CNMA is officially co-sponsoring SB 464, the California Dignity in Pregnancy and Childbirth Act. Learn more about Senate Bill 464 and join us on Lobby Day this May 7th to show support!

Register for lobby day HERE.

California Nurse-Midwives Association

APRIL 2019| Newsletter

https://www.cnma.org/news/categories/newsletter

Or on google docs

Why Lobby Day Really Matters This Year

A Pulse Check On Sacramento

CNMA Has Hired A Policy Strategist: Meet Andrew Crutchfield

Membership Dues and Alternatives

Short Survey RE: Insurance for Private Practice CNMs

Winners of the SNM Scholarships for ACNM!

Black Maternal Health Week: Events in LA, SF, and Oakland

Meet the Author: Lovie Beard Shelton, the first CNM in North Carolina

Why Lobby Day Really Matters This Year

Hello CNMs,

We are fast approaching Lobby Day 2019! Join us at the Capitol on May 7th from 9am-5pm. Lobby Day is an important opportunity to inform our own district legislators on why access to midwifery and removal of supervision is important. Additionally, CNMA has become an official co-sponsor SB-464. This bill, titled the California Dignity in Pregnancy and Childbirth Act authored by Senator Holly J. Mitchell (D-Los Angeles) and Assemblymember Shirley Weber (D-San Diego), would require all perinatal healthcare providers, including physicians, nurses, midwives and frontline personnel, to participate in an implicit bias training designed to curtail the impact of bias on maternal health, and will mandate data reporting of pregnancy-related deaths in a way that better informs the public, policy makers, and improvement initiatives.

It’s been a busy year already for the Health Policy Committee and Health Policy Work Group. Last fall we wrote an extensive strategic plan for the removal of supervision in 2020 or 2021. We prioritized five main focus areas for building a strong foundation for our ultimate goal of full practice authority:

Rebuilding and growing the health policy committee

Engaging in strategic research (e.g. through health law experts on potential non-legislative routes toward supervision removal, and engaging in California-specific research on the cost-effectiveness and outcomes of CNM care)

Improving our legislative presence and considering other “incremental” legislative opportunities

Developing and maintaining relationships with key stakeholders

Developing a PR strategy and effective messaging

I am ecstatic to say that while we are only 4 months into 2019, we are deeply and actively engaged in each one of these focal points. Getting to full practice authority will be a step-by-step, brick-by-brick endeavor, and thus far we are putting each piece in place. Your job as a CNM constituent involves the last three points. But don’t worry, your job isn’t hard. We only ask that you show up and support this process. Please join us for Lobby Day. Let’s make our voices heard, keep a CNM presence at the Capitol, and work toward our ultimate goal of making nurse-midwifery care more accessible. We can’t do it without you! REGISTER HERE. As always, we’ll meet up for good drinks, warm hugs, and great conversation directly following Lobby Day events.

Sincerely,

Holly Smith, CNM

CNMA Health Policy Chair

advocacy@cnma.org

Find out more about this bill and our co-sponsors here , here, and here.

A Pulse Check On Sacramento

CNMA President, Kathleen Belzer, and Social Media Team member, Elizabeth Kicko, spent the day knocking on doors in Sacramento last month, doing a mix of social visits and lobbying for some bills coming down the pipeline in the current legislative cycle. CNMA is supporting AB 890, a Nurse Practitioner bill to remove physician supervision. “This bill would authorize a nurse practitioner who holds a certification as a nurse practitioner from a national certifying body to practice without the supervision of a physician and surgeon if the nurse practitioner meets specified requirements, including having practiced under the supervision of a physician and surgeon for an unspecified number of hours.” The passage of this bill would not only affect the more than 50% of Nurse-Midwives who are also Nurse Practitioners, but would help pave the way for removal of physician supervision in the near future for Nurse-Midwives. In addition, we offered support for Senate Bill 464 (SB464), known as the California Dignity in Pregnancy and Childbirth Act. CNMA is excited to host our annual lobby day (happening May 7th this year, registration HERE or on our homepage cnma.org), to get our members and allies on the ground in Sacramento reminding legislators that we are here and that we are the safe, cost-effective solution to the growing healthcare shortage in California. Kathleen and Elizabeth had fun storming the castle and are excited to do so again soon!

