AFT Resolution

ADVANCED PRACTICE REGISTERED NURSES (APRNs): KEY PROVIDERS OF PRIMARY CARE IN THE USA

WHEREAS, in 2012, delegates to the American Federation of Teachers national convention approved a resolution supporting APRNs as primary care providers who play a key role in providing access to care of the citizens of our nation; and who should be afforded the opportunity to practice to the full extent of their licensure and education: and

WHEREAS, the spring 2008 report of the Medicare Payment Advisory Commission (MedPAC), states that nurse practitioners provide the highest percentage of primary care visits compared to other Part B providers in the Medicare Fee-for-Service Program; and

WHEREAS, according to the American Academy of Nurse Practitioners, 89 percent of the APRNs are prepared in primary care; and

WHEREAS, there are almost 160,000 nurse practitioners in the US who take health histories and provide complete physical exams; diagnose and treat acute and chronic illnesses; provide immunizations; prescribe and manage medications and other therapies; and order and interpret lab tests and X-rays; and

WHEREAS, nurse practitioners have been providing primary care for over 45 years, and there is strong evidence that this care is cost-effective, of high quality and of great service in increasing access to care for vulnerable populations;[1],[2] and

WHEREAS, the Institute for Alternative Futures stated that the future primary care teams must broaden to include APRNs, as nurse-managed health centers expand;[3] and

WHEREAS, a systematic review[4] of 11 randomized controlled trials and 23 observational studies that compared nurse practitioners (NPs) and physicians providing care showed no differences in health status, prescribing, return patient visits, referrals and quality of care; and

WHEREAS, a meta-analysis[5] of 16 studies found no appreciable differences between physicians and nurses in health outcomes for patients, process of care, resource utilization, or cost. And the same study demonstrated patient health outcomes were similar for nurses and physicians, an increase in patient satisfaction with nurse-led care; and

WHEREAS, a study[6] using HEDIS (Health Employer Data Information System) national benchmarks found that nurse practitioners in six nurse-managed health centers met and often exceeded national benchmarks for treatment of chronic diseases such as hypertension, diabetes and asthma; and

WHEREAS, three studies reviewing patient complications and comparing nurse practitioners and non-nurse practitioner groups demonstrated a moderate level of evidence to support that the nurse practitioners had decreased complication rates;[7] and

WHEREAS, in a review of 69 studies[8] [20 random controlled trials (RCTs) and 49 observational studies] included in outcome aggregation the comparison of nurse practitioner and non-nurse practitioner groups demonstrated a high level of evidence to support equivalent or lower length of stays for patients cared for in the nurse practitioner group[9] and lower cost of care;[10] and

WHEREAS, according to data from the Medical Expenditure Panel Survey (MEPS), the average cost of a nurse practitioner visit is between 20 and 35 percent lower than the average cost of an office-based visit with a non-nurse practitioner;[11] and

WHEREAS, nurse practitioners treat many who are not insured or who have government insurance.[12] Over 88 percent of nurse practitioners accept Medicare patients; over 80 percent of nurse practitioners accept Medicaid patients; and almost 60 percent of nurse practitioners accept charitable, or uncompensated patients; 97 percent of nurse practitioners treat patients the ages of 66 and older;[13] and

WHEREAS, 89 percent of pediatric nurse practitioners report treating children covered by Medicaid; 42 percent of pediatric nurse practitioners indicate the majority of their pediatric patients have Medicaid as their primary coverage; and 74 percent report that they are currently accepting new patients with Medicaid;[14]

WHEREAS, 18 states and the District of Columbia have removed all barriers to practice:

RESOLVED, that the American Federation of Teachers will actively promote and support the removal of barriers that prevent registered nurses and all healthcare professionals from practicing to the full extent of their educational preparation in all states in our union; and

RESOLVED, that the AFT will actively promote and support APRNs as key providers of primary healthcare in our nation; and

RESOLVED, that the AFT will actively promote and support fair and equal employment recognition of nurse practitioner practice in all employment settings where equal services are provided by nurse practitioner and non-nurse practitioner providers through organizing and representing for collective bargaining; and

RESOLVED, that the AFT will actively promote and support fair and equal recognition of nurse practitioner services as providers through payment parity with non-nurse practitioner providers, and legislative efforts to infuse nurse practitioner practice as key contributors of healthcare access to our nation’s citizens in our healthcare system.



[1] Pohl J.M., Vonderheid S., Barkauskas V., Nagelkerk J. "The safety net: academic nurse- managed centers' role." Policy Polit Nurs Pract. 2004; 5:84-94.

[2] Mundinger M.O., Kane R.L., Lenz E.R., et al. "Primary care outcomes in patients treated by nurse practitioners or physicians." JAMA. 2000; 283:59-68. http://www.macyfoundation.org/docs/macy_pubs/JMF_PrimaryCare_Monograph….

[3] Institute for Alternative Futures. Primary Care 2025: A Scenario Exploration. Alexandria, VA. January 2012. Available from http://www.altfutures.org/pubs/pc2025/IAF-PrimaryCare2025Scenarios.pdf.

[4] Horrocks S., Anderson E., Sallisbury C. Systematic review of nurse practitioners in primary care can provide equivalent care to doctors. BMJ. 2002; 324:819-823.

[5] Laurant M., Reeves D., Hermens R., Braspenning J., Grol R., Sibbald B. Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev. 2005; 18:CD001271.
Horrocks S., Anderson E., Sallisbury C. Systematic review of nurse practitioners in primary care can provide equivalent care to doctors. BMJ. 2002; 324:819-823.

[6] Barkauskas V.H., Pohl J.M. Measurement of evidence-based clinical outcomes of nurse- managed health center care. Presented at the 10th Annual National/International Evidence-Based Practice Conference, Glendale, Ariz.: 2009.

[7] Newhouse, R. et al. "Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review" Nursing Economics, CNE Review. September/October 2011 (Vol. 29, No. 5} pp. 1-18, 17.

[8] Newhouse, R., et al. "Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review," Nursing Economics, CNE Review. September/October 2011 (Vol. 29, No. S) pp. 1-18.

[9] ibid., 17.

[10] ibid., 17.

[11] Eibner, C., et al. Controlling Health Care Spending in Massachusetts: An Analysis of Options—analysis by RAND for the Commonwealth of Massachusetts. www.rand.org p99.

[13] ibid., 2.

[14] ibid., 2.

 

(2014)