engaged, whether by keeping abreast with the changes on the legislative front, or finding opportunities for education in your own back yard and around the state and nation. We MUST stand up and learn to feel empowered to push back, but do so with professionalism, wisdom and conviction.
To date, the Coalition has raised more than $30,000 of our $100,000 goal!
FNPN in collaboration with coalition for advance practice nursing has had a great start to the campaign. It is critical for us to continue to raise more than $100,000 though the coalition efforts. This successful campaign will ensure an effective public relations effort in moving Advance Practice Nursing to the next level. The need to raise public awareness and stimulate effective access to healthcare can be achieved though this unity. Please read on as the campaign continues.
Please take a moment today to pledge your commitment of being an active supporter of this campaign and start nurturing those around you to help carry us to victory!! Your donation can make that happen! If every one of the more than 14,000 Advanced Practice Nurses were to donate at least $10 (or more), we would quickly surpass our goal. The campaign will not limit supporters from donating more than $10. In addition, supporters can encourage their colleague, friends and family to donate as well. Imagine the possibilities! Please visit our website today at www.fnpn.org and make that pledge today!
FNPN Shining Star
Name: Marifrances Gullo
NP as: Family Practice and Mental Health/Psych NP
Years as an NP: 10
Location: Volusia and Flagler Counties
Special mention: Marifrances has not only been active as a leader and current Director of the Volusia Flagler NP organization, she has developed and promoted their local NP Conference for the past 6 years. She has been recognized as a statewide success and has been recently appointed as the FNPN PAC Chair. This position requires someone with a positive attitude, outgoing community involvement and the ability to remain abreast of the political needs around the state. Marifrances is a graduate of UCF College of Nursing. She is board certified by the ANCC and the AANP. She is currently developing her private business titled Advanced Practice Nursing Services that contract with community organizations who require the services of advanced practice nurses. Marifrances has taught nursing at Daytona State College and the University of Central Florida. She was instrumental in launching the UCF nursing program in Daytona Beach and the Outreach Health Clinic at the Homeless Assistance Center. She has received the Presidential Award for Community Service by the Jaycees of Daytona and recently was named Provider of the Year by Haven Recovery Center for her dedication to the underserved populations of Volusia Flagler Counties. Thanks Marifrances for being such a great inspiration!
The following important educational opportunities have been posted for January and February; be sure to check back on our website at www.fnpn.org for additional updates and additions!
- Jan 21 Updates in Primary Care Friday, January 21 2011 at 9:00am HT in Honolulu, HI
- Jan 26 FNA EMPOWERMENT Webinars Wednesday, January 26 2011 at 2:30pm ET
- Feb 10 Pri-Med South Fort Lauderdale Thursday, February 10 2011 at 8:00am ET in Fort Lauderdale, FL
There have been many new job postings around the state on our web site 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!
Armando Riera-Membership Chair
I would like to wish each and every one of you a Happy and Healthy New Year.
In order for us to have our voices heard in Tallahassee, we will need to increase our membership, at the same time working hard to retain current members. One of our goals this year will be to actively work on recruiting new members to FNPN to make our organization stronger.
Renewal Reminder-Membership in FNPN runs on an annual basis Jan-Dec. Please renew your membership today. Membership in FNPN can be as a group or individual member.
Individual members belong and receive many benefits as part of their membership-frequent communication during the legislative session (or special sessions), a paid lobbyist based in Tallahassee, access to posted job opportunities, access to posted upcoming conferences and many more benefits. If you belong to your local NP group you are not an FNPN member until you join FNPN individually, group and individual membership are two separate levels of membership. I encourage you to visit our newly redesigned web page today www.fnpn.org and while you're there you can renew online.
Group Presidents- please renew today and continue to be an integral part of our growing organization. We value our group members as this creates a vital network of NP groups throughout the state. These groups help disseminate information about trends, issues and changes impacting NP's at the state and national level. As a group member we will also assist with conference planning and obtaining approval for CEU's if offered. We will also assist with promoting your conferences and activities and can provide assistance or link you with support in web design.
FNPN now has several options for membership:
- 2 year Renewal (2011 & 2012) - $ 100
- 1 year Renewal (2011) - $ 60
- Student/Retired 2 year Renewal (2011 & 2012) - $ 50
- Student/Retired 1 year Renewal (2011) - $ 30
- Student group membership waive first year member fee Free!
As the Chair of the Membership Committee I am always open to suggestions and new ideas. If you have any questions, please contact me. This year, when joining/renewing, we also ask you to consider ‘bringing a friend’ to the registration table and helping build our organizations to where they should be. With the numbers of Advanced Practice Nurses nearing 15,000 in Florida, we should have a strength that can overcome any push from our medical community. We hope you will let us nurture that side of you if you need it and engage those around you to do the same. Please be sure to contact us should you have questions about legislation, membership, education and more. Our Executive Assistant, Regina, is always available either by phone, computer and even skype!
