Advanced Registered Nurse Practitioner Care
Internet Edition, May, 1996, Volume 7, Number 5
Copyright 1996, Nurse Practitioner Support Services
Official Newsletter of ARNPs United

Table of Contents

Legislative Update

by Tracy Lin, ARNP, and Gail Toraason McGaffick, JD

Welcome to the “interim.” The “interim" is the time period between legislative sessions. While Washington technically has a part-time Legislature, in reality legislators work all year long. When the Legislature is not officially in session, this work takes the form of interim studies that are conducted by the various standing committees. The results of these interim studies may be the subject of legislation in 1997. Articles in this newsletter will briefly highlight some of the interim studies being undertaken by the Legislature that are of interest to ARNPs United.

Each of the studies noted below will be monitored through the Legislative Committee. If you would like to participate with the Legislative Committee in monitoring one of these studies, your help would be most appreciated. It's not necessary to attend meetings. If interested, please contact Tracy Lin, at 206.383.5777 Ext. 326.

Editors note: Gail Toraason McGaffick is the ARNPs United contract lobbyist. Tracy Lin is the chair of the ARNPs United Legislative Committee.

Senate Health and Long-Term Care Committee

Insurers' liability for insureds' medical outcomes. This deals with Wickline clauses that are frequently being included in provider contracts. These clauses attempt to shift responsibility for liability from the plan to the provider when the plan elects to deny treatment. This has been very troubling to provider groups, including ARNPs United, and the Committee will review this issue to determine if legislation is needed. (Legislation introduced in both 1995 and 1996 to deal with this issue failed due to insurer opposition.)

Teen pregnancy, STD prevalence and prevention. The Committee recently held a hearing collecting information on these challenging topics.

End-of-life care and decision making, and bioethics. These studies are being driven by recent court decisions that have overturned laws prohibiting aid in dying. We are uncertain whether the Legislature will be recommending any changes.

Medicaid reform. The Committee will closely track Congressional action.

Drug addicted infants. The Committee will examine the resources available to these children and how to reduce the number of infants born with these problems.

Workplace violence. This issue was the subject of legislation in 1996 that was not enacted into law. The Committee will revisit this topic to develop a viable approach to preventing workplace violence.

Certificate of need. This program is currently under review by the Department of Health to determine if changes are needed. The Committee will be monitoring the Department's work.

Nurse delegation. The Committee will monitor the implementation of nurse delegation. WSNA is the lead on this issue.

Individual insurance market crisis. Rates continue to rise for those insured in the individual market. The 1996 Legislature could not come to consensus on a solution. The Committee will monitor the work of the Health Care Policy Board as they attempt to solve this crisis.

Trauma care. In 1996, a statewide trauma care system went into effect. The Committee will be monitoring whether this system is working equitably.

House Health Care Committee

Similarly to the Senate, the House is also studying issues related to the individual health insurance market, Medicaid reform, trauma care, nurse delegation, and certificate of need. In addition, the Committee will focus on the following:

Utilization review. The Committee will review proposals developed by the National Association of Insurance Commissioners, and others to determine appropriate policy for Washington's health care system.

Uniform health information act. This law governs confidentiality and disclosure of patient records. In its current form it is inconsistent with other state statutes relating to mental health, alcohol and substance abuse programs, and STP/HIV/AIDS laws. The Committee will explore whether changes in this act are needed.

Health carrier description, classification. Our health care delivery system has changed dramatically, and we no longer have laws that relate specifically to the new types of carriers being formed. The Committee will review whether the laws need to be updated to reflect these changes.

Sunrise reviews. The Department of Health is conducting several sunrise reviews, including one to determine if surgical assistants should be registered, and another to determine if optometrists should be allowed to inject therapeutic drugs. The Committee will monitor the Department's work.

Telemedicine. In the age of information, this is a "hot" topic. The new technology is viewed as one way of making health care more accessible to rural areas. However, it brings with it questions related to confidentiality of medical records, provider accountability, etc. The Committee will determine if legislation is needed.

Prescriptive Authority Benefit

by Sally Plumly

It was an “Afternoon Delight!” A sunny, spring afternoon in an elegant `50s Deco Tacoma home with music, fine wine, great coffee, delectable desserts, a breathtaking view, and informal conversation on the issue of concern. Ticket proceeds and donations totaled $3000, which will be invested in prescriptive authority completion. Thanks to all who participated in presence and proceeds, especially to Martha Herriott for the inspiration, fine wine, and lovely place.

Editors note: Article reprinted by request from the AAPPN newsletter.

WSNA

ARNPs United and WSNA now have a working agreement. In lieu of any direct financial support from WSNA, ARNPs United is receiving staff support time. We are pleased with the progress that has been made.

