Note: This blog post was updated in November 2017 according to new scope-of-practice law information from the AANP.
Concerns about the future of healthcare under the Affordable Care Act have lawmakers scrambling, searching for solutions. In response to public outcry and doubts about the efficacy of Obamacare, state representatives are taking action, and they are looking to nurse practitioners as one answer to their problems.
Nurse practitioner scope of practice, the ability to diagnose, treat, and prescribe medications, is governed by state law. Currently, laws in 22 states plus D.C. allow nurse practitioners to practice independently, without physician oversight. Laws in other states restrict NPs’ ability to treat patients. These laws prevent nurse practitioners from opening their own practices or writing certain types of prescriptions, limiting their utility.
Some groups, namely physician organizations, oppose allowing NPs the ability to practice independently and have successfully lobbied in the past against increasing the nurse practitioner scope of practice. But, with the arrival of healthcare reform, more and more policymakers are voting to relax restrictions on NPs, seeing them as part of the solution to their healthcare woes.
Last month, Gov. Susana Martinez of New Mexico announced she is pushing for state funds to be allocated to a nurse practitioner recruitment campaign. She hopes to encourage NPs in neighboring Texas to relocate to New Mexico, helping provide lower cost and make healthcare more accessible to a larger number of residents. New Mexico is facing growing problems with access to medical care, especially in rural areas, and is short an estimated 2,000 physicians. New Mexico allows nurse practitioners to practice independently. However, Texas requires nurse practitioners practice under physician supervision and be delegated the authority to prescribe Schedule II controlled substances. Gov. Martinez believes New Mexico’s more favorable scope of practice laws will attract NPs across the border.
New Mexico’s recruitment campaign signals an important trend in laws governing nurse practitioners’ ability to practice and prescribe. As NPs leave Texas, lawmakers in the state may be pressured to rethink their own scope of practice laws. Recent data regarding nurse practitioner cost of care adds to this pressure. One study this year suggested that retail health visits cost $34 less in states that allow NPs to prescribe independently. While $34 doesn’t seem significant, this difference could lead to a cost savings of $472 million in retail clinic visits alone by 2015.
A growing number of states are looking at how NPs increase accessibility and affordability of medical care and are reconsidering laws that restrict nurse practitioners’ scope of practice. Those hesitant to ease restrictions on NPs worry nurse practitioners aren’t as qualified as physicians. However, numerous studies show NPs and physicians have similar patient outcomes. The pressure for fewer restrictions on NPs is mounting, beginning to outweigh the cost of going against the wishes of physician organization opposition. The future for nurse practitioner scope of practice laws looks bright this season.
