Arizona Nurse Edition 17 : Page 6

From the board President KATHy MALLOCH, PHD, MBA, RN, FAAN Scope of Practice: Challenges for the future As the world turns, so too does the scope of practice for cli- nicians. New evidence, increasing technology, less than accept- able quality and a very costly healthcare system necessarily require professionals to review and revise scopes of practice to assure that the licensed groups are meeting the needs of society. Recent discussions have addressed shifting account- abilities specific to the scope of the medication technician, the registered nurse, and the advanced practice nurse. As the needs of the population increase, new advances and evidence emerge, and evaluations are implemented, more challenges to shift the scope of care-giving practices across the continuum will emerge. As most of us know or have experienced, the discussions about shifting scope often begin quite benignly, and then move quickly to issues of turf and concerns about patient safety. Consider the medication technician role evolution. Concerns about safe medication administration from non-licensed, minimally trained caregivers arose quickly. Medication admin- istration was the purview of the licensed registered or practi- cal nurse. Yet, the community need for the administration of routine medications in residential facilities and skilled nursing homes was significant and not always being met. Personally, I struggled with this recommendation. I could not support medi- cation administration by a non-licensed person. I didn’t have any evidence, it just didn’t feel right; and I truly believed it was not a safe practice. In spite of my feelings, the plan to pilot the use of a carefully crafted medication technician role went forward. It was during the pilot testing phase that my dad was a resident in a nursing home. For over four years, I watched the licensed practical nurse administer the same five medications in the morning and the same four medications in the evening. There was no need for a licensed nurse to be doing this techni- cal, repetitive task – my dad needed licensed nurses to observe, support and assure an effective plan of care was in place. I soon became a strong supporter of the medication technician based on observations and outcomes over a four year time span. This fresh look at patient care at the point of service events provided new information so that I am now able to support for the shift in the scope of practice from registered nurses to medication technicians. The issues of scope change are not limited to the nursing discipline. Issues with providers (nurse, physician, naturopath, podiatrists, and optometrists) are also increasingly common. In a recent publication of The American Medical Association, efforts to push back on expansions of scope of practice (http:// www.ama-assn.org/amednews/2010/01/18/prl20118.htm) and hopes to protect physician practice scope as the means to patient quality were noted. Questions such as these are posed regularly: • Should optometrists perform surgery and prescribe medica- tions? 6 arizona STATE BOARD OF NURSING RegulatoRy JouRnal • Should naturopaths become licensed? • Should chiropractors perform invasive procedures? Can they perform manipulations under anesthesia? • Who should diagnose, treat and manage pain? • Who should be able to do invasive procedures, prescribe medications, diagnosis and treat, patients with chronic pain? The American Medical Association has recommended model legislation for states to establish scope-of-practice review pan- els to evaluate plans by non-physician health professionals who wish to expand their practice. The panels would be composed of various regulatory board officials, university experts and other health care advisers to help lawmakers understand the underly- ing medical, educational and public interest considerations. Hopefully, such panels would include all of the regulated pro- fessions providing patient care and not be limited to physician providers. Nurses, pharmacists, psychologists, chiropractors, therapists and naturopaths all have good input for this impor- tant discussion. The challenges to scope should not be viewed as anomalous events; rather scope analysis should be an ongoing discussion among colleagues providing patient care. None of us should shy away from the need for healthy dialogue. As new ideas are proposed, I would hope that each professional consider the fol- lowing questions about the proposed changes AND the resis- tance being encountered. 1. How widespread is the issue that is being addressed by the proposed scope change? 2. Is there evidence to support the change in other states? 3. Will the change increase access to care? 4. Will the change increase the quality of care? 5. How will the cost of care be affected? 6. How will the proposed change be integrated into the cur- rent scope of practice? Is there education in nursing pro- grams (or whichever discipline is involved) currently? 7. Is the change consistent with the principles of the practice act? For sure, scope of practice will be forever challenging for all health professions as the new evidence emerges and the needs of society change. Thanks again for the opportunity to serve as your president. Kathy Malloch, PhD, MBA, RN, FAAN Board President