Thank you in advance for all your support.
Armando Riera, MSN, ARNP-BC
FNPN, Membership Committee Chair
From your AANP Representative
Doreen Cassarino MSN, ARNP, FNP-BC, BC-ADM
As you know, a vote to repeal the Affordable Care Act (Health Care Reform) is pending in the House of Representatives. Although we know the repeal will likely pass in the House, will NOT likely pass in the Senate, and WILL be vetoed by the president. Your help with communication with your representatives regarding the delivery of health care services by NPs and the needs of our patients at this time is imperative in order to prepare for other potential legislation.
Below is a sample letter for your use. You can also go to Cap Wiz on the AANP website at www.aanp.org and enter the Advocacy Center for assistance with finding your representative’s contact information.
I am writing to express my concern about the pending vote to repeal the recently passed Health Care Reform legislation. This legislation contains many needed provisions for our patients that will enhance access to care and increase badly needed primary care services through the use of nurse practitioners that you do not want to lose. While it is realized that this is not a perfect bill, and that some provisions need to be adjusted, I ask that you think about the patients and providers in your district who will not be able to access and provide much needed health care services if this legislation is repealed.
Please take this into consideration.
FNPN PAC Update
Marifrances Gullo - PAC Chair
The purpose of the FNPN~PAC is to promote the ARNP profession through advancing the outcome of political issues or legislation. This is accomplished by contributing to the support of worthy candidates for State or Local offices who we believe have demonstrated their support of the principles to which this professional organization is dedicated. To further their purpose the PAC is empowered to solicit and accept these voluntary personal contributions (up to $500 per year per person). These contributions are used to attempt to influence the selection, nomination, or election of any individual to any State or Local office. Your decision to make a PAC contribution will help to continue our efforts wherever possible. Contributions can be made @ www.FNPN.org via Pay Pal…or your check payable to FNPN-PAC sent to 4637 Golden Apples Tr. Port Orange, FL 32129. Let’s make things happen together! Thank you for your support!!
Around the State and Around the Nation
Pair push for change
By Dayna Harpster
Two women in Collier County are among those leading a charge to allow advanced-degree nurses to prescribe controlled medications — as they can in all states except Florida and Alabama.
Advanced registered nurse practitioners can write prescriptions for medications not regulated by the Controlled Substances Act, such as antibiotics. In Florida, only doctors can order drugs with high abuse potential, such as hydrocodone for pain and Ritalin for attention deficit disorder.
Ann Campbell and Doreen Cassarino, both of Naples, say that allowing greater prescribing privileges will enhance access to care and reduce medical costs.
Campbell, a nursing administrator and the League of Women Voters health care director at the state level, says the current regulation is senseless.
"Nurses who are out in the rural areas might be running a clinic, and they're the only ones who see patients," Campbell said. "They can order antibiotics and make diagnoses. But they can't order this medication. And they're certainly well equipped to handle this.
"The Florida Nurses Association has been trying to get this through the Legislature for three or four years and it hasn't even been brought to a vote."
That's likely due to opposition from the American Medical Association and the Florida Medical Association.
But Campbell and Cassarino have plenty of support - from Lee Memorial Health System, for one.
"We would like to have that authority granted," said Sally Jackson, its director of community projects. "We think it would benefit everyone in the community."
When the Affordable Care Act is fully implemented in 2014 and as many as 50 million more Americans are insured, an already overburdened system could be doomed.
"There's already a shortage of primary care doctors in this state and thousands of people looking for a doctor," Campbell said.
Hospices and nursing homes would benefit from this change, Campbell said. Where a nurse is now in charge and can diagnose and monitor patients, he or she cannot change orders for pain medication or sedation.
"I see a child with ADD, and I can diagnose that. But unfortunately I can't prescribe the medicine," said Cassarino, a nurse practitioner in Naples and president of the Florida Nurse Practitioner Network. "So then the child has to see a physician. And that's another cost, and maybe the mom has to take off work again for another appointment."
Which can take weeks, said Greg Gardner, executive director of the National Alliance for the Mentally Ill in Lee County.
"The primary opponents are our physician colleagues," Cassarino said.
That would include the medical societies of Lee and Collier counties. They say that with more people able to prescribe medications that are often abused, more could end up on the street.
"In a state that is having extraordinary difficulties in controlling the amount of prescriptions that are ending up on the street, this is probably not an ideal time to increase the number of people able to prescribe," said Dr. Craig Sweet, outgoing president of the Lee County Medical Society.
His opinion is echoed by his colleagues in Collier County, according to its medical society executive director Margaret Eadington. Additional Facts - More information - WHAT IS AN ARNP?
