States Roll Back Rule Forcing NPs to Practice With Physician Oversight


Some states are allowing nurse practitioners to practice without physician oversight – an act that is long overdue, according to the AANP president.

In most places, laws dictate that nurse practitioners (NPs) must work under the supervision of physicians. While their educational background is different, their duties are fairly similar.

Now, 22 states, plus Washington DC, the Indian Health Care Services, and the VA Health Care Services, currently allow NPs to practice without physician oversight. In a recent interview with Oncology Nursing News, Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of the American Association of Nurse Practitioners (AANP) explained that this advancement of the NP profession is far overdue, and she hopes that more states catch on.

“In oncology, nurse practitioners are an integral part of the health care team,” Thomas said.

Oncology Nursing News: Can you review the educational and clinical background that a person must undergo to become an NP?

Thomas: A nurse practitioner starts out with a bachelor's degree in nursing. Generally, that's a 4-year degree. They then work, [for] usually about 2 or more years. I think the average number of years or practice as a registered nurse is 10 years. And then they would go back to school to obtain a master's or doctorate degree upon the completion of their educational program. All nurse practitioners are required to sit for a national certification exam, and they have to recertify every 5 years.

What are the similarities and differences in scope of practice between a nurse practitioner and a physician?

So there are actually more similarities than there are differences. We take care of the same patient population, generally, although our educational models are different. The nurse practitioner educational model is grounded in nursing and brings that aspect of care and compassion and those innate qualifications that made us want to really go into nursing. So the nurse practitioner education is grounded in nursing, and we advanced that nursing education with the clinical and medical side as well.

The patients we care for are the same. We're expected to meet the same standards of care and follow the same clinical guidelines and recommended treatment regimens for every disease and diagnosis.

Some states now allow NPs to practice without physician oversight. What are the advantages to this, and conversely, why are some people opposed to it?

Well, what you're talking about is full practice authority. Currently, 22 states, the District of Columbia, Indian Health Care Services, a couple of US territories and the VA Health Care services, all allow full practice authority for nurse practitioners. There's really no need or justification for the outdated regulatory model that requires nurse practitioners to practice with what we call a collaborative practice agreement. Or sometimes it's called supervisory language.

There is no medical evidence to support that the care is any different, that there are any safety concerns, and really, we're working towards retiring the outdated licensure requirements that still exists in those 28 other states.

In fact, since [the coronavirus disease 2019 (COVID-19) pandemic], started, 6 additional states have authorized full practice authority for nurse practitioners through the use of government-written mandates that allow NPS to practice to the top of their education and training without regulatory restrictions. And the reason for that is that we know that NPs will go to these surge areas and volunteer and bring themselves to go wherever the patient need is the greatest. When the COVID-19 numbers were serving surging in New York, nurse practitioners went to New York and volunteered to help care for those patients. And they were able to do that because there were no licensure requirements that said they had to be tied to a specific physician to do that.

Nurse practitioners collaborate with health care providers across the health care spectrum, every day, and we don't have written agreements with them. And so it's really an outdated licensure law with no real evidence to support the need that we need to continue to do that.

Can you elaborate more on an NPs role in cancer care?

Well, nurse practitioners that practice in oncology are an amazing part of the health care team. They bring their medical knowledge to the table but also that great compassion that is innate with them in their nursing careers and so not only do they care for patients and function as a very valuable part of the healthcare team and a use their knowledge and skills to educate patients and to work with families and do so much more than simply just patient care. It's about the patient relationship, making the patients comfortable, working them, guiding them through the whole process of having cancer.

Read more: Nurses Need a Seat at the Table: COVID-19 Task Force and Beyond

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