WEBVTT 00:00:00.700 --> 00:00:04.800 position:50% align:middle - [Woman] Brendan Martin is the Director of Research for NCSBN. 00:00:04.800 --> 00:00:09.590 position:50% align:middle He has more than 13 years in quantitative modeling and consulting. 00:00:09.590 --> 00:00:13.605 position:50% align:middle Brendan has extensive graduate-level statistical training in the fields of 00:00:13.605 --> 00:00:17.050 position:50% align:middle mathematics and public health sciences. 00:00:17.050 --> 00:00:20.102 position:50% align:middle His research interests include post-secondary access, 00:00:20.102 --> 00:00:25.336 position:50% align:middle biostatistics, healthcare reform, and regulation. 00:00:31.492 --> 00:00:35.150 position:50% align:middle - [Brendan] Hello. My name is Brendan Martin, and I am the director of NCSBN's 00:00:35.150 --> 00:00:39.512 position:50% align:middle research department. I'm here today to discuss the results of a recently completed 00:00:39.512 --> 00:00:44.004 position:50% align:middle study assessing the impact of executive orders or legislative or regulatory actions 00:00:44.004 --> 00:00:49.220 position:50% align:middle waiving certain practice restrictions on APRNs during the COVID-19 pandemic. 00:00:49.220 --> 00:00:52.760 position:50% align:middle For today's presentation, we're going to cover a few major points. 00:00:52.760 --> 00:00:56.632 position:50% align:middle To start, I'll provide a bit of background on the study to give you all the necessary 00:00:56.632 --> 00:01:00.369 position:50% align:middle context for why we wanted to pursue this study in the first place and what we hope 00:01:00.369 --> 00:01:05.049 position:50% align:middle to achieve. I'll then share a brief overview of the study methodology so that you are 00:01:05.049 --> 00:01:08.577 position:50% align:middle clear on how we selected our sample, went about collecting the data, and how 00:01:08.577 --> 00:01:13.183 position:50% align:middle we analyzed the responses. Then, we'll get into the meat of the presentation in which 00:01:13.183 --> 00:01:17.367 position:50% align:middle I will cover the results in detail before wrapping things up with a few key takeaways. 00:01:17.367 --> 00:01:21.863 position:50% align:middle As always, I'll attempt to leave ample time at the end for any follow-up questions or 00:01:21.863 --> 00:01:26.159 position:50% align:middle necessary clarification. So, please feel free to use the chatbox to submit your 00:01:26.159 --> 00:01:31.025 position:50% align:middle comments as I go through the material. Since the onset of the COVID-19 pandemic, 00:01:31.025 --> 00:01:34.898 position:50% align:middle many states that have historically restricted APRN practice chose to 00:01:34.898 --> 00:01:38.573 position:50% align:middle temporarily suspend their collaborative practice agreement requirements either 00:01:38.573 --> 00:01:43.375 position:50% align:middle in part or in full. Like the state-based supervisory arrangements themselves 00:01:43.375 --> 00:01:47.531 position:50% align:middle though, the lived reality of these waivers across impacted states remains unclear 00:01:47.531 --> 00:01:52.433 position:50% align:middle and likely uneven. For instance, little evidence has emerged about how such 00:01:52.433 --> 00:01:56.662 position:50% align:middle waivers ultimately affected financial requirements, provisions regarding the 00:01:56.662 --> 00:02:00.927 position:50% align:middle extent and frequency of collaboration, telehealth usage, and other elements 00:02:00.927 --> 00:02:05.272 position:50% align:middle directly linked to patient access. In addition, how these changes have 00:02:05.272 --> 00:02:10.589 position:50% align:middle impacted APRN discipline rates, if at all, is unknown. To augment the literature 00:02:10.589 --> 00:02:14.690 position:50% align:middle on these important topics, NCSBN designed a cross-sectional study to identify 00:02:14.690 --> 00:02:20.410 position:50% align:middle current APRN practice trends across the US during the COVID-19 pandemic. 00:02:20.410 --> 00:02:24.421 position:50% align:middle The primary research question driving the study was what is the impact of the 00:02:24.421 --> 00:02:28.784 position:50% align:middle temporary practice waivers on APRN's direct patient care during the COVID-19 00:02:28.784 --> 00:02:32.810 position:50% align:middle pandemic? The primary objectives of the study were as follows. 00:02:32.810 --> 00:02:37.043 position:50% align:middle First, determine to what extent APRN practice changed during the COVID-19 00:02:37.043 --> 00:02:41.270 position:50% align:middle pandemic as a result of executive or legislative actions. 