In 11 states, they are pushing legislation that would permit nurses with a master’s degree or higher to order and interpret diagnostic tests, prescribe medications and administer treatments without physician oversight. Similar legislation is likely to be introduced soon in three other states.
If the proposals, which face vehement opposition from some physicians’ groups, succeed, the number of states allowing nurses to practice without any type of physician supervision would increase from 16 to 30, in addition to the District.
Maryland is considered almost in this category as well because the state merely requires a nurse practitioner who wants to operate an independent practice to identify a physician to consult if necessary. By contrast, Virginia is among the most restrictive states, with physician oversight required.
The broader authority being proposed around the country could spur tens of thousands of nurses to set up primary-care practices that would be virtually indistinguishable from those run by doctors. About 6,000 nurses operate independent primary-care practices.
“We have a ready-made, no-added-cost workforce in place that could be providing care at a much higher level if we modernize our state laws,” said Taynin Kopanos, director of health policy and state issues for the American Association of Nurse Practitioners. “So the question for states is, are you going to fully deploy this resource or not?”
The nurses’ last big legislative push, a state-by-state effort that began in the late 1980s, sputtered by the early 1990s. This time, however, the campaign is being coordinated nationally by the nurse practioners association and other nursing groups and is getting a critical boost from consumer advocates and state officials concerned about the 2010 health-care law’s looming impact on the availability of doctors.
Beginning in January, about 27 million uninsured Americans are expected to get coverage under the law, contributing to a projected shortage of about 45,000 primary-care physicians by 2020, according to the Association of American Medical Colleges.
Claudio Gualtieri of the AARP’s Connecticut branch said it makes sense to empower qualified nurses to step into the breach.
“These are actually good ideas that we should have put into practice a long time ago,” he said. “But now, with the timetable for the [health-care law] rolling out, there’s an extra impetus to do so.”
The nurses have won the support of faith-based organizations, social workers, patients’ groups and the National Governors Association. Perhaps the most valuable endorsement came from experts convened by the National Academy of Sciences’ prestigious Institute of Medicine. The IOM panel, in a report issued in 2010 after the adoption of the health-care law, found no evidence that nurse-run practices were unsafe and concluded that “now is the time” to allow nurses to practice to the full extent of their education and training without limitations by doctors.