Where Can Nurse Practitioners Work Without Physician Supervision?
Since the inception of the first Nurse Practitioner education program in 1965, men and women in the profession have experienced great success and heated opposition. Physician organizations have openly opposed the use of Nurse Practitioners as primary care providers, claiming that educational gaps render them unsafe and unqualified to care for patients independently.
Even though the decades-old debate continues, research has proven time and again that Nurse Practitioners can provide safe care and nearly identical clinical outcomes to their primary care physician counterparts. As hundreds of thousands of new patients gain access to medical care and one-third of primary care doctors retire over the next decade, many Nurse Practitioners are gaining independence and establishing autonomy as they provide medical care without the oversight or management of a physician.
Understanding Practice Status
Scope of practice guidelines for advanced nursing professions varies by state. Currently, 21 states and the District of Columbia have approved “full practice” status for Nurse Practitioners, allowing them to assess, diagnose, interpret diagnostic tests, and prescribe medications independently. Nurse Practitioners who operate in these areas are also free to establish and operate their own independent practices in the same way physicians do.
Full practice status is the recommended model by the Institute of Medicine and the National Council for State Boards of Nursing, but not all states are on board with the measure. The remaining states continue to hold reduced or restricted practice regulations for Nurse Practitioners. While the practice guidelines for each of these levels is slightly different depending on location, all require NPs to have either a signed collaboration agreement with a physician or direct oversight of a physician. Not all states require the physician to be physically present or even in the same building with the NP during patient care, but he or she should be available by phone or email.
Independent Care Gaining Steam
In an address on NP safety to the Florida House Select Committee on Health Care Workforce Innovation, Catherine Dower of the Center for Health Professions for the University of California San Francisco said, “None of the hundreds of studies that have been done on the topic showed that care was better in states with more restrictions.”
Florida is just one of a handful of states who continue to battle for a competitive edge when recruiting new Nurse Practitioners. Despite aggressive opposition from the medical community, lawmakers are looking closely at the NP’s role in expanding coverage to underserved areas and easing the burden on the dwindling number of primary care physicians who remain — calling the NP role “necessary for long-term health care.”
Nurse Practitioners have full practice authority in the following states:
- District of Columbia
- New Hampshire
- New Mexico
- North Dakota
- Rhode Island
The National Conference of State Legislators reported that 349 measures focused on loosening NP restrictions were heard in 2011 and 2012, and 178 were considered in the first half of 2013. Several states have also approved new privileges for NPs including the right to sign death certificates and some formal health records, and the ability to prescribe certain medications.
Communication and Collaboration in the Future
Health care leaders from nursing and medicine agree that there should be more conversations addressing the independence of NPs. Both sides agree that the NP role is vital to the health and delivery of medical care in this nation, but neither can agree on the best way to achieve the goal. As both sides hold strongly to their convictions, there is sure to be more debate — and potentially more autonomy — for Nurse Practitioners.
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