President's Message

Principles and Effective Strategies for Full Practice Authority

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President Mary Chesney, PhD, RN, CPNP, FAAN

For many states, this time of year brings the start of a new state legislative session. I just returned from presenting at the Tennessee Action Coalition’s APRN Legislative Boot Camp. It was an exciting day and the APRNs of Tennessee are gearing up to bring full practice authority legislation to their state. I know that many of you and your advanced practice registered nurse (APRN) colleagues are also engaged in efforts to either introduce or continue work on bills before your state legislatures to reduce or eliminate barriers to APRN practice. Full practice authority bills are on the docket this year for Delaware, Massachusetts, Michigan, Illinois, Kansas and Nebraska. Legislation to reduce barriers is being introduced in Arkansas, Missouri and other states. 

Based on my own experience in leading Minnesota’s successful 2014 legislative campaign for full practice authority, I’d like to share a number of common sense principles and effective strategies that may serve you well in working to pass legislation in your own state:

  • Keep in mind that it is much harder to change or repeal a law than to maintain the status quo.  This means that your legislative journey will be a difficult, up-hill battle. Every NP and APRN in your state (yes—this means you!)  is going to need to be committed to the cause. Every APRN will need to get involved, write and talk with legislators, and encourage their family and friends to write emails and call legislators asking them to support APRN bills. Movement leaders or lobbyists do not sway legislators—constituents who can vote sway legislators. This is a numbers game. You need everyone so that legislators hear from large numbers of their constituents who support the bill.
  • It will be important for you to work with other APRNs to build as broad a coalition as possible.  Legislators need to know that consumer groups, hospital associations, insurers, employers and others beyond the APRN community believe that removing barriers from APRNs increases consumers’ access to care and choice of providers. Ask organizations and consumer groups for their support, ask them to write letters of support and maintain a list of supporters to share with legislators.
  • Work in concert with your state’s APRN group and leaders to communicate with a unified voice and a clear message. Watch for talking points and use them to communicate with your legislators.  Typically, using 3-4 simple key messages is the best strategy. Legislators often have little knowledge about APRNs or NPs. Be prepared with a concise one-minute elevator speech about APRN or NP, how we’re educated, and what we are able to provide for patients.
  • When you talk to legislators, be kind, polite and truthful.  If he/she asks you a question you do not know the answer to, don’t fake it. Simply state that you do not have the answer but will do some research and get back to him/her with an answer. In general, staying positive, respectful, and professional no matter how difficult things get will serve you well at the legislature.
  • Although you will likely meet with strong, organized medical opposition and negative anecdotal stories from your state’s medical associations and societies, take the high road and speak well of your physician colleagues. Be clear that granting APRNs full practice authority is simply allowing APRNs to function to the fullest extent of their training and education. Share the strong evidence that APRN care is safe, effective and high quality. Explain that your legislation is not about replacing physicians, nor is it about APRNs being anti-team-based care. We respect physicians and their expertise in complex differential diagnosis and complex care management.  We will continue to consult and collaborate with our physician colleagues and refer to them when warranted by the needs of the patient. We will continue to work in teams, although we do not believe it is in patients’ best interest to mandate that a physician must always be the leader of the team.
  • The MOST important thing to remember is that advancing APRN legislation is not about us—it’s about consumers and their needs for increased access to health care and choice of providers. 

I wish all of you engaged in this important work much success! Please share your comments about legislative activities going on in your state. Let’s use this forum to discuss issues, suggest strategies and support each other! I look forward to hearing from you.

Yours in health,

Mary Chesney
President of NAPNAP

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