Maryland Academy of Advanced Practice Clinicians

In 2005, a group of nurse practitioners (NPs) in rural Southern Maryland had a problem and a dream. The problem was lack of access to healthcare for their neighbors and friends, and a scarcity of employment for the NPs who wished to live and practice in Southern Maryland. Underlying the issues were a lack of physicians who wanted to practice in rural Maryland, and, without physicians, NPs could not see patients.

In 1981, Maryland had already changed from a supervisory to a collaborative state, NPs could prescribe and sign various forms that were essential to patient care. But the one thing that was missing was the ability to practice without the oversight of the Board of Physicians and a signature of a collaborating physician. MCNP realized it that it would take decades to update the Maryland Nurse Practice Act line by line to produce this change.

Subsequently, in August 2005, 16 NPs gathered to discuss the formation of an organization that would support not only their educational and networking goals in Southern Maryland, but also to recruit members and supporters to assist them in realizing their dream. 

The first MCNP legislative committee, comprised of Beth VandeGeijn, Bridget Vetere-Overfield and Lorraine Diana, a founding member of the organization, formed to act as a legislative mechanism to eliminate the collaborative agreement (CA). Lorraine went to fundraising activities in Charles, Calvert, and St. Mary’s counties to gain audiences with Southern Maryland politicians.  At that time, among other restrictions, NPs could not sign for handicap stickers.  Lorraine’s pitch to the politicians was, "I can diagnose your pain, treat your injury, write prescriptions, but not sign your handicap sticker.  You will have to find a doctor to do that for you” and politicians understood the message. By 2006, Southern Maryland politicians had become well acquainted with, and educated about, NP's.

In 2007 MCNP effectively petitioned to add an APRN as a voting member on the Board of Nursing. And in 2008 continued its mission to update the language in the Nurse Practice Act by expanding NPs authority to sign birth and death certificates, advanced directives, and applications for handicapped license tags.

Also in 2008, at MCNP’s request, Attorney Carolyn Buppert, NP, assisted with drafting a bill to eliminate the CA. MCNP had a meeting with the Southern Maryland Delegation on the opening day of the 2009 session where it came to light that there was a prior agreement between another state NP association and the Maryland State Medical Society, MedChi, that no legislation regarding the CA could be introduced until 2010. The MCNP leadership, in the interests of professional harmony, graciously agreed to honor this agreement.

In 2009, Lorraine Diana, Beth VandeGeijn, and Susan Delean-Botkin led a strategic planning session with other interested NPs at Rip's Country Inn in Bowie. They decided to introduce the bill to remove the CA in the 2010 session. Susan and Lorraine developed a slide presentation with a strategy introducing Maryland’s limitations in patient access to care and the issue of health care shortages throughout the state.  They had examples of NP's who lost their collaborative physicians and had to close practices, leaving hundreds of patients without access to care. To support the idea of eliminating the CA, they collected research on the safety and efficacy of NP practice and statistics on the increasing cost of patient care without access to primary care providers.  Susan and Lorraine used the presentation along with the research to educate Maryland stakeholders on the importance of full practice authority (FPA) for NPs. In 2010, legislation eliminating the written CA, Certified Nurse Practitioners - Authority to Practice, was signed by Gov. Martin O’Malley. This legislation, despite the addition of an attestation requirement by an outside stakeholder, also removed the Board of Physicians from NPs prescriptive authority promulgation which is now solely under the Board of Nursing.

In 2011, MCNP changed its name to the Maryland Academy of Advanced Practice Clinicians (MAAPC) and through a bylaw change became the first organization in the nation to include all Advanced Practice Nurses (APN) and Physician Assistants (PA) in one association! MAAPC’s objective was to implement the ambitions of the Institute of Medicine's Health Care Quality Initiative (the IOM Report) and the Consensus Model for APRN Regulation for Licensure, Accreditation, Certification and Education (the LACE Report). MAAPC members also believed that to promote the new health care paradigm and improve the health care system in Maryland, NPs needed to support and understand our APN and PA colleagues.  Lorraine Diana states, “it was a perfect time for all advanced practice clinicians to come together as a cohesive group with similar goals to obtain equitable payment for our services, recognition by insurance companies as independent providers, and legislative changes that allow us to practice to the full extent of our education, training and experience.” 

In 2015, MAAPC’s legislative team, joined by then DNP candidate, Elaine Crain, created a website and social media presence to disseminate information about the proposed legislation to remove the attestation requirement and finally achieve FPA for NPs. Once the platforms were active, several other states seeking FPA were given total access to the information to assist them in their own legislative efforts. MAAPC then worked with an expert to draft a bill, generated support, built a shareholder community, acquired sponsors, testified in front of the General Assembly and in May MAAPC’s bill, Certified Nurse Practitioners – Authority to Practice, was signed into law by Gov. Larry Hogan. In addition, they successfully defended a psychiatric nurse practitioners’ ability to provide and receive reimbursement from the State for telemental health services.

MAAPC continues to support and work with our fellow APNs and PAs in their legislative and educational endeavors and has partnered with the Board of Nursing, the Maryland Department of Health, the Maryland Nurses Association, the American Association of Retired Persons, and many other organizations through the years. Members volunteer to testify during legislative sessions in Annapolis, review and help rewrite bills that effect Advanced Practice Clinicians and, when needed, introduce legislation that improves and ensures the continuation of FPA for NPs.

MAAPC holds continuing educational conferences/webinars which focus on clinical practice, pharmacology and information that goes beyond day-to-day clinical practice for those who want to enhance their career and become leaders in their field. Membership in the organization is open to all Advanced Practice Clinicians including nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, physician assistants, as well as others involved/interested in health care.  

For updates in MAAPC’s history please see our Milestones and Legislative Platforms.