From the Board President

Scope of Practice: Challenges for the future As the world turns, so too does the scope of practice for clinicians. New evidence, increasing technology, less than acceptable quality and a very costly healthcare system necessarily require professionals to review and revise scopes of practice to assure that the licensed groups are meeting the needs of society. Recent discussions have addressed shifting accountabilities specific to the scope of the medication technician, the registered nurse, and the advanced practice nurse. As the needs of the population increase, new advances and evidence emerge, and evaluations are implemented, more challenges to shift the scope of care-giving practices across the continuum will emerge. As most of us know or have experienced, the discussions about shifting scope often begin quite benignly, and then move quickly to issues of turf and concerns about patient safety. Consider the medication technician role evolution. Concerns about safe medication administration from non-licensed, minimally trained caregivers arose quickly. Medication administration was the purview of the licensed registered or practical nurse. Yet, the community need for the administration of routine medications in residential facilities and skilled nursing homes was significant and not always being met. Personally, I struggled with this recommendation. I could not support medication administration by a non-licensed person. I didn’t have any evidence, it just didn’t feel right; and I truly believed it was not a safe practice. In spite of my feelings, the plan to pilot the use of a carefully crafted medication technician role went forward. It was during the pilot testing phase that my dad was a resident in a nursing home. For over four years, I watched the licensed practical nurse administer the same five medications in the morning and the same four medications in the evening. There was no need for a licensed nurse to be doing this technical, repetitive task – my dad needed licensed nurses to observe, support and assure an effective plan of care was in place. I soon became a strong supporter of the medication technician based on observations and outcomes over a four year time span. This fresh look at patient care at the point of service events provided new information so that I am now able to support for the shift in the scope of practice from registered nurses to medication technicians. The issues of scope change are not limited to the nursing discipline. Issues with providers (nurse, physician, naturopath, podiatrists, and optometrists) are also increasingly common. In a recent publication of The American Medical Association, efforts to push back on expansions of scope of practice (http:// www.ama-assn.org/amednews/2010/01/18/prl20118.htm) and hopes to protect physician practice scope as the means to patient quality were noted. Questions such as these are posed regularly: • Should optometrists perform surgery and prescribe medications? • Should naturopaths become licensed? • Should chiropractors perform invasive procedures? Can they perform manipulations under anesthesia? • Who should diagnose, treat and manage pain? • Who should be able to do invasive procedures, prescribe medications, diagnosis and treat, patients with chronic pain? The American Medical Association has recommended model legislation for states to establish scope-of-practice review panels to evaluate plans by non-physician health professionals who wish to expand their practice. The panels would be composed of various regulatory board officials, university experts and other health care advisers to help lawmakers understand the underlying medical, educational and public interest considerations. Hopefully, such panels would include all of the regulated professions providing patient care and not be limited to physician providers. Nurses, pharmacists, psychologists, chiropractors, therapists and naturopaths all have good input for this important discussion. The challenges to scope should not be viewed as anomalous events; rather scope analysis should be an ongoing discussion among colleagues providing patient care. None of us should shy away from the need for healthy dialogue. As new ideas are proposed, I would hope that each professional consider the following questions about the proposed changes AND the resistance being encountered. 1. How widespread is the issue that is being addressed by the proposed scope change? 2. Is there evidence to support the change in other states? 3. Will the change increase access to care? 4. Will the change increase the quality of care? 5. How will the cost of care be affected? 6. How will the proposed change be integrated into the current scope of practice? Is there education in nursing programs (or whichever discipline is involved) currently? 7. Is the change consistent with the principles of the practice act? For sure, scope of practice will be forever challenging for all health professions as the new evidence emerges and the needs of society change. Thanks again for the opportunity to serve as your president.

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