Advanced Registered Nurse Practitioners are registered nurses with graduate-level advanced degrees who have passed a national certification test.
In 14 states, they may practice independently and may prescribe controlled drugs. In all other states except Florida and Alabama, they may prescribe these drugs with various levels of supervision by doctors or limits to this ability. Some cannot order refills or prescribe weight-loss drugs, for instance.
They are regulated by their state boards of nursing.
ARNPs include four categories of nurses: nurse practitioners, certified nurse midwives, clinical nurse specialists or certified registered nurse anesthetists.
ACCESS TO CARE
Now, more than half of uninsured adults have no regular access to health care, according to the Kaiser Family Foundation. Using the latest census numbers, that would be half of the 24.2 percent of Floridians younger than 65 who are uninsured, among them 31.9 percent in Collier County and 28.2 percent in Lee.
But that number may be low. Kaiser believes there are many more, as the census figures are based on 2007 totals and therefore don’t account for the recent recession
Expanding ARNP Practice Could Save Millions
A recent report to evaluate the potential savings to our state through use of Advanced Registered Nurse Practitioners (ARNPs) to their full scope. Please click here to see this very important report done by the Florida Legislature's Office of Program Policy Analysis and Government Accountability (OPPAGA) regarding potential cost savings to Florida. The report also addresses the use of Physician Assistants (PAs), optometrists, and dental hygienists.
The critical findings of this report concludes that there could be huge cost savings to the state if ARNPs were used to their full education, training and experience. Feel free to use this report when you meet with your legislators, share with your friends and colleagues, and to print and copy to distribute.
The Coalition for Advanced Practice Nursing is happy to see confirmation in writing of what we already knew about the great work of ARNPs. Spread the word!
Nursing Groups Work for National APRN Standards
By Janet Boivin, RN
The barriers that prevent advanced practice registered nurses from practicing to their full capabilities are coming down as states begin to adopt national standards to educate, license, accredit and certify nurse midwives, nurse anesthetists, clinical nurse specialists and nurse practitioners.
Members of state boards of nursing and nursing associations, national nursing leaders, and healthcare policy experts shared ideas on how to adopt an already-agreed-upon national model for the licensing and regulation of APRNs at a summit in San Diego starting Jan. 13 sponsored by the National Council of State Boards of Nursing.
“Everybody understands that we need to lift these barriers,” says Ann L. O’Sullivan, CRNP, PhD, FAAN, president of the Pennsylvania State Board of Nursing and professor of primary care nursing, University of Pennsylvania.
The NCSBN has been working for several years now with various nursing organizations on uniform standards of APRN licensure, accreditation, certification and education standards. In 2008, about 50 nursing organizations unanimously approved a consensus model of legislative language. Once adopted by all 50 states, the consensus will allow APRNs to perform the same services from state to state, such as prescribing medications and providing primary care. APRNs will have more mobility to practice in different states, and Americans will have more access to healthcare, particularly those who live in underserved populations, says Mary Ann Alexander, RN, PhD, chief officer of nursing regulation for the NCSBN.
Each state controls how APRNs are licensed, accredited, certified and educated. In some states, such as Colorado, APRNs practice more independently than in more restrictive states, such as Illinois and Pennsylvania.
The consensus model eliminates some of the most controversial restrictions on APRNs, including the requirement that APRNs work in collaboration with physicians and that they have limited prescribing authority.
To standardize APRN licensure and regulation, each state needs to change its laws and rules or regulations to follow the consensus model, but each state will continue to license its own APRNs, Alexander says. “Each state has to make the decision that they are going to do it [adopt the consensus model] and they have to do it themselves,” Alexander says. “The NCSBN is providing the resources to help them adopt the consensus model and are encouraging them to build statewide, grass-roots coalitions.”
Some states are further along than others in achieving this goal. “It varies from state to state,” Alexander says. For example, Maryland recently eliminated collaborative practice with physicians as a requirement for APRNs.
The goal is to have all states adopt the consensus model by 2015, but it actually might take a few years more, O’Sullivan says. However, she believes the amount of research now available showing the effectiveness of APRNs in improving access to care while saving money and the support of major think tanks and organizations, such as the Institute of Medicine and Robert Woods Johnson Foundation, will propel the consensus movement forward.
AARP is one of those groups that believes consumers should have access to APRNs who can deliver high-quality care. “We commend the National Council of State Boards of Nursing for their efforts to offer consumers this assurance by working with experts across the states to agree on what it takes to deliver care at the APRN level,” says Susan C. Reinhard, RN, PhD, FAAN, senior vice president and director, AARP Public Policy Institute and chief strategist, Center to Champion Nursing in America.
“Assurances that these nurses have achieved the high levels of education and training needed to deliver this care is essential.”