00:02:41.270 --> 00:02:45.683 position:50% align:middle And second, to identify the downstream implications of these changes regarding 00:02:45.683 --> 00:02:49.161 position:50% align:middle patient access, and in particular APRN discipline. 00:02:50.390 --> 00:02:54.521 position:50% align:middle Regarding the methodology, as I mentioned, this was a cross-sectional observational 00:02:54.521 --> 00:02:58.600 position:50% align:middle study. The proposed study utilized a two-phased approach. 00:02:58.600 --> 00:03:02.800 position:50% align:middle The first was a survey of APRNs practicing across the US. 00:03:02.800 --> 00:03:06.804 position:50% align:middle This confidential survey was designed to assess the extent to which temporary 00:03:06.804 --> 00:03:11.334 position:50% align:middle practice waivers during the COVID-19 pandemic affected APRN practice and the 00:03:11.334 --> 00:03:16.328 position:50% align:middle resulting implications for patient access. The second phase of the study linked 00:03:16.328 --> 00:03:20.690 position:50% align:middle these response trends with discipline data to examine issues pertaining more directly 00:03:20.690 --> 00:03:27.357 position:50% align:middle to patient safety. Given our dual interests and practice in safety, we leverage NCSBN's 00:03:27.357 --> 00:03:32.326 position:50% align:middle Nursys database for the study. For those of you who are not familiar, Nursys is a 00:03:32.326 --> 00:03:36.704 position:50% align:middle national database for verification of licensure, discipline, and practice 00:03:36.704 --> 00:03:40.540 position:50% align:middle privileges for all nurses license and participating boards of nursing. 00:03:40.540 --> 00:03:46.275 position:50% align:middle We focused on APRNs in participating Nursys jurisdictions to ensure access to both the most 00:03:46.275 --> 00:03:52.090 position:50% align:middle up-to-date contact information and licensure information, but also to establish a baseline 00:03:52.090 --> 00:03:54.640 position:50% align:middle understanding of disciplinary trends. 00:03:54.640 --> 00:03:59.204 position:50% align:middle There are currently a total of 27 states that share their APRN data through the Nursys 00:03:59.204 --> 00:04:03.518 position:50% align:middle database. Those states are colored orange on the map you see on this slide. 00:04:04.007 --> 00:04:07.899 position:50% align:middle As you will note, while not a complete picture of the US, the Nursys database 00:04:07.899 --> 00:04:13.340 position:50% align:middle gave us good coverage across the country and fairly strong geographic diversity. 00:04:13.340 --> 00:04:17.471 position:50% align:middle While these 27 states constituted the sample for our survey, we drilled down 00:04:17.471 --> 00:04:21.456 position:50% align:middle even further for the following analysis and presentation to focus on just three 00:04:21.456 --> 00:04:27.410 position:50% align:middle jurisdictions. They were Maine, West Virginia, and Louisiana. 00:04:27.410 --> 00:04:31.178 position:50% align:middle These three states were chosen based on the results of our active monitoring of 00:04:31.178 --> 00:04:35.930 position:50% align:middle executive orders or legislative or regulatory actions across the US which highlighted 00:04:35.930 --> 00:04:40.001 position:50% align:middle these three locales as the areas in which significant restrictions were temporarily 00:04:40.001 --> 00:04:44.289 position:50% align:middle waived. When data become available, Kentucky will also be added to the 00:04:44.289 --> 00:04:49.456 position:50% align:middle analysis. The survey component of this study was initially fielded in early 00:04:49.456 --> 00:04:53.547 position:50% align:middle December 2020, with scheduled reminders running through the beginning of the new 00:04:53.547 --> 00:04:59.390 position:50% align:middle year. A 42-item confidential online survey was administered using Qualtrics. 00:04:59.390 --> 00:05:03.266 position:50% align:middle Questions were divided into three topic areas, demographic and professional 00:05:03.266 --> 00:05:08.257 position:50% align:middle information such as age, role, years experience, practice which includes 00:05:08.257 --> 00:05:12.908 position:50% align:middle specialization, setting, collaborative practice agreement details, and finally, 00:05:12.908 --> 00:05:18.030 position:50% align:middle telehealth, with a particular focus on usage prior to the pandemic, current usage, and 00:05:18.030 --> 00:05:24.539 position:50% align:middle anticipated usage after COVID-19 subsides. For the analysis presented today, results 00:05:24.539 --> 00:05:28.090 position:50% align:middle are limited to a detailed descriptive summary of the survey data, and a 00:05:28.090 --> 00:05:31.924 position:50% align:middle summary of aggregate year-to-year disciplinary trends in the three highlighted 00:05:31.924 --> 00:05:37.291 position:50% align:middle states. To kick things off, we first wanted to highlight the summary disciplinary 00:05:37.291 --> 00:05:42.110 position:50% align:middle trends comparing overall APRN discipline rates from 2019 and 2020. 