HHS Announces New Opportunities for APRN Training

August 1st, 2012

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By , BSN, RN

Opportunities to train as an Advanced Practice Registered Nurse (APRN) multiplied this week as U.S. Secretary of Health and Human Services Kathleen Sebelius announced the recipients of a $200 million grant.

"With this important initiative, we are putting more advanced practice nurses on the front lines of our health care system and further strengthening and growing our primary care workforce," Sebelius said in a statement.

Sebelius announced the Graduate Nurse Education Demonstration at Duke University Hospital in Durham, one of five hospitals across the country selected to receive the funding.

The other four hospitals are: Hospital of the University of Pennsylvania in Philadelphia; Scottsdale Healthcare Medical Center in Scottsdale, Arizona; Memorial Hermann-Texas Medical Center Hospital in Houston, and Rush University Medical Center in Chicago.

The five hospitals will share the estimated $200 million in federal funding to help train additional APRNs the Department of Health and Human Services (HHS) announced on Monday. The money will be spread over four years and is provided under the Affordable Care Act (ACA).

This announcement comes amid growing concern that the demands of healthcare reform and the Affordable Care Act (ACA) will exceed the ability of primary care practitioners to meet those needs.

Hospitals in the program must partner with accredited schools of nursing in their area. As a condition of participation each hospital has committed to support nurse training in nonhospital settings such as community health centers and rural health clinics. "This program will bring talented nursing students into five communities that have a real need for additional primary care and healthcare access," Sebelius said.

Duke Medicine expects to double the number of advanced practice nurses it trains under the initiative. By 2016, 216 additional students are projected for enrollment.

"The complexity of the challenge to make care more accessible and affordable, while enhancing quality, is exacerbated by the continuing decline in the number of primary care physicians and the expected influx of patients into the healthcare system as a result of health care reform," said Victor J. Dzau, M.D., president and chief executive officer of Duke University Health System, in a news release. "We are proud to be a part of this important effort to help solve this problem."

The funding will cover as many as 400 additional over the next four years, said Nancy Busen, assistant dean of the University of Texas Health Science Center at Houston’s School of Nursing.

UTHSC-SON, along with nursing schools at the University of Texas Medical Branch in Galveston, Texas Woman's University in Houston, and Prairie View A&M University, will handle the academic component, while Memorial Hermann provides clinical training.

APRN Areas of Practice

"Having more of these kinds of skilled nurses will increase access to essential healthcare services," Sebelius said during the press conference.

There are four different specialties associated with APRNs:

  • Nurse AnesthetistsNurse Anesthetists administer anesthesia to patients in collaboration with anesthesiologists, surgeons, dentists and other qualified health care professionals. As advanced practice registered nurses, CRNAs practice with a high degree of autonomy. CRNAs are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals. They have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI, including current conflicts in the Middle East.
  • Nurse MidwivesNurse Midwives provide counseling and care during preconception, pregnancy, childbirth, and the post-partum period. Nurse Midwives also provide family-centered primary healthcare to women throughout their reproductive lives. Skilled midwifery can reduce the need for high-tech interventions for most women in labor, but midwives also are trained in the latest scientific procedures to assist in normal deliveries. CNM-attended births account for 10% of all spontaneous vaginal births in the US, and 7% of all US births in total. Of these deliveries, 97% occur in hospitals, 1.8% in freestanding birth centers, and 1% at home.
  • Clinical Nurse Specialists – A clinical nurse specialist (CNS) is an advanced practice nurse who also assists with specialized research, education and advocacy. In addition to being Registered Nurses, Clinical Nurse Specialists also have earned an MSN and completed additional CNS certification for their respective area of expertise. Clinical Nurse Specialists are, as the name implies, trained and educated in a particular medical specialty. For example, a CNS of psychiatry would be highly trained in the treatment of psychiatric patients. A CNS of psychiatry may assist with clinical trials, and hold informational or educational meetings for psych patients and their families or other psychiatric nurses. Additionally, the CNS for psychiatry may assist in developing nursing protocols or quality improvement methods within the psychiatric department of a hospital. Clinical Nurse Specialists are found in areas as diverse as oncology, cardiology, infectious disease and many more.
  • Nurse PractitionersNurse Practitioners (NPs) are registered nurses with advanced degrees and clinical training who provide preventive and acute health care services. NPs take health histories and provide complete physical examinations; diagnose and treat many common acute and chronic problems; interpret laboratory results and X-rays; and prescribe and manage medications and other therapies. NPs provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance and refer patients to other health professionals as needed. Nurse practitioners are also in very high demand in rural areas. Primary care providers of any kind are frequently scarce, and much of the rural U.S. has no primary care providers at all. In many states NPs practice independently and are legally allowed to prescribe medications. Laws regarding nurse practitioners vary widely and in some states NPs are required to practice under the supervision of a physician, and must have a licensed physician to sign off on their work.

APRNs can diagnose illnesses, prescribe medications and treatment regimens, and perform procedures consistent with their scopes of practice.

Hospitals Reimbursed

According to the program description, the Centers for Medicare & Medicaid Services will provide reimbursement for the "reasonable cost of providing clinical training to APRN students added as a result of the demonstration." Payments will be linked directly to the number of additional APRNs trained and will be calculated on a per-student basis, comparing previous enrollment levels in APRN training programs with enrollment under the demonstration.

It is hoped that the program will relieve some of the barriers experienced by hospitals and colleges in providing APRN training. Last year nursing schools were forced to turn away more than 14,000 qualified APRN applicants, according to Polly Bednash, PhD and RN, CEO and executive director of the American Association of Colleges of Nursing, who attended the program announcement.

The primary reasons were the lack of clinical sites and budget cuts, explained Bednash, who added that the demonstration program addresses those specific concerns.

that the Obama administration has earmarked for nurse training, education, and job placement.

The academic portion of the program will begin this fall.

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