Legislative Day Wrap-up

by Ted Ritter, ARNP

At the February, 1996 ARNPs United Board Meeting there was a long discussion about the most recent Legislative Day sponsored by WSNA. We are asking feedback from those of you who were able to attend so that we may begin planning for next years event. What were your perceptions of the event? Did you feel that your concerns were addressed appropriately? Is there a better way to present ourselves to our legislators? Should we continue to participate with WSNA or shooed we have our own session? What were your reasons for attending, and equally important what were your reasons for not attending?

We are anxious to hear from you so that we can have the most effective Legislative Day possible next year. Please contact me directly at home: 206.788.6308, work: 206.788.6888, or via fax: 206.788.8326.

Update On The Sound Health Saga

by Suzan Watanabe

Sound Health continues to drop or deny from their health plan any ARNPs who are not employed by physicians. ARNPs United has written two letters to the Medical Director, Fitz van Passchen, MD, requesting an explanation for this action. We have received no response to either letter. The first, dated February 14, 1996 was copied to Senator Quigley, Representatives Campbell and Dyer and the Insurance Commissioner, Debra Senn. The second letter was copied to the Board of Directors of Sound Health as well. ARNPs United will continue to pursue this matter.

Core Competencies

by Susan Caverly

As many nurse practitioners are aware, there has been a history of disagreement between the traditional certifying bodies and the National Council of State Boards of Nursing (NCSBN) regarding the process by which nurse practitioners become certified. In August of 1994, the NCSBN announced intent to explore development of a generic core competency examination for nurse practitioners. Certifying bodies were invited to make proposals for such an examination to the NCSBN. In response, the organizations jointly dissented on the basis of the following:

Among the concerns historically expressed by the NCSBN has been the psychometrics of existing certification examinations. A resolution made in August 1995 provided for the NCSBN to collaborate with nurse practitioner specialty certification organizations to make "significant progress toward legally defensible, psychometrically sound nurse practitioner examinations which are sufficient for regulatory purposes...that if at any time, the Board of Directors determines that significant progress is not being made, the Board is authorized to conduct a job analysis of entry level nurse practitioners." a formal review process would be implemented in such an event.

The process of collaborative work stopped on March 25, 1996 when the NCSBN stated that an impasse had been reached between the Board and the certifying bodies. Four days later, the Board announced a "task analysis" and published a Request for Proposals to develop a task analysis for a generic core competency examination and specialty examinations. Specialty examinations specifically named adult, family, geriatric, neonatal, pediatric, psychiatric/mental health, school, women's health and acute care nurse practitioners.

This RFP followed a January 22, 1996 written statement that "the National Council is not looking to become involved in preparation of any examination for nurse practitioners." The dissonance between action and statement have led the certifying organizations to conclude that the NCSBN has not been completely open in the negotiation process, and has not negotiated in good faith.

Thus, the four primary certifying bodies, the American Nurses Credentialing Center, the American Academy of Nurse Practitioners, the National Certification Board of Pediatric Nurse Practitioners and Nurses, and the National Certification Corporation for Gynecologic and Neonatal Nursing have issued a Call to Action:

"The State Boards of Nursing need to hear your opposition to this unnecessary additional regulatory barrier to nurse practitioner practice. It is imperative to take the time to contact them since constituency views often carry more weight than those of third parties. Questions regarding this issue may be addressed to any of the four certifying bodies listed below."

The AACNP: 202.966.6414
The ANCC: 202.651.7259
The NCBPNPN: 301.340.8213
The NCCGNN: 312.951.0207

It is essential that nurses and nurse practitioners contact the Washington Nursing Quality Assurance Council prior to August 5, 1996. At that time the NCSBN will meet in Baltimore. Write or call Patty Hayes the acting Executive Director of the Council, and the ARNP representatives on the Council. Tell them your opinion regarding the proposed plan for a core competency examination. If you are opposed tell them. Also, contact your State legislators to inform them of any concerns you may have regarding such a regulatory action. If you are opposed encourage them to intervene in the process as it unfolds in Washington State. Contact your colleagues, employers and nurse educators to apprise them of the history of current events with regard to this issue. Finally, work with your professional organizations at the State and National level to provide collective response to legislators, the governor, and the Council. Washington State Nursing Quality Assurance Commission: 360.753.2686.

Of Interest

Good Reading

submitted by Susan Caverly, ARNP

For a "Good Read" the editors of ARNP Care recommend an article by Nancy Sharp in the March 1996 Nurse Practitioner Journal entitled: Nurse Practitioner Reimbursement: History and Politics, Vol 21, No.3.

