Advanced Registered Nurse Practitioner Care
Internet Edition, November, 1996, Volume 7, Number 11
Copyright 1996, Nurse Practitioner Support Services
Official Newsletter of ARNPs United

Table of Contents

Inserts Included With Mailed Issue

ARNPs United Board of Directors Meeting October 1996
by Rodie Renn Lasher, Secretary

Meeting was called to order by President Ted Ritter. There was a total of 7 present.

Correspondence included the following letters:

Financial Report: (from annual meeting) $4,600 in General Fund. $1,003 in Lobbying Fund.

Membership Report: Currently have 543 members. 310 are affiliates through WSNA, 65 affiliates through NP specialty groups, 28 individuals, 12 students and 2 lifetime members. Renewal letters are planned within the next couple of months. The renewal date will be on the anniversary of payment of dues. Membership pins are on hold due to cost considerations.

Unfinished Business: It was agreed that we would continue with our affiliation contract with WSNA. Ted will notify them. (WSNA was notified by phone October 24, 1996 and by fax October 28, 1996.)

By-laws: Discussion was led by Chairperson Hazel Fleck. Changes were reviewed and approved. Changes will be presented to the general membership.
(Changes were voted on and passed at the General Membership Meeting.)

Prescriptive Authority: Ted presented the results of the survey. 85% felt we needed to do this and 25% said they were willing to help with time and/or money. Gail McGaffick, Lobbyist, presented the legislative agenda and all were in agreement. She also presented a budget for moving forward with the prescriptive authority issue. We will need additional funding of $1,100.00/month during the legislative session for her to do the job. It was decided that we would present this to the body tomorrow night and that will determine our direction. (General membership voted to proceed with this.)

Presidential Authority: The authority of the President was discussed. This President is to make decisions in the best interest of the organization. S/he may consult with members of the board as necessary or bring the issue to the board at a meeting. We will improve communications through e-mail, fax, letters and phone calls.

Secretarial Reports: A discussion of the duties of the Secretary concluded that summaries of the meetings will be submitted to ARNP Care and that the minutes of the meetings will be compiled and distributed to the board members and affiliate representatives in a timely manner.

New Business

Elections: Hazel nominated Rodie Renn Lasher for Secretary. Motion seconded and carried. We still need nominees for Board representation of WHCNPs and GNPs. Volunteers will be sought at the annual meeting. CNM position is not up for election and an appointee will be selected to complete the remainder of the CNM term.

ACNP Survey: We agreed to support the American College of Nurse Practitioners in their survey. There will be no cost to ARNPs United for this.

Annual Meeting: Discussed the details of the annual meeting and conference.

The meeting adjourned at 5:00 pm.

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

Every fall, the Legislative Committee for ARNPs United (AU) holds a Saturday retreat to establish a legislative agenda. It's based on the “intelligence” we've been able to gather about what may be coming at us during the next session, as well as AU's priorities. Issues are divided into three categories: 1) support, 2) oppose, and 3) monitor. The Legislative Committee's recommendations are presented both to the Board, and the membership at the annual meeting for their approval. As this publication is going to print, we've just completed this process. In this issue is a summary of the key provisions of the legislative agenda.

In addition AU, through its Legislative Committee, monitors all other legislation that will be introduced during the 1997 session that impacts ARNPs practice.

Completion of Prescriptive Authority
by Tracy Lin, ARNP and Gail Toraason McGaffick, JD

Completion of prescriptive authority for ARNPs headlines the agenda. As you all know ARNPs are currently authorized to prescribe legend drugs and Schedule V controlled substances. The only exception are CRNAs that are allowed to work under facility-specific protocols to select, order and administer Schedules II through IV.

The proposed legislation would allow all ARNPs to prescribe Schedules II through IV. As many of you know, this legislation is long overdue. Perhaps that's why an overwhelming majority of 85% of ARNPs responding to a survey believe it is important for ARNPs to have full prescriptive authority.

