For APRNs, Innovation Trumps Barriers
But what I found the most interesting about this report were the three institutions that were spotlighted as APRN innovators.
The first profiled institution is the US Department of Veteran Affairs, which the brief says employs more than 5,000 APRNs "to deliver primary, specialty, acute, ambulatory, telehealth, and home healthcare services." The VA plans to implement a new, system-wide policy this year that will allow all APRNs who meet certain criteria to practice without direct physician supervision, even in states that don't allow it, using its federal status to override state laws, the brief says.
The policy aims to standardize rules across different VA facilities so that APRNs who work at several facilities won't encounter differing rules about the ways they can practice. The VA will also issue guidance about an expanded list of APRN core privileges including signing admission and discharge orders, making patient rounds, and preparing progress notes.
Another example highlighted in the brief is the Transitional Care Model (TCM) at the University of Pennsylvania Health System, which uses APRN specialists to develop and execute wide-ranging discharge plans. Trials of the effectiveness of the program in high-risk, high-cost, high-volume patients found that it resulted in everything from reduced costs for at-risk pregnancies and preterm infants to improved outcomes and satisfaction among chronically ill older adults. Experts say that use of the TCM in the broader healthcare system could have amazing results.
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