As a new service, we encourage you, our readers, to share useful and interesting news. This article is just one example. Please jot down a note or an E-mail if you find something that you think no one should miss! We will diligently attempt to publish your recommendations in the next issue with available space! Not everyone has time to read all the journals, this option for sharing pearls has potential to help us all stay current in both practice and policy arenas, but we need YOU to participate!

Classified Ads

Geriatric/Family NP

GNP or FNP with 5+ years of experience caring for adults and older adults; part time to full time position available; competitive base salary with production based salary incentives; benefits - full medical/dental, CME stipend, pension plan. This position is in a high quality, busy and exciting Internal Medicine practice, affiliated with Highline Medical Group and Highline Community Hospital in South Seattle. Inquiries call 206.244.9481 or fax CV to 206.431.3939.

Adult Nurse Practitioner

Kaiser Permanente has an excellent opportunity for an experienced Adult Nurse Practitioner to join the Department of Internal Medicine at our East Interstate Medical Offices in North Portland. We offer a competitive salary and flexible benefits package, which includes family medical/dental, two pension plans, TSA, CME, malpractice coverage and more. Please refer to position #9601694 and send resume to Judy Parmenter, Kaiser Permanente, 500 NE Multnomah, Suite 100, Portland, OR 97232-2099. EOE.

Family Nurse Practitioner

Family practice in rapidly growing community seeks full-time and part-time colleague with strong interest in female/child health care and/or sports medicine. Personality important. Experience preferred. First-class environment. Send resumes and salary requirements to: Village Family Medicine, 450 NW Gilman Blvd, Suite 105, Issaquah, WA 98027 or phone: 206.391.8645.

Planned Parenthood ARNP

Planned Parenthood of Western Washington is seeking an outstanding clinician to work on a per diem basis in our Centralia, Shelton and Olympia clinics. We are a progressive, non-profit organization with 17 clinics; one of the largest providers of reproductive health care in the state. Position requires current WA State RN & ARNP (WHNP, FNP, ANP or CNM) licenses. Please mail CV/resume to PP/HR, 2211 E Madison, Seattle, WA 98112. EOE.

Adult/Geriatric NP

Kaiser Permanente, one of the most successful managed care programs in the country, has a full time position available in Portland, Oregon, for a certified NP in our Continuing Care Services Department. Our new NP will work a multidisciplinary team in the direct care management of our frail elderly patients in area nursing facilities. Experience in Geriatrics preferred. Competitive salary and benefits including family medical/dental, life and disability insurance, two pension plans, TSA's, continuing education allowance, assistance with relocation and more. Forward resume to: Judy Parmenter, Professional Staff Recruiter, Kaiser Permanente, 500 NE Multnomah, Suite 100, Portland, OR 97232-2099 or call 800.813.3762. EOE.

Continuing Education

The INTERNET: New Dimensions for Health Care

June 1, 1996. Providence General Medical Center, 14th & Colby Ave - Colby Campus, Everett, WA. Pending Approval 6.8 CEUs for nursing and approved for 6 hours CME (category II). Through this conference, participants will be able to describe how the Internet works, describe how to connect to the Internet, search for healthcare resources on the Internet, identify the impact of the Internet & the corporate intranet on healthcare professionals. Your speakers: Bob Baxter RN, CNOR & Janet Regan RN, CNOR, are familiar with Mac & PC platforms. Both have vast experience "cruising" the Information Superhighway. Registration: $55 if postmarked by Friday, May 3rd, $65 for later registration. Make check/money order payable to "AORN of Pacific Cascade" Mail to: PLANNING CHAIRMAN, 7324 - 48th Ave W, Mukilteo, WA 98275. Direct questions to 206.347.0582.

Mood Disorders 1996: An Update for the Primary Care Clinician

June 21, 1996. This conference will enable primary care physicians to recognize and initiate treatment of the major mood disorders as they present in the primary care setting. Topics related to DSM IV diagnostics, pharmacological management, psychotherapeutic modalities, differential diagnosis of medical vs. psychiatric disorders, pain management and others. Location: Westin Hotel, Seattle, 8:30 am-5:15 pm. Speakers: John Wynn, MD, David Tauben, MD, Doron Raphaely, MD. CE credits of 8.6 contact hours is pending through WSNA. Of the 8.6 total hours, 3.3 are in the category of pharmacology. For information, contact Orca Healthcare Resources, 1717 16th Ave, #6, Seattle, WA 98122 or phone: 206.328.9416

Assoc of Reproductive Health Professionals' Annual Reproductive Health `96

November 14-17, 1996. Location: Nashville, TN at the Stouffer Renaissance Hotel. This meeting will be held in conjunction with Planned Parenthood Federation of America and cosponsored by the National Association of Nurse Practitioners in Reproductive Health. Sessions focus on interaction of AIDS and other STDs, diagnostics and the consequences of STDs, contraception, cancer prevention and detection, pregnancy management and the latest in primary care therapies. The method will be lecture style. ARHP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The credit hours earned will be in Category One of the Physician's Recognition Award of the American Medical Association. All sessions are also approved by ACNM and CNM for accreditation.

