Stephanie Hutchins-CA

Hello, I am IN SUPPORT of most of CMS-2011-0160-001. Having been a hospital nurse and also a nursing instructor, I see that allowing Advance Practice Nurses (APNs) to ability to write orders and to practice within the full extent of their scope of practice and state law will: * lessen the impact of the current national shortage of general practitioner MDs, thereby allowing patients fuller access to care. Please see the attached publication by the US Agency for Healthcare Research and Quality (AHRQ). However, I DO NOT SUPPORT allowing the patient or a "support person" to administer medications to hospital patients. Currently studies have shown that 30-50% of patients ignore or otherwise compromise instructions concerning their medication (see link to reference article below). * If a person other than the nurse administers medications in the hospital, the potential for lack of adherence and therefore lack of crucial therapeutic benefit from the prescribed meds in the hospital is high. * Also, if nurses are required to monitor meds given by a person other than the nurse to ensure adherence, it would create a time backlog for the nurse, negating much of the benefit of having them given by another person. Stephanie Hutchins, RN, BSN, PHN, CHPN http://jrnlappliedresearch.com/articles/Vol3Iss3/Wertheimer.htm