28th Annual APRN Legislative Update

28th Annual APRN Legislative Update: Advancements Continue for APRN Practice

Posted by ONS Staff

Oncology Nurse Practitioner Competencies


New Stage 2 Meaningful Use Resource from ONC

New Stage 2 Meaningful Use resource from ONC

The Office of the National Coordinator (ONC) has developed training modules around the Stage 2 Meaningful Use rule to train eligible professional (EPs) and others on how to implement new standards to support:

  • Transitions of Care
  • Lab Exchange
  • Patient Engagement
  • Public Health Measures

FTC’s Position on Scope of Practice Issues Related to Advanced Practice Registered Nurses

FTC’s Position on Scope of Practice Issues Related to Advanced Practice Registered Nurses

With scope of practice discussions being mounted at the state and federal level, the Federal Trade Commission issued a policy paper for state legislators. To read the FTC's position on scope of practice issues relating to Advanced Practice Registered Nurses, visit http://www.ftc.gov/news-events/press-releases/2014/03/ftc-staff-paper-state-legislators-should-carefully-evaluate


NPs Love Their Jobs, For Now

Nurse Practitioners Love Their Jobs, For Now
John Commins, for HealthLeaders Media , October 3, 2013
Unlike physicians and RNs, nurse practitioners report remarkably high levels of job satisfaction thanks to a rise in opportunities to practice independently, and confidence that their earning power will increase.

A small survey gauging job satisfaction among nurse practitioners [PDF] found that 100% of them are upbeat about their profession. The survey also found that 99% of NPs are optimistic about their future, 97% would recommend becoming an NP to their children, and 96% are optimistic about the future of their profession.

The survey sample was limited and included responses from 222 NPs who attended the June annual meeting of the American Association of Nurse Practitioners in Las Vegas. Phillip Miller, vice president of communications at Irving, TX-based healthcare recruiters Merritt Hawkins and Staff Care says there are about 155,000 nurse practitioners in the United States and he conceded that only limited observations could be drawn from such a small sampling.

"It is not a scientific survey but it is more of a weathervane indicator of where things are going," Miller says. "The reason we think it is somewhat significant is that the response to the questions was overwhelming. Literally all 222 said they felt positive about it, even if it is not that great to that extent we think it is an indicator that they are pretty happy in their profession."

"And unlike physicians and even nurses we have surveyed we have never seen satisfaction rates as high. We usually get 10%–15% of the people who have something to grumble about or something that didn't meet their expectations or who have regrets. We got almost none of that this time."

High Pay and Emotional Rewards

Miller says NPs have a lot to be upbeat about.

"They are feeling pretty heady about where the scope of practice for NPs is heading. It is broadening," he says. "They are getting more autonomy. More states are allowing NPs to practice independently. There is a sense of confidence that their income and prestige are going to increase."

When asked what they plan to do in the next three years, 63% of NPs said they will continue in their practice. However, 10% said they would work independently, 10% said they would work in temporary practice, and 12% said they would work part-time.

The NPs reported seeing an average of 17 patients per day and earned an average of $95,800 a year. Miller says it is not uncommon for NPs to command six-figure salaries. "It's a good return on investment on your time and money and education for what you get," he says. "They also get the emotional rewards of taking care of patients."

The results of the NP survey provide a sharp contrast to surveys gauging job satisfaction among physicians. A recent national survey of physicians conducted by Merritt Hawkins found that 32% of respondents said they feel positively about their profession, 13% said they are optimistic about the future of medicine, and 42% would recommend medicine as a career to their children or other young people.

Shifting Roles

"NPs and doctors are a mirror image of each other," Miller says. "The things that NPs are happy about, increasing income and clinical autonomy and the feeling of more power within the system, most doctors are experiencing exactly the opposite. Doctors feel like their clinical autonomy is being eroded and that reimbursements are being cut, and in a lot of cases they are. Before they were preeminent on the healthcare team and now it's more like they are part of the team and not the dominant player."

Miller says other surveys have found dissatisfaction among registered nurses. "They're dealing with a lack of autonomy. Everyone is breathing down their necks. They have a physically more demanding job than an NP, who is pretty much interacting with patients and nurses are doing physical things such as lifting the patients and running from bed to bed in a hospital. They actually complain a lot about their bodies just not holding up," he says.

"Nurse income is not that bad but it is not as good as what you're getting as an NP. They don't have that satisfaction and they are not really feeling like they are managing the patient's care like an NP would but they are doing sort of the grunt work."


While much has been said about NPs and physicians' assistants alleviating the physician shortage, the survey shows that 75% of NPs said there is a national shortage of NPs. More than 80% of NPs said they are overworked in their practices or are at full capacity. NPs said they spend an average of 25% of their time on non-clinical paperwork.

"We have this hope that NPs and PAs are going to ride to the rescue in the doctor shortage but we are already seeing evidence that NPs and PAs are already overextended," Miller says.

While the future looks rosy, when 100% of the responses are positive there is no place to go but down.

"The only negative I see is be careful what you wish for," Miller says. "When you become an independent practitioner the onus of running a practice and having the responsibility falls on you and a lot of doctors find that to be a challenge. That is the only caveat I see there out there right now."

The survey was conducted by Staff Care, a temporary physician and NP staffing firm and an affiliate with Merritt Hawkins under AMN Healthcare.


APRN Consensus Model NP Scope of Practice

Progress Is Steady for Implementation of APRN Consensus Model

FDA joins with health professional organizations in encouraging prescribers to seek training to safely prescribe opioid pain medications.

