Advanced practice: treating the paperwork.

It happens everyday and it impacts your ability to provide efficient patient care. It is the paperwork barrier. You have just finished a well child exam on ten-year old Amanda when her mom asks you to sign the form to allow the albuterol inhaler to be dispensed at school in case of an asthma attack. This should be simple enough. After all, you were able to treat Amanda by providing the exam, confirming that her asthma is well controlled, and even refilling her inhaler. However, you are unable to "treat the paperwork." The form requires a physician signature.

This barrier to efficient, timely care by qualified advanced practice nurses (APN) illustrates one of the areas that the Colorado Nurses Association, along with its members from the Colorado Advanced Practice Society (DNA 30), the Colorado Society of Clinical Specialists in Psychiatric-Mental Health Nursing (DNA 31) and other advanced practice associations around the state will be working to remove during the 2008 Colorado legislative session. Legislation will be introduced that will provide for APN signature recognition on forms that pertain to routine healthcare matters, and that improve patient care access by providing for APN enrollment on insurance panels and that also update the State Medicaid language. The time has come for Advanced Practice Nurses in the state of Colorado to work together to decrease the roadblocks faced in providing healthcare to patients. The 2007-2008 Legislative year is very important all advanced practice nurses: clinical specialists, nurse midwives, nurse anesthetists and nurse practitioners (of all specialties). The Colorado Nurses Association will be introducing legislation that is intended to decrease these type of roadblocks. This will better allow us to continue to improve the healthcare of our fellow citizens.

Your help is needed to convince legislators of the need for these changes. You can assist by doing three simple things:

1. Sign up for the APN legislative listserve to stay up to date on what is happening and to be notified when special help is needed. (This will generally involve contacting the legislators for your home district and your business district.) You can sign up by emailing your name, email address, phone number (work and home), specialty, work address and State Senator and Representatives names to [e-mail]. If you are unfamiliar with your legislators you can find them by zip code at www.congress.org.

2. Develop relationships with your legislators by letting them know what you do and educating them on the roles of APNs in improving healthcare in Colorado. Check out the www.csapn.org and the CXA's web page for information and tips on working with your legislator.

3. Finally, start a collection of all of your paper and electronic forms that require a physician signature to be accepted. Physicals and disabled parking permits are examples. Save them all, even if they are duplicates, to demonstrate how often this is an issue. Directions for collection of the forms will be sent out over the website at a later date. Please mark out or remove any patient identification information on the forms.

None of this will take much of your time, but it will be very important to your patients, your future and that of the profession. It has been said that "the best way to predict the future is to invent it" (Alan Kay). This is your opportunity to help invent and improve healthcare future for your patients and improve the healthcare delivery system in Colorado. We look forward to representing the nursing community with you this next session.

Submitted by Ladean Cross, MSN, FNP and Tay Kopanos, DNP, NP