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Expansion of Nurse’s Scope of Practice

As the Affordable Care Act increased the number of Americans with health insurance, the demand for care increased with it. Before long, it became clear that a need for practitioners capable of meeting the needs of this new demand exists, especially in rural areas, where the nearest physician may be a significant distance away.

The number of physicians in the United States hasn’t kept up with the increase in patient volume from the ACA coupled with the increase in physician demand due to population growth. According to the Association of American Medical Colleges, the supply of physicians will increase through 2025, but the demand for them will grow more steeply during the same period.

By 2025, the AAMC estimates there will be a shortage of somewhere between 12,500 and 31,100 primary care physicians, and a shortfall of between 28,200 and 63,700 non-primary care physicians.

To address this, some states, most recently Florida and West Virginia, have expanded the role of nurses with graduate level education. Advanced Practice Registered Nurses (APRNs) are now able to administer a wider range of care and prescribe many drugs without supervision from a doctor.

In order to do this, legislators around the country are being forced to consider relaxing long standing regulations known as “scope of practice” laws that prevent nurses from taking the lead role in providing health services.

Opposition to these changes often come from physician groups, according to Kaiser Health News. These organizations argue that nurses do not possess the training necessary to safely diagnose, treat, refer to specialists, admit to hospitals and prescribe medication for patients without being supervised by a physician.

Currently, 23 states and the District of Columbia allow APRNs full scope of practice privileges, meaning they can perform all of the aforementioned tasks. APRNs operating in these states are able to establish their own independent practices, much like a physician would.

Across the country, APRNs are gaining more traction as healthcare providers, but knowing the extent of the scope of practice is important for those taking on the extra challenge. To do this effectively, APRNs need to follow these steps:

  • Identify the issue and subsequent tasks — After clarifying a patient’s issues, nurses need to look at the healthcare facility’s policies and standard procedures, as well as their own documented competencies, to ensure that it’s OK for them to complete the task. If there is uncertainty, it’s important to consult an appropriate supervisor first and, if needed, obtain assistance.
  • Study laws, rules and standards — Just because something is commonplace at a healthcare facility does not mean it is legal. Working outside the scope of practice or inappropriately delegating work to another person has serious ramifications for an APRN, including disciplinary actions and medical malpractice claims filed by a state’s nursing board.
  • Self-determination — After considering all of the elements, nurses then have to decide if they are willing to proceed with treatment actions, accepting responsibility for the outcome of their decisions, good or bad. Having documented competency in the skills required is very important, but good judgement is more than just a piece of paper. A nurse’s view of scope of practice may change over time, but must remain focused on safe, high-quality, evidence-based care for their patients.
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