TRANSITIONS to PRACTICE

1. TRANSITIONS to PRACTICE Christine Armstrong, MSN, CNP, ACHPN ,

2. What’s Next • You chose a certification exam. • You joined a professional organization. • AACN/AANP • You apply to take the exam online. • Submit transcripts electronically. • Wait (patiently) for your OK to test.

3. While you wait… • You apply for your APRN License • APRN Modernization Bill went into effect April 4, 2017. • You only need to apply for APRN license. • OBN site states that all applications and payments must be on line. • Can apply before you graduate and before you test. OBN will keep on file for 1 year.

4. Application • Ohio Board of Nursing web site. • Apply on Line • Pay fees on line. • Submit Electronic Transcripts to the OBN • As there is no CTP or CTP externship, the Board will be paying close attention to your 45 hours of Pharmacology in the last 5 years.

5. Application • The Certifying Agency must submit your test results directly to the Board. • There is no fee to submit results to Board. • New law states that you will then be granted a license as an APRN. • You will be designated a CNP, CRNA, CNM, CNS with automatic prescriptive authority with licensure. Lucky Ducks!

6. Congratulations! • You passed your certification exam. • You have been granted a License to Practice as an APRN. • Now you have to find a job! • Where you worked as an RN. • Networking • Speciality

7. Common Mistakes • License expiration • You must be an RN to be an APRN • ANCC/AANP certification expiration • Lapsed, terminated, or inadequate SCA • Exceeding scope of practice • OBN is NOT your Friend! • OBN is to protect the consumer!

8. Practice • Compensation for services rendered. • Contract negotiation. • Standard Care Arrangement • National Provider Number. • DEA number. • Medicare Number. • Medicaid Number.

9. Compensation • The average Nurse Practitioner salary in Ohio is $101,126 as of January 31, 2019 according to salary.com. • the range typically falls between $93,836 and $109,856. • Salary ranges vary widely depending on the city, education, certifications, additional skills, the number of years you have spent in your profession.

10. Compensation/Contract • Vacation/PTO • Continuing Ed – Time/Expenses • Malpractice • Licensure Fees • Hospital Staff Fees • Health Insurance • Legal Fees • Disability

11. Compensation/Contract • Life Insurance • Car • Phone/Pager • Subscriptions • Retirement Plans • Moving Expenses • Maternity Leave • OAAPN, AANP, ACNP – dues

12. Post Contract • Non-Compete Clause • Time • Geography • Non-Solicitation • Patients • Employees

13. SCA • Standard Care Arrangement • Written, formal guide for planning and evaluating a patient’s health care that is developed by a collaborating physician/s and an APRN. • All APRN’s must have SCA even if not Prescribing per Modernization Bill. • Must submit to OBN within 30 days of practice or change in collaborator.

14. APRN Modernization • Collaborating: now 5 APRN’s to one Physician. Ambiguous. ????? • Collaborating Physician/s: SCA with APRN and is continuously available to communicate with APRN in person or with technology. • Psych NP can now collaborate with Psychiatrist or Primary Care Physician.

15. APRN Modernization • SCA review and resign every 2 years • No longer required to have a procedure for regular review of referrals by the nurse to other health care professionals and the care outcomes for a random sample of all patients seen by the nurse.

16. APRN Modernization • No longer need a policy for care of infants up to age one and recommendations for collaborating physician visits for children from birth to age three, if the nurse regularly provides services to infants. • APRN verifies collaborator’s license ever 2 years; Can use e-license site • Formulary of Exclusion

17. APRN Modernization • A Certified Nurse Practitioner, Clinical Nurse Specialist and Certified Nurse Midwife shall not prescribe any drug in violation of Federal or Ohio law. • No Schedule I. No Medical Marijuana • The prescriptive authority shall not exceed the prescriptive authority of the collaborating physician or podiatrist.

18. National Provider Identification • NPI number is a 10 digit numeric identifier to be used on claim forms submitted to payors. • Must have it to bill for services. • Medicare, Medicaid and private insurances. • Must update when changing practices. • Must have NPI to Apply for Medicare and Medicaid number.

19. Schedule II • Need to have a DEA number to Prescribe Schedule II • DEA $730.00. Employer cover cost? • www.deadiversion.usdoj.gov • Need to inform OBN of DEA number. • OARRS Registration. • www.ohiopmp.gov

20. Schedule II • 2012 law and rule changes allow APRNs to prescribe schedule II controlled substances. • Must Review OAARS. • Chronic Pain: 80mg Morphine Equivalent daily dose. • New Acute Pain limits. 7 day supply. • Can only prescribe schedule II drugs from select locations.

21. Schedule II Sites • NOTE: APRNs cannot prescribe schedule II controlled substances from a convenience care clinic even if it is owned/operated by one of the select locations listed on the next slides (with the exception of prescriptions limited to a 24 hours supply as set forth in pre-existing law) • Hospital

22. Schedule II Sites • Entity owned or controlled by a hospital or by an entity that owns or controls 1 or more hospitals • Health care facility operated by the Dept. of Mental Health or Dept. of Developmental Disabilities • Nursing home • County home or district home certified under Medicare or Medicaid

23. Schedule II Sites • Community mental health facility • Ambulatory surgical facility • Freestanding birthing center • Federally qualified health center or look-alike • Health care facility operated by board of health or an authority having duties of a board of health

24. Schedule II Sites • Medical practice, ONLY IF, practice has 1 or more physicians who are also owners of practice, practice provides direct patient care, and APRN has SCA and collaborates with at least 1 of the physician owners who practices primarily at that site

25. Medicare Number • Internet-based: Provider Enrollment, Chain and Ownership System. (PECOS) • Different for each Employer. • Submit the current version of the Medicare enrollment application (CMS-855) • Submit the correct application for your provider to the Medicare contactor servicing your state. (Palmetto)

26. Medicaid Number • Apply on Line. MITTS • Check list of documentation you need to even start application on line. • Must have NPI before you can apply. • Can apply for Medicare and Medicaid simultaneously. • CAQH https://proview.caqh.org

27. Practice • Professional organizations. • AANP • OAAPN • NEONP • Mentorship/Preceptorship. • Pay it Forward.

28. Nurse Practitioner History • Early 1960’s PCP recruited RN’s with clinical expertise and began collaborating to provide Primary Care. • 1965 Loretta Ford and Dr. Silver founded the first NP program at the University of Colorado. • 1967 first Master’s Program for NP and Ohio was using NP’s in Public Health

29. Nurse Practitioner History • By 1979 there were 15,000 NP programs in the US. • Ohio, especially Northeast Ohio, had a high number of programs. • Marymount Hospital, Lutheran Hospital and St. Joseph’s Hospital in Lorain, Ohio • 1980 Northeast Ohio Nurse Practitioner Group was founded.

30. Nurse Practitioner History • Goal of NEONP was to organize for NP’s. • Legislation for certification and licensure. • Fought to be recognized as a health care provider. • Out of NEONP, founding members went on to establish OAAPN. • This brought together all Advanced Practice. CNS, CNP, Midwife, CRNA

31. Nurse Practitioner History • 1997 Title Protection: gave NP’s the right to be paid for their Advanced Practice by Insurance Companies. • 2000 Ohio was the last State to obtain Prescriptive Authority. • 2008 APRN could prescribe Schedule II • 2017 APRN Modernization Act, removed some limits on practice.

32. Practice • Questions???