00:05:42.110 --> 00:05:46.440 position:50% align:middle The analysis includes a full snapshot of both calendar years. 00:05:46.440 --> 00:05:51.021 position:50% align:middle As you can see, discipline rates in Louisiana, Maine, and West Virginia remain largely 00:05:51.021 --> 00:05:55.912 position:50% align:middle unchanged despite the executive, legislative, and/or regulatory actions 00:05:55.912 --> 00:05:59.170 position:50% align:middle waiving practice restrictions in these three jurisdictions. 00:05:59.170 --> 00:06:03.075 position:50% align:middle So, right off the bat, this sets a good baseline understanding of comparable 00:06:03.075 --> 00:06:06.100 position:50% align:middle year-to-year of patient safety. 00:06:06.100 --> 00:06:09.799 position:50% align:middle With baseline patient safety confirmed, we now turn our attention to the 00:06:09.799 --> 00:06:12.320 position:50% align:middle survey results themselves. 00:06:12.320 --> 00:06:17.655 position:50% align:middle The overall survey response rate was approximately 14%, with a total of 17,000 00:06:17.655 --> 00:06:21.650 position:50% align:middle APRN respondents located across 26 states. 00:06:21.650 --> 00:06:26.429 position:50% align:middle The subsample for this three-state analysis consisted of 1,212 APRN 00:06:26.429 --> 00:06:30.903 position:50% align:middle respondents. On average, respondents were 50 years old and predominantly 00:06:30.903 --> 00:06:36.486 position:50% align:middle female and white non-Hispanic. Ninety-two percent indicated they were actively engaged 00:06:36.486 --> 00:06:41.683 position:50% align:middle in direct patient care. Over half of those not providing direct patient care reported 00:06:41.683 --> 00:06:46.530 position:50% align:middle being furloughed or losing their job or retiring early or otherwise leaving their 00:06:46.530 --> 00:06:52.170 position:50% align:middle place of employment specifically due to COVID-19. About 80% of the sample were 00:06:52.170 --> 00:06:56.400 position:50% align:middle nurse practitioners who indicated they were certified in family or across the lifespan 00:06:56.400 --> 00:07:01.628 position:50% align:middle care. Primary care was the most common clinical practice area at about 20% of the 00:07:01.628 --> 00:07:06.026 position:50% align:middle sample, and over 50% of respondents reported working in some manner of 00:07:06.026 --> 00:07:11.205 position:50% align:middle hospital setting. Of that cohort, equal proportions reported working inpatient, 00:07:11.205 --> 00:07:17.511 position:50% align:middle outpatient, or both. Finally, a plurality of respondents reported practicing in a 00:07:17.511 --> 00:07:22.639 position:50% align:middle rural area, with 1 in 6 APRNs working in a setting designated as a health provider 00:07:22.639 --> 00:07:28.552 position:50% align:middle shortage area. Two-thirds of all respondents reported having at least one collaborative 00:07:28.552 --> 00:07:32.220 position:50% align:middle practice agreement in the year prior to COVID-19. 00:07:32.220 --> 00:07:36.456 position:50% align:middle While most respondents reported having only one agreement, the median number 00:07:36.456 --> 00:07:40.810 position:50% align:middle of physicians with whom they had a collaborative practice agreement was 2. 00:07:40.810 --> 00:07:45.502 position:50% align:middle Respondents identified the signature or co-signature requirement as well as 00:07:45.502 --> 00:07:50.146 position:50% align:middle limited hospital admitting and home health approval privileges as the most pronounced 00:07:50.146 --> 00:07:53.050 position:50% align:middle restrictions associated with their collaborative practice agreements. 