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Nurse Practitioners Seen as Option to Meet Growing Primary Care Demand

May 1, 2019

Nurse practitioners (NP) in states across the country are asking lawmakers to relax onerous licensing regulations so they can help fill an anticipated shortage of primary care doctors.

The Association of American Medical Colleges projects a primary care physician shortage of 14,800 to 49,300 by 2030. Currently, 84 million Americans live in Primary Care Health Professional Shortage Areas as defined by the federal government. Tay Kopanos, vice president of state government affairs for the American Association of Nurse Practitioners (AANP), says NPs can fill the gap.

“Nurse practitioners are licensed to provide a higher level of care than what half of the states are willing to allow,” said Kopanos. States license nurse practitioners but can restrict what they’re able to do.  

“What they can provide and what they are able to do legally is what’s driving disparity and inefficiencies in the health care system and putting states in a poor position to address the rising elderly population, the rise in chronic disease, and growing health care costs.”

Although all states and the District of Columbia recognize NPs as health care providers and their training is standardized, a patchwork licensing system exists.

“There have been studies done on outcomes of care for those in a full authority practice state, and the outcome of care does not go down,” Kopanos said. 

Full authority refers to “full practice authority” which AANP defines as allowing NPs to “evaluate patients, diagnose, order and interpret diagnostic test, initiate and manage treatments, including prescribing medication and controlled substances, under the exclusive licensure authority of the state board of nursing.”

A License Needing Permission

Kopanos says the current NP licensing situation is “like having a driver’s license but needing to get a permission slip from someone with authority to use it.”

Primary care access improves when states remove licensing barriers on NPs, Kopanos says.

“Five years after removing the ‘physician permission slip’ in Arizona, there was a more than 50 percent increase in NPs working in the state, and more than 70 percent in rural or underserved counties,” said Kopanos.

More NPs, Better Outcomes

Susan Perry, vice dean at the University of South Florida College of Nursing and a certified registered nurse anesthetist, says allowing NPs to have a full scope of practice improves access to quality care.

“In the 23 states with full practice authority and in the 17 states where nurse anesthetists are practicing, the health outcomes are good,” said Perry.

Although physicians must undergo years of extensive education and training, Perry says much of this is generalized, in contrast to nurses’ education.

“Advanced practice nurses are trained in their specialty from the very beginning,” Perry said. “We haven’t changed or needed to increase our education and training.”

The National Council of State Boards of Nursing has written model legislation for states looking to expand nurse practitioner care.

“That is the gold standard,” Kopanos said. “The biggest takeaway for states is how we are going to reduce health care costs and get timely care to people.”

Ashley Bateman(bateman.ae@googlemail.comwrites from Alexandria, Virginia.