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Pushing beyond practice barriers: the Wisconsin Family and Injured patient Compensation and NP's.

There is a threat to our ability to practice as NP's under APNP Certification Statutes as set by the Wisconsin Board of Nursing. The threat has been gradually mounting over the last 10 years or so: the liability policy restrictions on NP practice set by the Wisconsin Family and Injured patient Compensation Fund, (Comp Fund).

The Comp Fund is an insurance policy paid into by physicians, CRNA's, and health care employers to cover Wisconsin citizens while also having a liability cap in place, which keeps insurance costs low to those covered by the fund. It was originally set up in the 1970's as a hospital insurance policy. Now, use of the Comp Fund as an insurer has spread so that all larger clinic employers are a part of it as well. It is an excellent vehicle for protection citizens while still providing a favorable practice environment for practitioners.

However, the Comp Fund is unfavorable when it comes to NP Practice. Having been created 35 or so years ago, Nurse Practitioner practice was not taken into consideration when it was founded. There were, in fact, very few nurse practitioners working in Wisconsin at that time. The Comp Fund states that Physicians and CRNA's are independently practicing providers. All other health care practitioners. Including NP's and other advanced practice nurses, are "supervised staff" of physician practices. As such, NP's must work under supervised, not collaborative, contracts and conditions, and are subject to the same rules as other Registered Nurses in Wisconsin, basically, such that our ability to practice under our collaborative APNP statutes does, in fact, not exist. Currently supervision has a loose interpretation, but like all interpretative statutes, it has the potential to take a restrictive and unfavorable turn at the whim of a committee or a lawyer.

Over the past fall and winter, Gina Dennik-Champion, WNA attorney Burt Wagner, AP Forum President Mary Beck, and myself (Trudy Mara), have been working to address this issue and the contradictions and problems it presents in how we practice. In the most recent meeting, Gina Dennik-Champion and Burt Wagner met with the Wisconsin State Insurance Commission during their 2008 Strategic Planning Session, and presented to them the incongruities between our APNP practice rules as set by the State of Wisconsin, and the rules we are forced to practice under with the Comp Fund restrictions as "supervised staff."

There are 2 possible futures for NP practice in our state: in one, we become covered as independent providers under comp fund rules, as are our peers, the CRNA's. Other insurances follow suit and payor (insurance company), barriers gradually dissolve. NP practice becomes the collaborative practice it is meant to be. In the other future, there is a lawsuit against an APNP. Under current comp fund restrictions, it is decided that practice under "supervised" conditions must include verbal or written protocols, co-signatures on prescriptions, and a physician onsite in order to practice. In other words-back to the 1980's!

The intention of the WNA Advanced Practice Nurse Forum is to have all APNP's included as independent providers under the Wisconsin Patient and Injured Family Compensation Fund, not just CRNA's. We would all need to pay into the fund, but it is likely to be in an amount that is equivalent to what employers are paying now, and not a large amount. We would also be covered under individual insurance policies, as the APNP Certification statutes require. And, as all APNP's would belong to the fund in order to practice in Wisconsin, our patients in rural areas would also benefit from the public protection afforded by the fund.

We ask that all APNP's support the WNA Advanced Practice Forum in our work to include APNP's as independent providers under the Wisconsin Patient and Injured Family Compensation Fund, and to end the supervised status of NP's in our state.


WNA Advanced Practice Forum Board Memb
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Author:Mara, Trudy
Publication:STAT Bulletin
Date:Aug 1, 2008
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