On January 1, 2021, Massachusetts became the 23rd state in the nation to pass full practice authority (FPA) legislation for Advanced Practice Registered Nurses (Mass Bill S.2984, 2021). Advanced Practice Registered Nurses (APRNs) include, nurse practitioners (NPs), certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNS). In most states, including my own state of North Carolina, APRNs practice under the supervision of a physician and are regulated by both the Board of Nursing and the Medical Board. I propose that APRNs should be governed solely by the Board of Nursing. This change will decrease the burden of supervision of physicians and provide patients with full and direct access to all the services that Nurse Practitioners are trained to provide (AANP, 2021). Accessibility is one of the most pressing issues in the nation’s healthcare system (NCIOM, 2020).
There are 248,000 licensed Nurse Practitioners in the United States and 90% of them are certified to care for primary care populations (AANP, 2021). Nurse practitioners help fill the gap in the provision of health care to underserved populations, especially in rural and underserved populations (Ramlagan, 2019). Duke University’s Shep Center for Health Services Research conducted a study that revealed that between 1990 and 2013, the nurse practitioner workforce increased by almost 500%, while the physician workforce only increased by 42% (Maier, Barnes, Aiden, & Busee, 2016). By 2030, the country could face a shortage of more than 100,000 physicians by the year 2030 (Ramlagan, 2019). States including my own (North Carolina) that restrict full practice authority have higher health care disparities, higher chronic disease burden, and lower standards on national health rankings (Wolff-Baker & Ordona, 2019).
If you live in a state that does not have full practice authority (FPA) for APRNs, I ask you to contact your State Senator or Representative to support passage of legislation for FPA. The reasons for enacting this legislation includes:
- Improved access – rural and underserved areas have very few physicians, and as a result, NPs are restricted from practicing in those areas.
- More efficient healthcare delivery – full practice authority for nurse practitioners prevents delays in care by reducing regulatory requirements.
- Cost-savings – Physician oversight creates unnecessary redundancies that result in duplication of services and double billing.
- Increased patient satisfaction – full practice authority allows patients to choose their primary care provider.
Respectfully Yours,
Ramesh C. Upadhyaya, MSN, MBA, RN, CRRN, CCHP
Correspondence may be sent to ram.upadhyaya@gmail.com
References
American Association of Nurse Practitioners (2021). Retrieved from https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief
Maier, C. B., Barnes, H., Aiden, L. H., & Busee, R. (2016). Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: Size, growth, physician substitution potential. BMJ Open, 6(9). E011901.
Massachusetts Bill S.2984. (2021). An Act Promoting a Resilient Health Care System that Puts Patients First. Retrieved from https://malegislature.gov/Bills/191/S2984
Ramlagan, N. (2019). Amid doctor shortage, nurse practitioners fill rural care gap. Public News Service [online]. Retrieved from https://www.publicnewsservice.org/2019-09-04/health-issues/amid-doctor-shortage-nurse-practitioners-fill-rural-care-gap/a67652-1.
Wolff-Baker, D., & Ordona, R. B. (2019). The expanding role of nurse practitioners in home-based primary care. Journal of Gerontological Nursing, 45(6). 9-14.