Achieving independence for advanced practice registered nurses in Connecticut.

Coming together is a beginning; keeping together is progress; working together is success. VHenry Ford On May 12, 2014, Florence Nightingale’s birthday, Connecticut’s Governor Dannel Malloy signed into law Public Act No. 14-12, An Act Concerning the Governor’s Recommendations to Improve Access to Health Care. With his signature, Connecticut became the 18th state to grant independence for advanced practice registered nurses (APRNs). Twenty-five years after the initial statutory provisions for an APRN license had been established in Connecticut, and building on the work of countless individual nurses andmultiple professional nursing organizations, APRNs who have been practicing for at least 3 years with a collaborative agreement and have completed at least 2000 clinical hours nowqualify for independent practice. This article highlights key events along the journey, describes the confluence of factors that set the stage for the historic turn of events, and reviews key lessons learned in the quest for independent practice. Paving the Way. It is likely that only the most visionary of Connecticut’s nurse leaders in 1976 could have foreseen the events that have recently unfolded. In that year, the firstNurse Practice Actwas entered into state statute with the word ‘‘diagnosis’’ being used for the first time in defining the practice of nursing. By the early 1980s, in response to a call by the American Nurses Association’s Council of Specialists in Psychiatric Mental Health Nursing, a group of Connecticut psychiatric clinical nurse specialists (CNSs) had formed a task force to examine legal barriers to independent practice in the state. After 18 months, the group had identified that the state statute needed to be changed to allow for insurance reimbursement for psychiatric CNSs; in 1984, they were instrumental in achieving direct insurance reimbursement forCNSs, nursepractitioners, and certified nurse midwives in Connecticut. Initial statutory provision for the license of APRNwas set forth in 1989, which formally defined advanced nursing practice and the activities such a nurse could perform. Prescriptive authority was also introduced at this time, limited to actions performed under the direction of a physician and in accordance with written protocols. One year later, the Connecticut Society of Nurse Psychotherapists was formed, in part due to the increasing need for an organized group of advanced practice nurses who would monitor the policy arena and advocate for the profession and the clients they served. Revisions were made to the general statutes in 1991Y1992 that addressed controlled substances and cosignature requirements; regulations at this time still required a ‘‘directing physician. ’’ Prescribing had by now become the act that differentiated the APRN from the RN; in fact, the APRN license was not needed if a master’s degreeYprepared nurse was not prescribing. Finally, in 1999, APRNs went from a direct supervision to a ‘‘collaborative practice’’ model; state statute now required APRNs to have a legal contract in place, which identified a physicianwhowas in the same field of practice and who had agreed to provide consultation and supervision on a regular basis to the APRN. Such a contract usually involved the APRN paying a fee for the service of the physician. Over the ensuing 12 years, multiple unsuccessful efforts were launched to remove the collaborative practice requirement. Setting the Stage. In 2013, the Connecticut Advanced Practice Registered Nurse Society, representing the interests of all APRNs throughout the state, had submitted a scope of practice request to Connecticut’s Department of Public Health (DPH) that would allow ‘‘licensed advanced practice registered nurses the flexibility to establish independent Author Affiliation: Associate Dean, Graduate Studies, Fairfield University School of Nursing, Connecticut. The author is an Advanced Practice Registered Nurse (APRN), with board certification as an adult psychiatric-mental health clinical nurse specialist andmore than 35 years’ experienceworking in multiple modalities and diverse settings. The author reports no conflicts of interest. Correspondence: Joyce M. Shea, DNSc, APRN, PMHCNS-BC, 96 Plank Rd, Prospect, CT 06712 (jshea@fairfield.edu). DOI: 10.1097/NUR.0000000000000107