3rd Biennial Clinical Women's Health in the Perimenopause `96

November 22-24, 1996. Location: Amelia Island, FL at the Ritz-Carlton. Sessions focus on contraception and cancer, practical guidelines for evaluation, diagnosis and treatment of disorders common to the midlife woman. Nationally respected speakers will discuss the latest research, future trends and public policy. The method will be lecture style. ARHP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The credit hours earned will be in Category One of the Physician's Recognition Award of the American Medical Association. All sessions are also approved by ACNM and CNM for accreditation.

Basic Colposcopy Training, Advanced Colposcopy, Endometrial Biopsy, IUD Insertion Training, Vulvar and Vaginal Lesion ID Course, Gynecology Review and LEEP/Cryo Training Seminar. CME Solutions, LLC has been approved as a provider by the Washington State Nurses Association. Contact hours are available for every course. Call Karen Taylor at 206.865.9005 for dates and location. Fax: 206.865.0616.

Masters of Science in Nursing & Post-Masters NP Pathways in Family and Adult/Gerontology

Earn your Master of Science in Nursing degree at Seattle Pacific University in our evening and weekend program. The MSN Program is a full (one year) or part-time (two year) program meeting one night a week and three Saturdays per quarter. Flexible packaging of courses and individual tailoring of your MSN degree are only a few of the benefits of SPU's Master of Science in Nursing Program. We also have master-post masters NP Pathways in Family and Adult/Gerontology. For more information, visit our web site at: http://paul.spu.edu/, call 206.281.2888 or 800.899.1769, write 3307 Third Ave West, Seattle, WA 98119 or E-mail us at: msninfo@spu.edu

Clinical Pharmacology Series 1996

A series of six one-day courses (8 hr sessions) is designed as a pharmacology update for NPs working in a variety of specialties, including Neonatal, Pediatric, Geriatric, Adult, Women's Health and Neuropsychotropic Drug Therapy. Sponsored by the U of W School of Nursing. For further information, please contact Sheila Keener at 206.543.1047.

Editorial Information
ARNP Care Office
212 Railroad Ave N, Kent, WA 98032
206.852.9042 Fax 206.480.0002
care@nurse.net

Editors:
Susan Caverly, MA, ARNP
Robert T. Smithing, MSN, ARNP
Madeline D. Wiley, MSN, ARNP 		Production Staff:
Melanie Finley, Kelly Libby, &
Pete Mullin
Contributing Editors:
Ted Ritter, MN, ARNP 		Publisher:
Nurse Practitioner Support Services

Ad Information

Copy deadline is the second Tuesday of the month prior to publication. Ads may be accepted later then this on a space available basis. Position Available Ads per insertion of less than 66 words are $45, of 66 to 130 words are $75. Continuing Education Announcements per offering for up to three (3) insertions of a BRIEF description are $35, sponsoring organizations of ARNPs United may publish CE announcements at no charge. New Product Announcements per product for one insertion of 130 words or less are $75. Ad Inserts are $480 for one issue. All ads are subject to space limitations and editing. Call for detailed rate information. Mail copy to ARNP Care, 212 Railroad Ave N, Kent, WA 98032. Phone 206.852.9042. Fax 206.480.0002. E-mail care@nurse.net

Please Join Us

You may believe that because this newsletter arrives every month you are a member of ARNPs United. That is wrong. Since 1989 ARNP Care has been sent to every ARNP in Washington regardless of membership status. This is in imminent danger of stopping due to a lack of funds. Remember the number of members is what makes an organization strong and credible with the legislature and others. So join us today. Individual memberships are $150 per year. Lifetime memberships are $1000. Student currently enrolled in a ARNP program may join for $50 per year. Make your check out to ARNPs United and mail it to: ARNPs United, 212 Railroad Ave N, Kent WA 98032.

Member Thank You!

Thank you for being one of the ARNPs in this state who have joined ARNPs United. Without your support it would not have been possible to have hired a lobbyist and had such a successful legislative session in 1995. It is also clear that without your support the organization would not have been capable of moving forward in developing a solid framework to build on the grassroots efforts of the ARNPs in this state. ARNPs who are not members of ARNPs United have received ARNP Care printed on lavender paper to let them know they are not members.

Nurse Practitioner Support Services
212 Railroad Ave N, Kent, WA 98032. Phone: 253.852.9042 Fax: 253.852.7725
npss@nurse.net
Copyright 1998 Nurse Practitioner Support Services