It Is Time To Restructure Health Professions Scope-Of-Practice Regulations To Remove Barriers To Care

Abstract

Regulation and licensure of health professionals-nurses, physicians, pharmacists, and others-currently falls to the states. State laws and regulations define legal scopes of practice for these practitioners. Concern is growing that this system cannot support workforce innovations needed for an evolving health care system or for successful implementation of the Affordable Care Act. Existing state-based laws and regulations limit the effective and efficient use of the health workforce by creating mismatches between professional competence and legal scope-of-practice laws and by perpetuating a lack of uniformity in these laws and regulations across states. State laws limit needed overlap in scopes of practice among professions that often share some tasks and responsibilities, and the process for changing the laws is slow and adversarial. We highlight reforms needed to strengthen health professions regulation, including aligning scopes of practice with professional competence for each profession in all states; assuring the regulatory flexibility needed to recognize emerging and overlapping roles for health professionals; increasing the input of consumers; basing decisions on the best available evidence and allowing demonstration programs; and establishing a national clearinghouse for scope-of-practice information.

Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

“…One policy recommendation aimed at expanding primary care capacity is to use nurse practitioners (NPs) more effectively (Dower, Moore, & Langelier, 2013;Naylor & Kurtzman, 2010;Pohl, Hanson, Newland, & Cronenwett, 2010). A projected increase in the NP workforce (HRSA, 2013), along with the essential and steadily growing contributions of NPs to primary care (Druss, Marcus, Olfson, Tanielian, & Pincus, 2003;Kuo, Loresto, Rounds, & Goodwin, 2013), especially their historic and evolving role in improving access to primary care for vulnerable populations (Morgan, Everett, & Hing, 2015), offers compelling evidence for this policy recommendation.…”

Physician Assistant Job Satisfaction

“…Differences in national and state regulations result in a range of PA scope of practice. 9 Variation in organizational policies not only affects the clinical role of PAs but also determines work environment, professional growth, and benefits. Within the context of regulation and organizational policy, the role of the PA is usually negotiated with the supervising/collaborating physician but may be influenced by the expertise and preferences of team members and the needs of the patient population served.…”

The Impact of Establishing a Full Scope of Practice for Advanced Practice Registered Nurses in the State of Indiana

“…One strategy for addressing this problem is to expand the supply of and utilization of advanced practice registered nurses (APRNs). While APRN programs prepare graduates to independently diagnose and treat patients, as well as prescribe medications, tests, and procedures, scope-of-practice (SOP) regulations at the state level, which govern the breadth of services that APRNs can independently provide, may affect APRNs' ability to meet patients' care needs (Dower, Moore, and Langelier, 2013;Tolbert, 2013). In some states, these regulations place restrictions on the type of care that APRNs can actually provide.…”

“…In some states, these regulations place restrictions on the type of care that APRNs can actually provide. Advocates of SOP regulations have argued that they are necessary to ensure patient safety and high-quality care, but other policymakers have noted that SOP regulations for APRNs may limit the supply of health care services without appreciably affecting quality or outcomes of care (Dower, Moore, and Langelier, 2013). Since 2010, an increasing number of states have removed SOP restrictions, especially for nurse practitioners (NPs), with a nationwide trend toward allowing full practice and prescription authority, referred to here as full SOP (Tolbert, 2013).…”