Every APRN in the country needs to be aware of the consensus and hopefully will help their state boards and local nursing associations and organizations work toward adoption of the proposed legislative language, O’Sullivan and Alexander say.
“We want nurses to know the power and influence they have when they join together and unite as one,” says Alexander. “That’s the theme of this summit — The Campaign for Consensus: Uniting APRNs, Promoting Uniformity, and Fostering Collaboration.”
O’Sullivan also encourages APRNs to review their own licensing and credentialing in anticipation of states adopting the consensus model. They might need to obtain new or updated education and certification to be in compliance with the new standards, she says. “If you do not have national certification, that is the first thing I would do,” O’Sullivan says.
One of the biggest obstacles to achieving consensus will come from national and local medical associations, particularly the American Medical Association, which has long fought the expansion of APRNs’ scope of practice, says O’Sullivan. But she says most individual physicians are in favor of APRNs practicing to their full capabilities.
APRNs practicing within their full scopes also is the recommendation of the Institute of Medicine’s report The Future of Nursing: Leading Change, Advancing Health, released this past October. The report had four key messages, one of which was that “Nurses should practice to the full extent of their education and training.”
The new healthcare reform laws also calls for APRNs to practice to their full extent in order to improve access to care, particularly in underserved areas, and to provide more access to primary care practice.
For more information about the APRN Consensus Model go to the NCBSN’s website at www.ncsbn.org.
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.
FDA MedWatch - Acetaminophen Prescription Products Limited to 325 mg Per Dosage Unit: Drug Safety Communication
AUDIENCE: Pharmacy, Pain Management
ISSUE: FDA notified healthcare professionals that it has asked drug manufacturers to limit the strength of acetaminophen in prescription drug products, predominantly combinations of acetaminophen and opioids, to 325 mg per tablet, capsule, or other dosage unit, making these products safer for patients. This action will help to reduce the risk of severe liver injury and allergic reactions associated with acetaminophen. A Boxed Warning highlighting the potential for severe liver injury and a Warning highlighting the potential for allergic reactions (swelling of the face, mouth, and throat, difficulty breathing, itching, or rash) will be added to the label of all prescription drug products that contain acetaminophen.
BACKGROUND: Acetaminophen, one of the most commonly used drugs in the United States, is widely and effectively used in both prescription and over-the-counter (OTC) products to reduce pain and fever. Examples of prescription products that contain acetaminophen include hydrocodone with acetaminophen (Vicodin, Lortab), and oxycodone with acetaminophen (Tylox, Percocet). OTC products containing acetaminophen (e.g., Tylenol) are not affected by this action. Information about the potential for liver injury is already required on the label for OTC products containing acetaminophen. FDA is continuing to evaluate ways to reduce the risk of acetaminophen related liver injury from OTC products. No drug shortages are expected, because the 3-year implementation period should permit adequate time for necessary reformulations.
RECOMMENDATION: Healthcare professionals were reminded to advise patients not to exceed the acetaminophen maximum total daily dose (4 grams/day), and not to drink alcohol while taking acetaminophen-containing medications.
Healthcare professionals were encouraged to inform patients that there is no immediate danger to patients who take these combination pain medications, and patients should continue to take them as directed by their health care provider. The Drug Safety Communication provides additional information for healthcare professionals, information for patients, a data summary and a list of all affected products.
Read the MedWatch safety alerts, including links to the FDA Drug Safety Communication, Q&As, and Consumer Update, Click Here
Healthy People 2020 Objectives: Now available for Viewing and Implementation
On December 2, 2010, the U.S. Department of Health and Human Services (HHS) unveiled the Nation's new 10-year goals and objectives for health promotion and disease prevention. The launch, marking the beginning of Healthy People 2020, included remarks from the HHS Assistant Secretary for Health, Dr. Howard K. Koh; HHS Chief Technology Officer, Todd Park; Director of the Los Angeles County Department of Public Health and Health Officer, Dr. Jonathan Fielding; Associate Dean for Health Promotion and Disease Prevention, University of Pennsylvania, School of Medicine, Dr. Shiriki Kumanyika; and many others.
For more details about the initiative and how you can get involved, visit the newly redesigned Healthy People Web site at www.healthypeople.gov. The Web site allows users to view the new Healthy People 2020 topic areas and objectives, tailor information to their needs, and explore evidence-based resources for implementation.
Get the latest information about Healthy People 2020. Sign up for the Monthly e-Bulletin or the periodic News You Can Use, which features new tools, events, and resources to help you implement Healthy People.
Find other professionals implementing Healthy People, share ideas, and network. Join the Healthy People 2020 LinkedIn group and invite your colleagues to do the same.
Stay current with the latest Healthy People information on Twitter; @GoHealthyPeople
The Consortium is a diverse, motivated group of agencies and organizations that is committed to achieving the goals and objectives of Healthy People 2020.