In addition to the support of ARNPs, it would also appear that physicians believe this is important. No, we haven't received an endorsement from the Washington State Medical Association (WSMA). However, we have been made aware through The Nursing Commission Newsletter, Summer 1996, that physicians are giving nurse practitioners pre-signed prescription blanks. While this practice is not legal and can subject both the nurse practitioner and physician to disciplinary action, it does demonstrate that the current system is not workable. Clearly, physicians are indicating through their actions that nurse practitioners are competent to prescribe all scheduled drugs. This provides a positive legislative environment in which to update the law.

A lot of work needs to be done between now and the legislative session, as well as during the session, if we're to accomplish our goals. In addition, early contact with the WSMA indicates that there will be strong opposition to this legislation.

Please see related articles in this issue about legislative activities. One of the inserts requests your help in our legislative effort. Please take a moment to review it. Remember we do need your help!

Finally, a few words about the 1997 legislation session. It starts on January 13 and lasts 105 days. It's almost twice as long as the 60 day session in even numbered years, because it's the budget year for the 1997-99 biennium. Normally, the Legislature takes a “little” longer than 105 days to decide about budget issues. We'll have to wait and see whether 1997 is the norm or exception to the rule.

As always, if you have questions, you may reach Tracy at tlin@wolfenet.com or 206-759-9640 or Gail at mpwrmnt@aol.com or 360.754.7266.

Legislation To Support

Legislation To Oppose

Legislation To Monitor

Legislative Grassroots Meeting

The Legislative Committee is planning a Saturday grassroots training/meeting in late November or early December. During the meeting information will be presented about how to establish effective relationships with your legislators and how to advocate for completion of prescriptive authority. Please contact Tracy Lin at tlin@wolfenet.com or 206.759.9640 to indicate your interest in attending. We need your help!

NP Publications

For ARNPs who are seeking a general prescribing guide that is geared toward nurse practitioners, there is a quarterly publication called the Nurse Practitioners' Prescribing Reference. For more information about obtaining the reference, contact: Circulation Department, Prescribing Reference, Inc.; 53 Park Place, New York, NY 10007-2407.

Newsline for Nurse Practitioners is a monthly mini-journal that contains short articles related to Nurse Practitioner practice around the country. It also is described by more than one NP as a good resource for job opportunities for NPs seeking relocation. It can be obtained free by calling 610.337.1050 or faxing a request to 610.337.1049.

Botanical Preparations
by Susan Caverly

In the past few weeks there have been a number of pieces of information about herbal preparations, safety and the process of gathering information and literature regarding safety and use guidelines. It has been proposed that the Medline search key words that are most helpful in such searches include: subject = disease or diagnosis; textword = Chinese and medicine or acupuncture or therapeutic and touch etc. For herbal medicine information it may be worth reviewing the German literature carefully and for homeopathic literature, consider a focus on British, French or Indian sources.

In the September 1996 edition of the University of Washington Medical Center\Harborview Medical Center Drug Therapy Topics, an article adapted from a lecture by Ms Peggy Brevoort, past president, American Herbal Products Association; CEO East Earth Herb, Inc at the USP Open Conference on botanicals for Medical and Dietary Use, July 7, 1996, Washington DC listed the following herbs as either "considered safe/effective by non-US regulatory authorities, or unsafe or otherwise unfit for human consumption. Those considered safe include: Chamomile, Echinacea, Feverfew, Garlic, Ginger, Ginkgo, Saw palmetto, Valerian, and Ginseng.

Those considered unfit for human consumption include: Borage, Calamus, Chaparral, Coltsfoot, Comfrey, Ephedra; Ma-huang, Germander, Licorice, Life root, Pokeroot, and Sassafras.