00:07:53.050 --> 00:07:58.964 position:50% align:middle A majority of APRNs worked in the same office or facility, but if not in the same 00:07:58.964 --> 00:08:03.441 position:50% align:middle location, respondents reported working only a median of 15 miles from their 00:08:03.441 --> 00:08:08.571 position:50% align:middle supervising provider. The median fee to establish a collaborative practice 00:08:08.571 --> 00:08:13.441 position:50% align:middle agreement was $150, while the median annual fee to maintain a collaborative 00:08:13.441 --> 00:08:19.685 position:50% align:middle practice agreement was $500 per month. Not surprising at all, the vast majority of 00:08:19.685 --> 00:08:24.720 position:50% align:middle respondents indicated the COVID-19 pandemic affected their direct patient care. 00:08:24.720 --> 00:08:29.415 position:50% align:middle Specifically, 1 in 5 respondents witnessed a significant decrease in their patient volume, 00:08:29.415 --> 00:08:34.077 position:50% align:middle while somewhat smaller proportions were reassigned to or changed positions or 00:08:34.077 --> 00:08:39.270 position:50% align:middle volunteered in a new practice setting or clinical practice specialty area. 00:08:39.270 --> 00:08:44.555 position:50% align:middle Of note, 1 in 6 APRNs who reported a pandemic effect indicated they worked 00:08:44.555 --> 00:08:49.845 position:50% align:middle directly with COVID-19 patients. In addition, 1 in 4 participants also 00:08:49.845 --> 00:08:53.500 position:50% align:middle reported they expanded the geographic boundaries of their direct patient care, 00:08:53.500 --> 00:08:57.961 position:50% align:middle with the most dramatic increase coming in the form of increased outreach to patients 00:08:57.961 --> 00:09:03.550 position:50% align:middle in rural areas, and to a lesser extent, health provider shortage areas. 00:09:03.550 --> 00:09:07.189 position:50% align:middle I say to a lesser extent because approximately 9% of the original 00:09:07.189 --> 00:09:12.996 position:50% align:middle HPSA coverage area saw expanded care, but no new shortage areas were added as 00:09:12.996 --> 00:09:18.003 position:50% align:middle the primary practice site during the pandemic. In total, two-thirds of all 00:09:18.003 --> 00:09:23.035 position:50% align:middle respondents reported awareness of the COVID-19 waiver in their state. Comparing 00:09:23.035 --> 00:09:28.052 position:50% align:middle pre and post-waiver activities, we see 51% of respondents indicated their 00:09:28.052 --> 00:09:32.249 position:50% align:middle supervising provider conducted regular chart reviews frequently or very frequently 00:09:32.249 --> 00:09:37.679 position:50% align:middle in the year prior to COVID-19. About 12% indicated their supervising provider never 00:09:37.679 --> 00:09:42.430 position:50% align:middle conducted regular chart reviews in that time frame. Approximately 49% of 00:09:42.430 --> 00:09:45.914 position:50% align:middle respondents indicated they referred patients to specialists outside of their 00:09:45.914 --> 00:09:49.637 position:50% align:middle state-mandated collaborative practice agreements frequently or very frequently 00:09:49.637 --> 00:09:54.982 position:50% align:middle in the same time period. And to add context to this last point, prior to the 00:09:54.982 --> 00:09:59.439 position:50% align:middle onset of COVID-19, about 92% of respondents indicated their clinical 00:09:59.439 --> 00:10:04.310 position:50% align:middle practice specialty area and that of their supervising physician were in alignment. 00:10:04.310 --> 00:10:08.459 position:50% align:middle So, perhaps, due to these overlapping skillsets, only 28% of respondents 00:10:08.459 --> 00:10:12.544 position:50% align:middle indicated they referred patients to their supervising physician frequently or very 00:10:12.544 --> 00:10:19.953 position:50% align:middle frequently in the year prior to COVID-19. By contrast, a whopping 78% of respondents 00:10:19.953 --> 00:10:23.980 position:50% align:middle indicated the COVID-19 waiver reduced restrictions under direct patient care 00:10:23.980 --> 00:10:29.120 position:50% align:middle during the pandemic. This did not change all levels of communication though. 00:10:29.120 --> 00:10:32.635 position:50% align:middle Fifty-seven percent of respondents indicated they still referred patients 00:10:32.635 --> 00:10:36.683 position:50% align:middle to specialists outside their state-mandated collaborative practice agreements frequently 00:10:36.683 --> 00:10:40.680 position:50% align:middle or very frequently after the COVID-19 waiver was issued. 00:10:40.680 --> 00:10:44.639 position:50% align:middle However, the proportion of respondents that referred patients to their supervising 00:10:44.639 --> 00:10:49.216 position:50% align:middle physician frequently or very frequently decreased even further after the COVID-19 00:10:49.216 --> 00:10:56.478 position:50% align:middle waiver was issued to just 14%. Unfortunately, only one-third or 36% of respondents 00:10:56.478 --> 00:11:00.843 position:50% align:middle indicated the COVID-19 waiver had an impact on their direct patient care. 00:11:00.843 --> 00:11:04.972 position:50% align:middle For those who indicated the waiver did have an impact, the most common reported 00:11:04.972 --> 00:11:09.543 position:50% align:middle outcome was an