Like nurses in states across the country, advanced practice registered nurses in Minnesota are working to eliminate the barriers to autonomous practice, something called for in the Institute of Medicine's Future of Nursing report.
But it's not just the policy experts and nursing association leaders who are doing so: It's also nursing students, the people who make up the real future of nursing.
Helping to rally these future nurse leaders and APRNs is Catherine Miller, DNP, RN, CNP, associate professor at The College of St. Scholastica and a pediatric nurse practitioner who's also a congressional district leader for the Minnesota APRN Coalition.
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"As educators," she says. "It's just imperative that we engage our students who will be our future workforce." It's critical, she says, that students not only understand the clinical side of their work, but also the political and regulatory issues that will affect their practice.
"It's not just going to work," she says. Instead, being an effective nurse means knowing "what's going on that's going to affect your ability to keep people healthy."
Miller is one of the many APRNs in Minnesota who are lobbying for the passage of two companion bills in the Minnesota House and Senate, which would remove the requirement that APRNs have a written collaborative agreement with physicians and allow them to practice independently.
Miller explains that in Minnesota, APRNs must practice under collaborative agreements with individual physicians which have to be specific to the practice setting they work in. The agreements are specific to each practice site, outline which drugs they may prescribe, and must be kept on file at each worksite.
"It does nothing to ensure safety," she says of the agreements. They're also cumbersome: APRNs need different collaborative agreements for every, physical venue where they practice. This is not only inconvenient for APRNs, but also costly and time-consuming when it comes to credentialing.
"There's a price that gets added on when you have to monitor" all of these disparate pieces of paper, Miller says.
Plus, such a requirement can leave practices in a lurch. For example, if a physician leaves a practice, nurses "could be able to prescribe one day and not the next," Miller says. The situation is especially bad for APRNs in areas like rural Minnesota, which has a dearth of mental health physicians.
"They can't practice because they can't find a psychiatrist to sign their collaborative agreement," Miller says.
She and her colleagues are working with their graduate- and doctorate-level students to engage them in the legislative process, encouraging them to attend town hall meetings and community gatherings that are focused on health. They also ask students to participate in letter-writing campaigns to legislators and the governor and to join Minnesota APRN Coalition meetings by phone.
In addition, some students went to the Minnesota capitol and met with their local legislators and senators to share how removal of practice barriers would enable their real-world work in their local communities.
"We really were just impressed with the compelling stories that these students told about how this will affect their future practice," Miller says.
In addition to providing health policy courses, educators also provide students with relevant documents, such as The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care from the National Governor's Association, and Roadmap to a Healthier Minnesota, in which the Minnesota Health Care Reform Task Force calls for "removing practice barriers for advanced practice registered nurses (APRNs) by adopting the Advanced Practice Registered Nursing Consensus Model and enacting the APRN Model Act and Rules."
Miller says education about health policy is critical, not only among practicing APRNs, but also among graduate and doctoral students, nurse leaders and staff nurses, and undergraduate nursing faculty and students because educating nurse leaders and faculty will have a trickle-down effect to everyone from future nurses to patients.
"We want to keep our well-educated nurses in Minnesota," she says. "This is the time nursing really needs to move forward."
Alexandra Wilson Pecci is an editor for HealthLeaders.