FDA is extremely concerned about the inappropriate use of opioids, which has reached epidemic proportions in the U.S., becoming a major public health challenge.  Recognizing your boss’s efforts to tackle this significant problem, we want to share with you an important step being taken by FDA, joined by health professional organizations, to work together to ensure appropriate use of opioids in an effort to reduce this epidemic.  FDA sees three key roles for prescribers in curtailing the U.S. opioid epidemic, 1) ensuring that they have adequate training in opioid therapy, 2) knowing the content of the most current opioid drug labels and 3) educating patients about the appropriate use of opioids, their potential risks, and proper disposal techniques.


While much of the prescription drug abuse problem is attributable to illicit use which can include sharing medication with family and friends or theft of the drug from home medicine cabinets, legitimate use of medications for pain may also lead to unnecessary adverse events, addiction, and death for some patients. Our nation’s front-line health care professionals, especially physicians and other prescribers can play an important role in efforts to reduce this trend. 


FDA believes it is critically important to facilitate prescribers’ education about the best uses of opioids, including knowing when and for which patients they should be used.  That is why today, FDA issued an open letter to prescribers urging prescribers to take advantage of educational programs designed to promote responsible opioid prescribing, improve pain management, and minimize prescription drug abuse and diversion.


The American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American Academy of Physician Assistants (AAPA) and the American Academy of Pain Management (AAPM) have graciously agreed to distribute the open letter to their members. All these organizations are actively engaged in activities, including training, aimed at reducing the misuse and abuse of opioid medication, as are many others.


See Commissioner Hamburg's message to prescribers at:


For more informationon the open letter and FDA's other efforts to address opioid misuse is available at:


Investigational Targeted Drug Induces Responses in Aggressive Lymphomas


Investigational targeted drug induces responses in aggressive lymphomas

Preliminary results from clinical trials in a subtype of lymphoma show that for a number of patients whose disease was not cured by other treatments, the drug ibrutinib can provide significant anti-cancer responses with modest side effects.These results were presented as part of the opening plenary session at the American Association of Cancer Research (AACR) Annual Meeting 2012 on April 1 by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and colleagues.

Lymphomas are the fifth most common form of cancer. They are caused by an abnormal proliferation of white blood cells, can occur at any age, and are often marked by lymph nodes that are larger than normal, fever, and weight loss. Diffuse large B-cell lymphomas (DLBCL), which were studied in this trial, are aggressive cancers that grow rapidly and represent 30 percent to 40 percent of newly diagnosed lymphomas. DLBCL originates from B cells, which play a crucial role in the body's immune response.

There have been no major advances in the treatment of DLBCL in more than a decade. However, important advances have been made in understanding that this disease is comprised of at least three molecular subtypes, each derived from B cells at unique stages in their development. The activated B-cell (ABC) subtype of DLBCL accounts for approximately 40 percent of cases and has the poorest clinical outcome with current therapy.

Recent genetic studies have revealed that chronic activity of receptors that sit on the surface of B cells play an important role in the progression of ABC lymphomas. In normal B cells, these B-cell receptors help the cells recognize infections. In malignant B cells of ABC lymphomas, these receptors provide crucial signals that promote tumor cell survival. Over one-fifth of ABC tumors have mutations that alter the activity of the B-cell receptor. Based on these findings, researchers looked for ways to target B-cell receptor signaling therapeutically. This research identified the enzyme Bruton's tyrosine kinase (BTK) as a key element in the B-cell receptor pathway that is required to maintain the survival of ABC lymphoma cells.

"Our trial is a prime example of precision medicine," said Louis Staudt, M.D., Ph.D., deputy chief, Metabolism Branch at NCI. "A better understanding of the changes in cancer cells is leading us to what we hope will be more effective treatment strategies tailored to the genetic profile of each patient’s cancer."

Based on this molecular research, investigators chose to use the drug ibrutinib (formerly PCI-32765), a potent inhibitor of BTK, in their clinical trials. Ibrutinib is an oral, highly specific and irreversible inhibitor of the BTK enzyme. Pharmacyclics Inc., Sunnyvale, Calif., and Janssen Research and Development, L.L.C., Horsham, Pa., are developing the drug to target B-cell malignancies, including various forms of leukemia, lymphoma and multiple myeloma.

In studies led by Staudt and his NCI colleague, Wyndham Wilson, M.D., ibrutinib was first evaluated in a pilot trial at NCI in ABC DLBCL, and is now being evaluated in an ongoing multicenter study in DLBCL. Results from the pilot trial and individual cases from the ongoing trial indicate that the use of the single agent pill form of ibrutinib can elicit major anti-lymphoma effects with minimal side effects.

Participants in these studies were given ibrutinib as a pill at a fixed dose of 560 milligrams daily until the disease progresses. Ibrutinib induced multiple responses including some complete remissions in ABC lymphomas. Remissions were also observed in patients with non-ABC DLBCL, suggesting a broader role for the B-cell receptor pathway in this type of lymphoma. A final analysis will provide additional insights into the safety and efficacy of ibrutinib in the treatment of DLBCL.

"These results illustrate how an understanding of the molecular machinery inside a cancer cell can lead to new therapies which can kill tumor cells while sparing normal cells, thus greatly reducing toxicities for patients," said Staudt.

To read details about this trial (identifier # NCT01325701), please go to


NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at

www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

About the National Institutes of Health (NIH):

NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH...Turning Discovery Into Health