Nurse Practitioners Scope Of Practice Case Study

Issue Statement

There has been a major debate on whether Nurse practitioners who are advanced-practice registered nurses to provide primary care. Nurse practitioners are registered nurses who have received a postgraduate nursing degree and at this time it is only required to be a master's degree (http://www.healthaffairs.org). There are scope-of-practice laws in many states that give Nurse practitioners the ability to perform primary care services that may be offered when people make an initial approach to a doctor or nurse for treatment as well as ongoing care for chronic diseases. “There’s a predicted shortage of primary care as the population grows and as millions of people become newly insured starting in 2014, one proposed solution is

Much of the controversy plays out in state capitals, where medical boards and legislators determine scope of practice for nonphysicians, including nurse practitioners. There are also considerations at the federal level that bear on nurse practitioners' ability to be reimbursed for the care that they provide.

Background

Primary care services can be provided by physicians and by a range of nonphysician practitioners, such as physician assistants and nurse practitioners, both of whom have graduate degrees and are authorized to examine, diagnose, and treat patients. Although physician assistants must practice in association with a physician, state law determines whether nurse practitioners can work independently of a physician.

In 2012, 18 states nurse practitioners to diagnose and treat patients and prescribe medications without a physician's involvement. Meanwhile in 32 states, they required physician involvement to diagnose and treat or prescribe medications, or both. “The Health Resources and Services Administration (HRSA)--the federal agency responsible for improving access to health care services for people who are uninsured, isolated, or medically vulnerable--has identified roughly 5,700 geographic areas containing 55 million residents as being Primary Care Health Professional Shortage Areas” . It is estimated that these areas will need more than 15,000

The report recommended changes at the state and federal levels to allow nurse practitioners to practice to the full extent of their education. The IOM recommended specifically that state legislatures reform scope-of-practice laws and regulations to conform to the National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules, which outline scopes of practice for advanced-practice registered nurses. It further recommended that state legislatures require fee-for-service plans within the state to similarly cover nurse practitioner services. At the federal level, the IOM recommended that the Federal Trade Commission identify state regulations related to advanced-practice nursing that have an anticompetitive effect without contributing to the health and safety of the public, and that states be urged to change such policies”