ability to see more new patients, followed closely by the ability to 00:11:09.543 --> 00:11:13.347 position:50% align:middle expand the geographic boundaries of their care, and a reduction in the frequency 00:11:13.347 --> 00:11:17.323 position:50% align:middle of their communication with their supervising physician. For the two-thirds 00:11:17.323 --> 00:11:20.750 position:50% align:middle of respondents who indicated the waiver did not have an impact on their direct 00:11:20.750 --> 00:11:25.139 position:50% align:middle patient care, the most common reported reason was that their employer requirements 00:11:25.139 --> 00:11:31.306 position:50% align:middle did not change. To a much less significant extent, APRNs also expressed reservations 00:11:31.306 --> 00:11:35.242 position:50% align:middle regarding the legal and practice implications of not abiding by their 00:11:35.242 --> 00:11:39.520 position:50% align:middle prespecified collaborative practice agreement requirements. 00:11:39.520 --> 00:11:43.510 position:50% align:middle Switching topics a bit, approximately two-thirds of all respondents also 00:11:43.510 --> 00:11:46.700 position:50% align:middle reported they actively practiced telehealth. 00:11:46.700 --> 00:11:49.661 position:50% align:middle Of those who indicated they had a collaborative practice agreement prior 00:11:49.661 --> 00:11:55.181 position:50% align:middle to the onset of COVID-19, about 27% indicated at least some restrictions 00:11:55.181 --> 00:11:59.476 position:50% align:middle on their telehealth practice. Over two-thirds of that cohort reported 00:11:59.476 --> 00:12:04.640 position:50% align:middle their state's COVID-19 waiver temporarily eased these restrictions as well. 00:12:04.640 --> 00:12:08.520 position:50% align:middle This change allowed half this cohort to report seeing more current patients, 00:12:08.520 --> 00:12:12.709 position:50% align:middle adding new patients, and generally expanding the geographic boundaries of 00:12:12.709 --> 00:12:17.579 position:50% align:middle their direct patient care. One in five respondents indicated they provide 00:12:17.579 --> 00:12:22.428 position:50% align:middle telehealth services across state borders, with 12% switching a majority or at times 00:12:22.428 --> 00:12:27.849 position:50% align:middle all their patient care online due to COVID-19. In total, the waiver allowed 00:12:27.849 --> 00:12:32.863 position:50% align:middle respondents to provide cross-border care across 16 different jurisdictions. 00:12:33.530 --> 00:12:38.399 position:50% align:middle Not surprising, telehealth experienced significant and near-instantaneous growth 00:12:38.399 --> 00:12:43.722 position:50% align:middle with the onset of COVID-19. Prior to the start of the pandemic, APRNs reported 00:12:43.722 --> 00:12:48.407 position:50% align:middle nearly no significant telehealth usage. This changed dramatically during the 00:12:48.407 --> 00:12:54.760 position:50% align:middle pandemic however with APRNs reporting a median increase of 50% telehealth usage. 00:12:54.760 --> 00:12:59.655 position:50% align:middle As you can see, the 75th percentile during the pandemic increased even further to 80%. 00:12:59.655 --> 00:13:04.319 position:50% align:middle Across the board, respondents also underscored the durability of this trend, 00:13:04.319 --> 00:13:08.454 position:50% align:middle projecting a quarter of their care would continue to be delivered using telehealth 00:13:08.454 --> 00:13:14.186 position:50% align:middle after the pandemic subsides. Those positive telehealth trends notwithstanding, 00:13:14.186 --> 00:13:18.690 position:50% align:middle respondents reported significant barriers to telehealth delivery. 00:13:18.690 --> 00:13:21.860 position:50% align:middle For a clear majority, these concerns were patient-focused, 00:13:21.860 --> 00:13:25.843 position:50% align:middle rather than provider-sided. A majority of APRNs indicated 00:13:25.843 --> 00:13:29.891 position:50% align:middle that their patients often lacked access to needed technology or had significant 00:13:29.891 --> 00:13:33.168 position:50% align:middle technology support problems. And nearly one-third 00:13:33.168 --> 00:13:39.090 position:50% align:middle also reported patient apprehension with adopting and utilizing new technologies. 00:13:39.090 --> 00:13:45.060 position:50% align:middle So, what are the key takeaways? First, COVID-19 significantly reshaped APRN practice. 00:13:45.060 --> 00:13:50.250 position:50% align:middle Approximately 85% of APRNs reported an impact on their direct patient care. 00:13:50.250 --> 00:13:54.008 position:50% align:middle Most witnessed significant decrease in their patient volume or found themselves 00:13:54.008 --> 00:13:58.720 position:50% align:middle reassigned to new practice settings or clinical practice specialty areas. 