In addition, the Medical Letter (November 24, 1995) cited that 4 of 6 melatonin products obtained from health food stores "contained impurities that could not be characterized". This highlights the degree of uncertainty that exists when natural “food” products are used for medicinal purposes. However, the media attention to such products increasingly presses practitioners to acquire some minimal knowledge regarding the use and kinetics (if known) of common herbal remedies. The health care consumer is using these substances, often without appropriate education or advice, therefore it is important that we convey willingness to at least consider the potential side effects or drug interactions that potentially occur in relation to the allopathic drugs that are prescribed.

Increasingly, researchers are showing interest in evaluating traditional remedies. The future is likely to be quite interesting!

Well Well WellNet
by Alan Brown

WellNet is an Integrated Delivery System of Primary Care Providers (MD, DO, ARNP, PA and Alternative Health Care Professionals) with an emphasis on disease management, prevention, rehabilitation, wellness activities and integrating Services.

WellNet's main goals are to capitalize on the paradigm shift occurring in the health care industry, from treatment to prevention and to bridge the gap between traditional and alternative health care.
In Phase I of this pioneering effort, we are expanding our PCP directed multi-disciplinary clinic sites throughout the state of Washington. At the same time we are building a provider network for consumers, corporations, employer groups, insurance companies, managed care, self-insured and fee for service contracts.

The health care industry is going through major changes; with change comes opportunity. WellNet is poised to take advantage of this unique opportunity.

Under the new Washington State Law enacted in January 1996, insurers are now required to permit “every category of health care provider to provide health services of care.”

Most insurance companies and health care plans have implemented the use of a “Primary Care Provider (PCP) or gatekeeper system,” where health care providers outside of their system will require a referral by a PCP who is within the network.

Another change in the law, effective June 1996, now permits individual health care professionals to form professional services corporations or limited liability companies for the purpose of delivering a spectrum of health care services. WellNet is a PLLC (professional limited liability company). “Limited liability” implies that professional liability lies with each professional who has had direct contact with the client; it will not effect other associates in the same group.

WellNet's Provider Network consists of qualified and credentialed health care professionals: Primary Care Providers, Chiropractors, Naturopaths, Nutritionists and Dietitians, Wellness Nurses, Physical Therapists, Massage Therapists, Acupuncturists, Medical Exercise Therapists and Fitness Facilities.

WellNet is the first “vertically integrated” health care network in the country building bridges between Naturopathic and Allopathic Medicine. The time is right and the opportunity is now.

For further information about WellNet, please contact our Medical Director, Dr Nass Ordoubadi at 800.861.6556.

Editors Note: Alan Brown is employed by WellNet.

Classified Ads

Psychiatric Mental Health NP and Psychiatric RN

Central Washington Comprehensive Mental Health in Yakima, WA seeks a full time ARNP and/or a Psychiatric RN to be a member of the Adult and Geriatric Team. To provide mental health services to the geriatric community. Minimum 5 years outpatient geriatric experience required for the RN position only. Please call 509.575.3894 to request an application. Please include resume and salary requirements. EOE/ADA. Central Washington Comprehensive Mental Health, Yakima Main Office, 321 E Yakima Ave, Yakima, WA 98901.

Pediatric or Family NP

Harborview Sexual Assault Center seeks 3 pediatric or family nurse practitioners for occasional weekend and night call. Physical exams for children and teens presenting for sexual assault exams. Instruct and oversee pediatric residents in appropriate care by telephone and in person. Basic gynecology skills required. Training provided in pediatric gynecology, colposcopy and forensic evidence collection. Contact: Naomi Sugar, MD at 206.521.1800.

Continuing Education

Pharmacotherapeutics for ARNPs

December 6, 1996. Location: LaQuinta Inn, 1425 - 27th St East, Tacoma, WA. A variety of pharmacotherapeutic topics of interest to all ARNP specialties will be presented in general and concurrent sessions. Contact Pacific Lutheran University CCNL, phone: 206.535.7683, fax: 206.535.7590, E-mail: ccnl@plu.edu

Masters of Science in Nursing & Post-Masters NP Pathways in Family & 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

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