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New State Laws Give Nurse Practitioners Flexibility

Posted by Scott Harrah
August 21, 2014

Nurse practitioners play an important role in the medical community, but these highly trained individuals have both fans and critics. The Affordable Care Act (ACA/Obamacare) has brought many newly insured Americans into doctors’ offices, but due to the primary care shortage, there aren’t enough doctors to see everyone, particularly in medically underserved and rural communities. Nurse practitioners help bring care to people who otherwise would not get it.

The UMHS Endeavour looks at the ways nurse practitioners are redefining American health care as more states allow these health care professionals to operate without doctor agreements. We will also explore the reasons why some, including U.S. medical associations, are reluctant about giving nurse practitioners more flexibility. Our intent is to inform students at American and Caribbean medical schools about both sides of this ongoing issue in American medicine.

New State Laws Give Nurse Practitioners Independence

New laws passed in such states as New York, Minnesota, Connecticut and Kentucky have given nurse practitioners the flexibility to see patients and write prescriptions without having an agreement with a doctor, an article in USA Today published this week said. Some patients, however, prefer to see a doctor instead of a nurse practitioner or physician’s assistants because, quite simply, nurse practitioners aren’t doctors and haven’t had the same level of education and training.

“According to the American Association of Nurse Practitioners , 19 states and the District of Columbia now allow them to treat patients and prescribe drugs independently,” USA Today said. “Another 19 allow nurses to practice semi-independently, requiring a physician agreement for some piece of patient care, such as prescribing potent painkillers. Proposals to give nurses more autonomy have also been floated in some of the 12 states the association still considers restrictive.”

AMA Says Doctors Should Supervise Nurse Practitioners

The American Medical Association (AMA) thinks it is best for everyone if doctors oversee nurse practitioners. In many states, each nurse practitioner must have a written agreement with a doctor to write prescriptions.

"The (AMA) encourages physician-led health care teams that ensure health care professionals work together as the ideal way to provide high quality and efficient care," AMA officials said in a statement to USA Today. "Patients win when each member of their health care team plays the role they are educated and trained to play."

NY Times on Rift Between Doctors & Nurse Practitioners

In 2013, in a New York Times article “The Gulf Between Doctors and Nurse Practitioners,” Pauline Chen, M.D. wrote about the complex reasons why many doctors are reluctant to give nurse practitioners more freedom to practice independently.

Dr. Chen wrote about a New England Journal of Medicine study on doctors and nurse’s opinions on primary care providers.

“For several years now, health care experts have been issuing warnings about an impending severe shortfall of primary care physicians,” Dr. Chen wrote. “Policy makers have suggested that nurse practitioners, nurses who have completed graduate-level studies and up to 700 additional hours of supervised clinical work, could fill the gap. Already, many of these advanced-practice nurses work as their patients’ principal provider. They make diagnoses, prescribe medications and order and perform diagnostic tests. And since they are reimbursed less than physicians, policy makers are quick to point out, increasing the number of nurse practitioners could lower health care costs. If only it were that easy.”

Dr. Chen said a panel of experts recommended nurses should be able to practice “to the full extent of their education and training,” including such things as “leading medical teams and practices, admitting patients to hospitals and being paid at the same rate as physicians for the same work.”

Many physician organizations “opposed many of the specific suggestions, citing a lack of data or well-designed studies to support the recommendations.”

(Top photo) Nurse practitioners are redefining medical care. Photo: Deposit Photos


About UMHS:

Built in the tradition of the best US universities, the University of Medicine and Health Sciences focuses on individual student attention, maintaining small class sizes and recruiting high-quality faculty. We call this unique approach, “personalized medical education,” and it’s what has led to our unprecedented 96% student retention rate, and outstanding residency placements across the US and Canada. UMHS is challenging everything you thought you knew about Caribbean medical schools.

Posted by Scott Harrah

Scott is Director of Digital Content & Alumni Communications Liaison at UMHS and editor of the UMHS Endeavour blog. When he's not writing about UMHS students, faculty, events, public health, alumni and UMHS research, he writes and edits Broadway theater reviews for a website he publishes in New York City, StageZine.com.

Topics: Medicine and Health

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