CNMA Has Hired A Policy Strategist: Meet Andrew Crutchfield

CNMA is working diligently in 2019 to regroup and review our strategy in order to make our strongest push in 2020 and 2021 toward removal of supervision. In support of these efforts, we have contracted with strategist Andrew Crutchfield to advise CNMA on public affairs and legislation. To be clear, Andrew is not a lobbyist, but he will advise about hiring a lobbyist if that becomes necessary.

Andrew is a passionate supporter of CNMA. He has worked with CNMA President, Kathleen Belzer and health policy Chair, Holly Smith for the past year in his former position as the Director for Govern for California. Govern for California (G4CA) is a network of over 500 political donors who support state legislators who legislate in the general public interest. CNMA came to the attention of G4CA during our AB 2682 bill cycle. Andrew was lobbying our efforts behind the scenes before we even knew it! He believes that CNMs "provide better service at a lower cost” and that a “special interest group...stands in the way of giving women more choice and access to better care.”

Andrew will help us build a strategy for our future by forming coalitions with like-minded allies and “preserving our resources until it is the right time to act.” He has strong relationships with several members of the legislature and has proposed initiatives that will allow CNMA to solicit significant donations from funders. Andrew also plans to secure independent research regarding our cause.

We are inspired by the addition of Andrew to our team and look forward to a successful legislative future with Andrew by our side!

Membership Dues and Alternatives

CNMA wishes to remind everyone that your membership dues go directly to supporting our policy and legislative actions in Sacramento. Being a member of your professional organization is a great way to stay connected to your professional peers in California, and a great way to support the ongoing efforts to improve maternal child health outcomes for our patients. If you feel that you cannot afford a membership at this time but would still like to support CNMA, you can submit donations in place of your membership at an amount comfortable to you on our donations page: cnma.org/donate. Every dollar matters, every dollar counts!

Thank you for your continued support.

CNMA

Short Survey RE: Insurance for Private Practice CNMs

CNMA is exploring the need for affordable health insurance for members who are self-employed or employed without the benefit of health insurance.

I have started this conversation with a consultant in the insurance industry, but we first must determine the need for this service in order to negotiate a group rate.

Please complete THIS survey whether you are insured by your employer or not.

Gratefully,

Kathleen Belzer, CNMA President

Winners of the SNM Scholarships for ACNM!

On behalf of the CNMA Scholarship Committee and the CNMA BOD, we would like to congratulate the 2019 scholarship awardees and list their names and where they are going to school. Each of the awardees will receive a $500 scholarship to attend the ACNM Annual Meeting in Washington DC.

Casey Johnson (GU)

Adrienne Almada (CSF)

Debbie Lundgren (Frontier)

Valli Barrioz (GU)

Juliann George (GU)

Congratulations, Winners! We’ll see you in DC!

Rebecca Garrett-Brown

Black Maternal Health Week: Events in LA, SF, and Oakland

April 11-17 is Black Maternal Health Week

Please note the following events in LA, SF, and Oakland!

Black Momma's Matter Alliance Gatherings in LA area

UCSF School of Nursing Event in SF

CA breastfeeding Coalition in Oakland

Meet the Author: Lovie Beard Shelton, the first CNM in North Carolina

An exciting opportunity to hear from the author of a new autobiography: Lovie Beard Shelton, the first practicing Certified Nurse-Midwife in North Carolina!

4/16/2019

6:00 - 8:00

Main SF Library

Latino/Hispanic Community Room A/B

100 Larkin St., San Francisco, CA

Questions? News? Want to get involved?

Email us at info@cnma.org

That's all for this month's issue. Catch you next time!

