PCNP in Private Practice NP Owned Amy Dunson

PCNP in Private Practice: NP Owned Amy Dunson, Cynthia Mc. Galliard, Jamie Peavy and Jennifer Spann

Outline • • History of NPs Role Requirements Collaborative/Supervisory Agreement Interprofessional Collaboration Prescriptive Authority Private Practice Considerations Preparing for Role Salary Estimates

History 1950 s-60 s • Physicians-Nurse collaboration • Specializing MDs • Primary Care MDs • Establishment of Medicare and Medicaid • 1 st training program for NPs 1970 s • Campaigning for expansion in NP opportunities • Approx. 15 K NPs in the US (AANP, 2015) • NPs practiced under license of MD • 65+ NP programs in the US (AANP, 2105) 1980 s • Institute of Medicine (IOM) produced report beneficial to NPs • Establishment of the American Academy of Nurse Practitioners (AANP) • Approx. 22 K-24 K NPs in US (AANP, 2015) • 200+ NP programs

History 1990 s • Establishment of American College of Nurse Practitioners (ACNP) • Balanced Budget Act of 1997 • Prescriptive Authority • 68 K+ NPs in US (AANP, 2015) 2000 s 2010 s • Approx. 82 K NPs • Approx. 140 K NPs in US in 2001 in the US in 2010 (AANP, 2015) • AANP creates • Expanding state Political Action regulations for Committee (PAC) NPs throughout • US Congress’ US recognition of • 192 K+ NPs in US National NP Week in 2014 • Approx. 130 K NPs in the US in 2009 (AANP, 2015)

Role Requirements 5+ years experience National Certification Nurse Practitioner In Private Practice (AL) MSN Degree or higher – CRNP program Prescriptive Authority Controlled Substance Prescribing Authority- if needed Collaborative Practice Agreement

2015 Nurse Practitioner State Practice Environment Full Practice Reduced Practice Restricted Practice (AANP, 2015 b).

Collaborative Agreement- A formal relationship between a NP and physician that permits the NP to engage in advanced practice nursing according to the approved written protocols regulated by each state. Alabama requires a collaborative agreement for all NPs. Considerations for private practice: • Find a collaborative physician in exchange for pay or services • Flat Rate • Hourly Rate • Percentage • Exchange for Services • Establish a contract

Interprofessional Collaboration Bridging into Practice Expanded Roles Appreciation • Shared decision making • Interprofessional Collaboration • Sustained Relationships • Performance Improvement Commitment to Interprofessional Collaboration Necessity of Mentorship

Prescriptive Authority Alabama Nurse Practitioners Who can prescribe? CRNP, CNM Are controlled substances included? Yes; schedules III-V; limited II Requirements for controlled substances? DEA # ; QACSC * Collaborative practice agreement required? Yes Who grants prescriptive authority? BON/BOME- Joint committee *Must apply to Alabama Board of Medical Examiners (BOME) for a Qualified Alabama Controlled Substances Certificate (QACSC) to prescribe schedule IIIV controlled substances. May also apply for a limited-purpose permit to prescribe schedule II controlled substances. Must apply to the Board of Nursing (BON)/BOME for permission to prescribe legend and specialty formulary drugs.

Private Practice Considerations Ø Ø Ø Ø Ø Patient demand Reimbursement potential Financial management Tax & accounting Human resources Marketing Medical billing & coding Risk management State licensure Negotiation of hospital privileges Ø Insurance reimbursement contracts Ø Business plan Ø Medicaid/Medicare enrollment Ø Malpractice/Liability insurance Ø Employee salaries & benefits Ø Collaborative agreement w/ local physician

Salary Estimates National employment estimates Employment RSE 122, 050 1. 1% Mean Wage/Hr Mean Wage/Yr Wage RSE $47. 11 $97, 990 0. 3% National percentile wage estimates Percentile 10% 25% 50% (median) 75% 90% Hourly $33. 09 $39. 77 $45. 84 $54. 55 $63. 01 Annual $68, 830 $82, 720 $95, 350 $113, 470 $131, 050 *The relative standard error (RSE) is a measure of the reliability of a survey statistic. The smaller the relative standard error, the more precise the estimate.

References • • Alabama Board of Medical Examiners and Medical Licensure Commission of Alabama (2015). Requirements & Qualifications for CRNPs and CNMs. Retrieved from http: //www. albme. org/faq-qacscnp. html#qu 1 Alabama Board of Nursing (ABN). (2003). Advanced practice nursing: Collaborative practice. Retrieved from Alabama Board of Nursing website: https: //www. abn. alabama. gov/Ultimate. Editor. Include/ User. Files/docs/admin-code/Chapter 20610 -X-5. pdf Alabama Board of Nursing (ABN). (2015). Advance practice nursing. Nurse Practice Act. Retrieved from https: //www. abn. alabama. gov/Ultimate Editor. Include/User. Files/ docs/nurse-practice-act/ARTICLE-5. pdf American Association of Nurse Practitioners (AANP). (2015 a). Historical timeline. Retrieved from AANP website: http: // www. aanp. org/aboutaanp/historical-timeline

References • American Association of Nurse Practitioners (AANP). (2015 b). State practice environment. American Associations of Nurse Practitioners. Retrieved from AANP website: http: //www. aanp. org/legislationregulation/state-legislation/state-practice-environment • American Nurses Credentialing Center (ANCC). (2015). Family Nurse Practitioner Certification Eligibility Criteria. Retrieved from http: // www. nursecredentialing. org/Family. NP-Eligibility. aspx Furlow, B. (2011). Business advice for nurse practitioners considering private practice. Retrieved from http: //www. clinicaladvisor. com/ your-career/business-advice-fornurse-practitioners-consideringprivate-practice/article/ 203953/ Graduate Nursing EDU (2015). Steps to becoming an APN in Alabama. Retrieved from http: //www. graduatenursingedu. org/alabama/ • •

References • O’Brien, J. M. (2003). How nurse practitioners obtained provider status: Lessons for pharmacists. American Journal of Health-System Pharmacy, 60, 2301 -2307. Retrieved from http: //www. medscape. com/view article/464663_2 • Stokowski, L. A. (2015) APRN prescribing law: A state-by-state summary. Retrieved from http: //www. medscape. com/view article/440315 • U. S. Bureau of Labor Statistics. (2015). Occupational employment statistics. Retrieved from http: //www. bls. gov/oes/current/oes 291171. htm#nat • Zapatka, S. A. , Conelius, J. , Edwards, J. , Meyer, E. , & Brienza, R. (2014). Pioneering a primary care adult nurse practitioner interprofessional fellowship. Journal for Nurse Practitioners, 10, 378 -386. doi: 10. 1016/ j. nurpra. 2014. 03. 018

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