From the March 2014 issue of HealthCare Business News magazine


All these points are what help to make the case for the expanded recognition for NPs, the push to let them practice independently and the increased recruiting efforts to fill the ranks. While NPs can legally practice in every state in the country, their level of independence differs as they cross state borders. That is a situation that some, including health care experts and politicians, take exception to.

Physician oversight and physicians out of sight
The difference between a state where nurse practitioners are able to fully practice and those where they have reduced ability is significant, with the differences between reduced practice states and restricted being less so.



Even in full practice states, it’s not as easy as hanging up a shingle and opening doors for business though. “When you apply in an unrestricted state, you have to convince them you’re comfortable with all the additional responsibility that entails” says Rodney Hicks, professor at Western University of Health Sciences.

In part, the additional responsibility translates to knowing when to refer a patient to a qualified health care provider, acknowledging limitations in training, but also being able to perform up to their level of training.

However, with the requirements being established on a state level rather than a federal level, what meets the needs in one state may not pass muster crossing into a neighboring state. All states require an RN license, some require national certification, others require an advanced degree and some require all that and more. The Board of Nursing, the Board of Medical Examiners and Board of Medicine all having jurisdiction over nurse practitioners and in some states, more than one regulatory agency has a say.

However, that may change in the near future beginning with nurse practitioners graduating after 2015 who will be required to hold a Doctor in Nursing Practice Masters degree.

Although agency oversight and practice qualifications present challenges, the main gripe from NPs has to do with physician oversight. While the profession is currently free of oversight requirements in 17 states plus
D.C., the majority of states have reduced practice statutes, with 12 having restricted practices — California being a particular standout as the only western state to fall into that category.

In states where it’s a requirement, physician oversight requires the nurse to basically obtain a sponsor to allow him or her to practice. The sponsor, typically a family practitioner, may have to do as little as signing a letter stating the sponsor relationship. In other states, the nurse must check in with the physician, updating them on patient interaction, but that’s not the norm. “Physician oversight varies from state to state,” says Reid Blackwelder, president of the American Academy of Family Physicians. “In many cases, oversight does not require the physician and nurse to be in the same building,” he says.

March 2014 Magazine

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