-CNMA MEDIA TEAM

Visit us at CNMA.ORG

This newsletter will be archived on our website at cnma.org/news

By: Morgan M. Callahan 03/12/19

It is well-documented that California is facing a shortage of primary care providers.  The Californians most affected by these shortfalls are largely low-income, Latino, African American, and Native American and located in rural areas as well as in California’s largest and fastest-growing regions—the Inland Empire, Los Angeles, and the San Joaquin Valley.  Newly-proposed legislation aims to address this problem by permitting California’s nurse practitioners to practice under certain conditions without physician supervision.

Assembly Bill 890 was introduced by Assemblymember Jim Wood (D-Santa Rosa), Chair of the Assembly Health Committee, and co-authored by five Assemblymembers and four Senators on both sides of the aisle.  Among the co-authors are Cecilia Aguiar-Curry (D-Winters), member of the Assembly Health Committee; Jeff Stone, (R-Temecula) Vice Chair of the Senate Health Committee; and Connie Leyva (D-Chino), member of the Senate Health Committee. 

The bill, which amends Section 2837.1 of the Business & Professions Code (a section of The Nursing Practice Act), would expand nurse practitioner education and revise scope of practice regulations so that nurse practitioners could practice without physician supervision after a transitional period of collaboration with a physician or experienced nurse practitioner.  Specifically, the bill would authorize a certified nurse practitioner to practice without the supervision of a physician if the nurse practitioner meets specified requirements, including having practiced under the supervision of a physician and surgeon for an unspecified number of hours (to be determined by the Board of Registered Nursing).  The bill also would authorize a nurse practitioner to perform additional specified functions, including ordering and interpreting diagnostic procedures, certifying disability, and prescribing, dispensing, and administering controlled substances.  Because the bill would expand the scope of a crime (a violation of the Nursing Practice Act is a misdemeanor), the bill would impose a state-mandated local program under the Commission on State Mandates to review and assess alleged violations.

A report by the private-sector California Future Health Workforce Commission1, of which Assemblymember Wood is a member, makes the following statements:

Full practice authority for nurse practitioners would result in cost savings to Californians from reduced avoidable emergency department stays and hospitalizations, and the lower costs of retail clinic use and primary care.Removing scope of practice restrictions would increase the growth rate of nurse practitioner supply by 25 percent. Between 2010 and 2017, California’s NP supply grew 39 percent; with full practice authority, the growth rate would have been 49 percent, and the state would have 1,500 NPs more than it does today.If full practice authority is achieved by 2020, there would be nearly 50,000 fewer revisits to emergency departments for ambulatory sensitive conditions, resulting in cost savings of more than $58 million per year.

Currently regulations promulgated by the Board of Registered Nursing under present statutory provisions require nurse practitioners to collaborate with physicians to develop standardized procedures—written authorization to perform certain medical functions not otherwise part of a nurse practitioner’s scope of practice2.  There are no requirements in those regulations regarding the physical proximity of the supervising physician to the nurse practitioner —supervision could be done remotely.  However, the physician is still legally responsible for the nurse practitioner’s practice, and is expected to determine the appropriate level of supervision, communicate regularly with the nurse practitioner, and oversee quality of care.

Opponents of the bill say nurse practitioners lack the training needed to practice on their own, arguing that online coursework is not as effective as the in-person medical education received by physicians, and that nurse practitioners have fewer hours of actual patient contact than physicians.  The bill’s proponents point out that this concern creates a double standard between nurses and physicians because there is a mix of online and in-person programs offered by medical schools, which has been deemed sufficient for a physician and surgeon license.

If this bill passes, California would join 22 other states3 and the District of Columbia in allowing nurse practitioners to practice and prescribe without physician supervision or collaboration, as specified.  Doing so, the bill’s proponents state, would not only be cost-effective, but would expand access to care for the state’s most vulnerable populations.

1 California Future Health Workforce Commission, Final Report, February 2019.  2 Title 16, Code of California Regulations, Section 1485 (Scope of Practice). 3 Alaska, Arizona, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, and Wyoming.