00:13:58.720 --> 00:14:04.500 position:50% align:middle One in six switch gears to work directly with COVID-19 patients during the pandemic. 00:14:04.500 --> 00:14:08.250 position:50% align:middle Second, pandemic waivers did not have widespread impact. 00:14:08.250 --> 00:14:10.720 position:50% align:middle But when they did, it was positive. 00:14:10.720 --> 00:14:13.989 position:50% align:middle One in four participants reported they expanded the geographic boundaries 00:14:13.989 --> 00:14:19.820 position:50% align:middle of their direct patient care, in particular, in rural areas and health provider shortage areas. 00:14:19.820 --> 00:14:24.060 position:50% align:middle Overall, respondents indicated they were often able to see more patients, including 00:14:24.060 --> 00:14:27.470 position:50% align:middle new ones, more often as a direct result of the waivers. 00:14:27.470 --> 00:14:31.980 position:50% align:middle And then, finally, telehealth emerged and is here to stay. 00:14:31.980 --> 00:14:37.000 position:50% align:middle Telehealth usage increased nearly 50% overnight due to the onset of COVID-19. 00:14:37.000 --> 00:14:41.564 position:50% align:middle This was both due to adherence to local restrictions but also to ensure continuity 00:14:41.564 --> 00:14:46.054 position:50% align:middle of care. While APRNs believe telehealth will continue to account for significant 00:14:46.054 --> 00:14:49.877 position:50% align:middle proportion of their healthcare delivery moving forward, they highlighted several 00:14:49.877 --> 00:14:55.110 position:50% align:middle patient-centered barriers to such services which require thoughtful consideration. 00:14:55.110 --> 00:14:59.300 position:50% align:middle With that, I will open the floor to discussion and any questions you might have. 00:15:16.234 --> 00:15:22.359 position:50% align:middle So, as we wait for some questions to roll in, I will just let you 00:15:22.359 --> 00:15:28.751 position:50% align:middle know that we do plan to move beyond the descriptive analysis that you just recently 00:15:28.751 --> 00:15:34.453 position:50% align:middle reviewed, and we are going to be including pretty significant statistical modeling into 00:15:34.453 --> 00:15:38.738 position:50% align:middle our analysis moving forward. Just, we wanted to give you a preliminary and 00:15:38.738 --> 00:15:42.753 position:50% align:middle kind of high-level understanding of the impacts in the trends that we saw initially 00:15:42.753 --> 00:15:49.097 position:50% align:middle within this three-state subanalysis. So, the first question is, "How do you think 00:15:49.097 --> 00:15:53.910 position:50% align:middle your survey results impact the need for an APRN compact?" 00:15:53.910 --> 00:15:56.830 position:50% align:middle I think it's a really good question. 00:15:56.830 --> 00:16:01.060 position:50% align:middle So, with the APRN compact, you know, from my understanding obviously, we're 00:16:01.060 --> 00:16:06.279 position:50% align:middle trying to, you know, standardize some of the lived experience and the practice 00:16:06.279 --> 00:16:11.374 position:50% align:middle experience for APRNs across participating states and I think one of the things that 00:16:11.374 --> 00:16:16.626 position:50% align:middle this survey and this study really cast a pretty significant light on was that the 00:16:16.626 --> 00:16:20.630 position:50% align:middle lived reality for APRNs across these states, in particular, states that imposed 00:16:20.630 --> 00:16:26.353 position:50% align:middle some level of restriction on their care can be very, very different. And one of the 00:16:26.353 --> 00:16:31.427 position:50% align:middle things that we know from prior research as well is that if you just limit your analysis or 00:16:31.427 --> 00:16:35.875 position:50% align:middle your thinking to essentially kind of the high-level state policy, you also run the 00:16:35.875 --> 00:16:41.277 position:50% align:middle risk of missing other important elements that could potentially introduce restrictions 00:16:41.277 --> 00:16:44.580 position:50% align:middle to APRN care too such as facility-level barriers. 00:16:44.580 --> 00:16:49.070 position:50% align:middle So, I think anything, any efforts that can be made to really make sure that 00:16:49.070 --> 00:16:52.727 position:50% align:middle essentially APRNs are practicing to the full extent of their training and education 00:16:52.727 --> 00:16:57.108 position:50% align:middle are really vital because one of the things that we see repeatedly over not just this 00:16:57.108 --> 00:17:01.817 position:50% align:middle study but other studies as well is that the practice experience for APRNs across 00:17:01.817 --> 00:17:06.195 position:50% align:middle these states can be very, very different. Sometimes, it aligns with the state-level 00:17:06.195 --> 00:17:12.320 position:50% align:middle policy, sometimes, it doesn't, but there really is a lack of uniformity. 