Advanced practice registered nurses (APRNs) have had to start their careers in Colorado under regulations that rival few other states in stringency. Since the Colorado Nurse Practice Act was altered in 2010 by the Department of Regulatory Agencies’ (DORA) Nurse-Physician Advisory Task Force for Colorado Healthcare (NPATCH), APRNs have been required to complete 3,600 hours of supervised oversight before gaining the prescriptive authority for which they were trained in graduate school.
“The first 1800 hours had to be under the supervision or in collaboration with a physician, and then the second 1800 could be a physician or an APRN with prescriptive authority,” says Ernestine Kotthoff-Burrell, MS ’86, PhD, APRN, FAANP, an assistant professor at the College of Nursing who testified in front of the Senate Health & Human Services Committee on behalf of the University of Colorado. “As a result of [the requirement], because physicians perceived that they would be unable to provide that level of supervision, and because new graduates didn’t have prescriptive authority, they couldn’t get jobs.”
And because they couldn’t find employment, Colorado-trained APRNs were leaving the state. Surrounding states, such as Nebraska, New Mexico, Arizona, and Wyoming, have few or no required hours of APRN oversight.
The Colorado Center for Nursing Excellence (CCNE) sent out a survey in 2013 that garnered alarming results for the future of access to care in the state: “What we were finding is that APRNs in the state weren’t able to get jobs without provisional prescriptive authority and then the 3,600 hour requirement made it that much harder. We had somewhere between 60 and 70 percent of nurse practitioners or soon-to-be nurse practitioners and advanced practice nurses saying they were going to leave,” says Assistant Project Director Ingrid Johnson, RN, BSN, MPP, who focuses on CCNE’s efforts to provide care to Colorado’s rural and underserved areas.
Employers want NPs to have their prescriptive authority already,” says Director of Nursing at Adams State University Shawn Elliott, DNP ’12, RN, CPNP-PC. “I didn’t get my foot in the door to practice for two years after I finished the [post-master’s PNP certificate] program and then it was only part time. It was going to take me years to finish the 3,600 hour requirement! This is a very long time for a physician to co-sign all my scripts and just adds to their workload.”
This year, Senate Bill 15-197 proposed a reduction in those required hours as well as a change in the type of oversight and the type of provider who could be the APRN’s supervisor. The bill was bolstered by the collaborative efforts of several health care and community groups that were convened by the CCNE under the leadership of its CEO, Karren Kowalski, MS ’71, PhD ’84. Johnson says, “Karren Kowalski really did serve as a driving force behind that collaborative and pulling it together as the leadership consistently changed based on the needs, and I think without her leadership on that it would have been tough to pass it.”
Johnson also gives credit to CU for its role in the bill’s success: “The University of Colorado stepped in when it was time to testify and supported this bill from both the standpoint of nursing and medicine, which really was incredibly powerful because this is not just about nursing and medicine and we have to work together on these things … to give [health care] access to people who don’t have it.”
Elliott, who practices and teaches in rural Colorado, says SB 15-197 will make it easier and faster for new APRNs and experienced APRNs from outside the state to enter Colorado’s workforce. “This will help a lot because there aren’t physicians in some areas to even be the preceptors/mentors that the current rules require,” she says. “Now NPs can go into the very remote areas and practice without constraints.”
Although the exact interpretation and implementation of the bill remain to be seen, some of its provisions are clear:
- The number of oversight hours for APRNs will be reduced from 3,600 to 1,000,
- The required preceptorship will change to a mentorship, and the mentor can be a physician or an experienced APRN who has full prescriptive authority,
- The mentorship can be asynchronous, allowing the mentee to work anywhere in the state regardless of the location of the mentor,
- Provisional prescriptive authority will be granted upon the APRN’s completion of an accredited graduate program, passage of the certification exam, and admittance to the registry,
- Full prescriptive authority will be granted to an APRN who has at least three years of clinical work experience and the completed 1000-hour mentorship.