Nurse Practitioner’s Scope of Practice – Policy Recommendations and Future Directions

Various changes in the state legislation and nursing programs may help the nurse practitioners to play their role in cared delivery autonomously. One of the recommendations by the Institute of Medicine was that the federal authorities should repeal or abolish the outdated scope-of-practice discrepancies and institute reforms in the nursing profession through countrywide dissemination of best practices and provision of incentives to those who adopt such practices (Keough et. al. 2011). Since states that have wider scopes of practice and autonomy for NPs have not been shown to have a decline in quality of care (Keough et al., 2011), implementation of reforms that equip NPs to provide care autonomously in a broader scope would have benefits in enhancing access to care. In pursuit of such reforms, there have been numerous proposals in twenty-eight states that seek to widen the scope of practice and increase autonomy for NPs, but criticism from organizations such as the American Medical Association has prevented effective implementation of the policies. Such criticism creates tension between nurses and physicians thus reducing the extent to which nurses and other healthcare professionals can collaborate to better care provision.

Health reforms should seek to abolish laws and protocols that impede the cost-effective engagement of NPs, whether as independent medical practitioners or as qualified members of health care provision teams. Available literature supports reevaluation of policies and guidelines to permit the substitution of NPs for physicians in their corresponding areas of licensed practice (Running, Hoffman & Mercer, 2008). Findings indicate that clinical quality is not compromised when qualified NPs are used where there is a shortage of physicians. For instance, Maylone et al. (2011) note that NPs have been shown to provide equivalent level of care as physician do as evaluated by clinical results, client contentment, and other indicators of quality. Based on patient satisfaction, some studies have also indicated pre-eminence of NPs over physicians in care provision (Maylone, et al. 2011). Such findings thus imply a need to enhance the autonomy and scope of practice for NPs as a means to enhance access to care.

In future, reforms should focus on enhancing collaboration rather than supervision of NPs by physicians. Studies suggest that NPs enhanced autonomy supported by collaboration with other health care professionals, such as physicians and physician assistants, could help maximize NPs’ potential and strengthen their distinctive role in delivery of health care (Running, Hoffman & Mercer, 2008). However, for such autonomy to be beneficial, authorities mandated to certify and accredit NPs should implement a standardized model of certifying and accrediting NPs. One such model is the consensus model in which nurse accreditation bodies in all states collaborate to develop common standards for nurse education, certification based on nursing roles and population focus and specialty certification (e.g. APRN Joint Dialogue Group, 2008). Through such initiatives, the system would develop well-qualified nurse practitioners who can work effectively without physician supervision in all states.

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