00:17:12.320 --> 00:17:16.421 position:50% align:middle And then, we see, I see another question, "Did your survey inquire as to the comfort 00:17:16.421 --> 00:17:20.979 position:50% align:middle level of the APRNs working without a collaborative practice agreement, and 00:17:20.979 --> 00:17:24.540 position:50% align:middle do you feel they had the level of competency required?" 00:17:24.540 --> 00:17:31.608 position:50% align:middle So, for the first question, yes, we did ask. So that was one of the primary 00:17:31.608 --> 00:17:37.529 position:50% align:middle questions that we asked if you remember about why the waiver might not have had 00:17:37.529 --> 00:17:42.030 position:50% align:middle an impact in their actual kind of lived practice experience. 00:17:42.030 --> 00:17:46.320 position:50% align:middle If you remember back to that slide, about 80% of the participants said that it was 00:17:46.320 --> 00:17:50.820 position:50% align:middle specifically related to employers not communicating any changes in their 00:17:50.820 --> 00:17:54.870 position:50% align:middle practice restrictions or making any changes associated or kind of aligned 00:17:54.870 --> 00:18:01.082 position:50% align:middle with the state-level waiver. But we did ask for any kind of reservations due to 00:18:01.082 --> 00:18:07.069 position:50% align:middle possible legal ramifications or practice ramifications. So, in many of these 00:18:07.069 --> 00:18:12.667 position:50% align:middle jurisdictions, you know, the waiver kind of had a moving goalpost timeline and 00:18:12.667 --> 00:18:17.988 position:50% align:middle some did express reservations associated with knowing essentially when that waiver 00:18:17.988 --> 00:18:23.333 position:50% align:middle would cease to be in effect, and what that would mean for potentially necessitating 00:18:23.333 --> 00:18:26.219 position:50% align:middle them to go back out and get another collaborative practice agreement up 00:18:26.219 --> 00:18:30.010 position:50% align:middle and running. So, there were some reservations expressed. 00:18:30.010 --> 00:18:34.702 position:50% align:middle Vis-à-vis essentially, the employer-based restrictions and guidelines, they were 00:18:34.702 --> 00:18:42.604 position:50% align:middle much more minimal. So, I just saw, and then, in terms of the level of competency required, 00:18:42.604 --> 00:18:46.350 position:50% align:middle I'm not sure exactly what that relates to. 00:18:46.350 --> 00:18:51.302 position:50% align:middle Most of them expressed when asked a fairly high-level of awareness regarding the 00:18:51.302 --> 00:18:54.598 position:50% align:middle restrictions that were placed on their care associated with the collaborative practice 00:18:54.598 --> 00:19:00.228 position:50% align:middle agreement as well as the waiver. And so, I do think the vast majority of respondents 00:19:00.228 --> 00:19:04.496 position:50% align:middle were well-positioned to address many of those items. I do see another question that 00:19:04.496 --> 00:19:09.725 position:50% align:middle came in, "Do you anticipate a follow-up study to determine if when COVID has 00:19:09.725 --> 00:19:14.310 position:50% align:middle abated, we see the removal of some of these restrictions will continue?" 00:19:14.310 --> 00:19:15.750 position:50% align:middle Yes, that's an excellent point. 00:19:15.750 --> 00:19:22.304 position:50% align:middle So, we do anticipate, in particular, for some of these jurisdictions where there 00:19:22.304 --> 00:19:27.675 position:50% align:middle was kind of more pronounced easing or lifting temporarily of some of these 00:19:27.675 --> 00:19:32.762 position:50% align:middle restrictions, we do anticipate that we would follow up in some of these jurisdictions to 00:19:32.762 --> 00:19:38.805 position:50% align:middle understand if any of those waivers or any of those restrictions were effectively made 00:19:38.805 --> 00:19:42.880 position:50% align:middle permanent. I think that that's a very good question and I think that that's something 00:19:42.880 --> 00:19:44.510 position:50% align:middle that we're certainly interested in. 00:19:44.510 --> 00:19:51.810 position:50% align:middle We also do plan some outreach with APRN's supervising providers. 