College faculty lead charge on full practice authority legislation

How some advanced practice registered nurses (APRN) practice in Michigan could change thanks in part to the efforts of various state executive boards, which several Michigan State University College of Nursing faculty members hold positions on.

Advanced practice registered nurses in Michigan have a goal to achieve full practice authority. “Scope of practice” laws restrict what certain health care providers can do to treat patients. In Michigan, APRNs need a collaborative agreement with a physician to diagnose and treat patients and prescribe medications.

But that could be beginning to change. Earlier in 2021, Michigan lawmakers passed legislation that allows a certified nurse anesthetist (CRNA) to administer anesthesia without physician oversight if the CRNA is part of a patient-centered care team.

Angella Ruley, DNP, CRNA, NP-C, said the legislation was a long time coming and getting there involved lots of meeting with state representatives and senators to educate them on the issues. Ruley is the immediate past president of the Michigan Association of Nurse Anesthetists and the assistant director of the college’s Nurse Anesthesiology program.

“One of our big issues in Michigan is lack of services in rural areas,” Ruley said. “We also have shortages, especially now, of health care providers. COVID-19 has unveiled in a time of crisis the need for skilled and credentialed providers to take care of patients.”

The Michigan Council of Nurse Practitioners is currently advocating for similar legislation to grant Michigan nurse practitioners full practice authority. While a bill has not been introduced on the senate floor, the hope is lawmakers will see one by the end of September. The council’s current president Denise Hershey and immediate past president Ann Sheehan are both faculty members in the college.

Hershey, PhD, RN, FNP-BC, said nurse practitioners are a solution to addressing health disparities.

“We have to move out of antiquated models of health care if we are going to make an impact in our communities and keep people in Michigan healthy and improve access to care,” Hershey said.

In the current collaborative agreement model, Hershey said if a physician retires then a nurse practitioner can no longer practice — which creates a gap. The Health Resources and Services Administration predicts by 2025, Michigan will have a primary care provider shortage of more than 900.

Michigan is among the states with the most restrictive scope of practice regulations, but a change that supports APRN has been made. The Michigan Board of Nursing rewrote regulations regarding RNs and APRNs and the changes went into effect in 2017. An APRN is licensed as an RN and has received specialty training through a masters or doctoral degree in a specific area of nursing practice. Title protection restricts the use of a certain title from unqualified and unregulated individuals.

Jackeline Iseler, DNP, MSN, RN, ACNS-BC, CNE and an assistant professor in the college, said even with title protection, some hospitals have been slow to utilize clinical nurse specialists (CNS) in the most effective way for patients.

CNS are skilled in providing care for adults across the lifespan; they champion health care policy and operational changes while assuming leadership roles in health care settings. Iseler, who is also the college’s CNS program director and president of the Michigan Association of Clinical Nurse Specialists, said nurses need to come together and use their voices.

“We’re not asking to be another hand that is writing prescriptions,” Iseler said. “We’re asking for the simplicity of things not being missed and done in timely fashion.”

One of the ways students can be involved is by writing legislators about the bill and why there should be full practice authority.

“Students are our future and full practice authority will impact them more than it impacts me,” Hershey said.

There are also groups for students to be involved in, such as the Michigan Association of Nurse Anesthesiology Students. In the past, Ruley said students have been part of a MANA trip to Washington, D.C. to speak with legislators.

“If you don’t protect and progress your profession, other people make decisions for you,” Ruley said.

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