• emphasized the issue of access to care for rural and disadvantaged populations;

  • ensured that policy makers knew what APRNs do (Ms. Jones invited legislators to her clinic);

  • promoted unity among Iowa nursing groups and with organizations such as the Iowa Hospital Association; and

  • partnered with leaders, such as former Iowa governor Tom Vilsack (now U.S. secretary of agriculture), the first governor to opt out of Medicare’s requirement that the state’s CRNAs be supervised by physicians.

Evidence that it is safe to remove restrictions on APRNs comes from an annual review of state laws and regulations governing APRNs that now includes malpractice claims in its analysis. The 2010 Pearson Report documents no increase in claims registered in the Healthcare Integrity and Protection Data Bank in states where APRNs have full authority to practice and prescribe independently. The report also notes that the overall ratio of claims against NPs is 1 for every 166 NPs in the nation, compared with 1 for every 4 physicians (Pearson, 2010).

In June 2010 President Barack Obama addressed the House of Delegates of the American Nurses Association to announce “a number of investments to expand the primary care workforce.” These included increased funding for NP students and for nurse- and NP-run clinics—two important steps, the President said, in “a larger effort to make our system work better for nurses and for doctors, and to improve the quality of care for patients” (White House, 2010).

A mother brings her son for an appointment with nurse practitioner Cheryll Jones, who provides high-quality care in the rural community of Ottumwa, IA.

A mother brings her son for an appointment with nurse practitioner Cheryll Jones, who provides high-quality care in the rural community of Ottumwa, IA.



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