00:19:51.810 --> 00:19:56.412 position:50% align:middle One of the final questions on the surveys, for those that were willing to share the 00:19:56.412 --> 00:19:59.338 position:50% align:middle contact information for their supervising providers so we could also get the 00:19:59.338 --> 00:20:03.610 position:50% align:middle physician perspective associated with this particular topic. 00:20:03.610 --> 00:20:08.343 position:50% align:middle As when you saw with the discipline data, it looks as though the lived reality in these 00:20:08.343 --> 00:20:12.006 position:50% align:middle jurisdictions of kind of a proxy of full-practice authority was quite 00:20:12.006 --> 00:20:22.410 position:50% align:middle effective and safe. And then, some of your slides... Ow. So, my apologies. 00:20:22.410 --> 00:20:27.108 position:50% align:middle If any of the slides appeared corrupted or were difficult to read, similar to the first 00:20:27.108 --> 00:20:31.584 position:50% align:middle presenter, if you contact me and would like a copy of the slide deck, I am more 00:20:31.584 --> 00:20:34.610 position:50% align:middle than happy to provide that so you can have that for your records. 00:20:35.677 --> 00:20:41.292 position:50% align:middle And then, another question regarding the publication of the results, so yes, 00:20:41.292 --> 00:20:44.230 position:50% align:middle we do absolutely intend to publish these results. 00:20:44.230 --> 00:20:47.141 position:50% align:middle One of the initial comments that I made when the live Q & A session started, 00:20:47.141 --> 00:20:52.476 position:50% align:middle for those of you who might have missed it, we are going to pursue some statistical 00:20:52.476 --> 00:20:54.800 position:50% align:middle modeling associated with this. 00:20:54.800 --> 00:20:57.449 position:50% align:middle So, for today's presentation, we really wanted to give you a high-level 00:20:57.449 --> 00:21:01.509 position:50% align:middle understanding of the trends that we were seeing in the data in particular for these 00:21:01.509 --> 00:21:07.624 position:50% align:middle three jurisdictions. But the next steps are to essentially understand which of those 00:21:07.624 --> 00:21:12.557 position:50% align:middle observed trends are significant in nature and, you know, what aspects of essentially 00:21:12.557 --> 00:21:18.667 position:50% align:middle the practice profile do correlate with, you know, certain better outcomes in 00:21:18.667 --> 00:21:24.565 position:50% align:middle terms of APRN practice. So, we are going to pursue some further analysis, but yes, 00:21:24.565 --> 00:21:31.173 position:50% align:middle then, we do anticipate probably a mid to late summer publication timeline, at least 00:21:31.173 --> 00:21:38.130 position:50% align:middle for submission of the results. And I will just kind of build on that answer a little bit. 00:21:38.130 --> 00:21:44.284 position:50% align:middle Obviously, we have a very robust sample of 17,000 APRN respondents across now 00:21:44.284 --> 00:21:50.500 position:50% align:middle 27 states. So, the responses from Kentucky are now rolling in as that survey is live. 00:21:50.500 --> 00:21:54.431 position:50% align:middle So, we did get coverage across all the states that are participating in Nursys 00:21:54.431 --> 00:22:00.357 position:50% align:middle to date, and we do anticipate several analyses out of this sample as there are 00:22:00.357 --> 00:22:03.424 position:50% align:middle many important topics that we tried to cover in the instrument. 00:22:08.230 --> 00:22:12.760 position:50% align:middle And I know we only have a few more minutes left, and I don't see any additional questions, 00:22:12.760 --> 00:22:17.773 position:50% align:middle but I'm happy to wait for a second to see if any roll in. 00:22:29.359 --> 00:22:34.602 position:50% align:middle Okay. So, I think that's it. We got all the questions. So, I appreciate everyone 00:22:34.602 --> 00:22:40.736 position:50% align:middle attending today. As I mentioned, if you have any questions... I do see something 00:22:40.736 --> 00:22:47.070 position:50% align:middle just came in. Ow. This is just a link for everyone who's participating to review. 00:22:47.070 --> 00:22:51.242 position:50% align:middle If you do have any additional questions regarding this research or what directions 00:22:51.242 --> 00:22:54.140 position:50% align:middle we might take with future research, please feel free to contact me 00:22:54.140 --> 00:22:56.860 position:50% align:middle directly at bmartin@ncsbn.org. 00:22:56.860 --> 00:23:00.370 position:50% align:middle Otherwise, I will give you a little bit of a break before the next session. 00:23:00.370 --> 00:23:02.788 position:50% align:middle Thank you so much for attending. Bye.