Granting NPs full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure during the pandemic. Nurses are likely to be an important healthcare workforce to help the nation recover from COVID and make health system changes necessary to address inequities that the crisis exposed. Today, NPs continue to have a critical role in delivering primary care services in rural and low-income areas and medically underserved urban communities that suffer from primary care shortages.
In these areas, the healthcare needs of the population far exceed what can be offered by the available number of healthcare providers U. The clinical consequences of living in HPSAs include a higher risk of under-diagnosis and suboptimal management of chronic diseases Durant et al. However, in states where full practice authority laws are in place, NPs are more likely to reside within HPSAs and have their own practices there, thus improving access to primary care for underserved populations DePriest et al.
Studies consistently demonstrate that expanding SOP policies to support the full practice authority of NPs helps increase access to high-quality healthcare Buerhaus et al. When supervision or collaboration is required under law, it creates unnecessary access roadblocks which NPs are forced to address to care for patients Xue et al.
These roadblocks range from extra time and effort to seek physician oversight to decreased access to care for patients in rural and underserved areas. Likewise, NPs are an especially critcial component of the primary care workforce in rural and low-income communities. NPs represent one in four providers in rural practices, and this proportion is even higher in states with full practice authority laws Barnes et al.
In one study, the average number of NPs serving rural communities increased from In the same study, among areas with the highest proportion of low-income residents, the number of NPs rose from Projections of primary care provider shortages are generally based on traditional healthcare delivery models and do not consider the potential of an expanded primary care role for NPs, a redesign of health care, greater utilization of telehealth, and other innovations Institute of Medicine, ; Institute of Medicine, ; National Academies of Science, Engineering and Medicine, To adequately meet the growing demand for primary care services and assure all Americans have access to high quality health care services will require fundamental shifts in the healthcare delivery system including expanding SOP regulations for NPs.
These changes do not require simple adjustments but a transformative rethinking of how to balance the uncertainty of crises with traditional methods of projecting workforce needs. Addressing the varied SOPs of NPs so that credentialing, education, and practice are more uniform across the country will be a fundamental and critical step for planning for both predictable and unpredictable scenarios in health care.
Numerous studies have documented the cost effectiveness of healthcare services provided by NPs Buerhaus, According to a recent systematic review of 11 studies, NPs in ambulatory care were cost-effective and had equivalent or better patient outcomes compared to other providers Martin-Misener et al.
A recent large-scale study using Veteran Affairs data found that the use of NPs and physician assistants as primary care providers for complex patients with diabetes was associated with less use of acute care services and lower total costs compared to physicians Morgan et al.
These findings suggest that expanding the role of NPs as primary care providers could result in savings to the Medicare program. Increased access to NP care can expand the primary care workforce and help address the increasing care needs of our aging population.
Other studies have shown that granting NPs full practice authority led to reductions in costs in some settings but certainly did not lead to systematic increases in costs Poghosyan et al. The NP workforce is capable of delivering high quality care and improving patient outcomes particularly among patients with chronic diseases. Multiple studies since then have evaluated the outcomes of NP care in several health care settings.
The results across the studies were consistent regarding the high quality of care delivered by NPs to diverse groups of patients across multiple settings. Comprehensive reviews of the literature also have made similar conclusions that the NP workforce is capable of delivering high-quality, safe care Horrocks et al. The evidence consistently demonstrates that NP-led primary care is of high quality, efficient, and comparable to physician-led primary care. A substantial body of research suggests that removing practice restrictions on NPs and granting NPs full practice authority has the potential to improve access to care without compromising quality or increasing costs Ortiz et al.
Thus, the SOP restrictions on NP practice are unnecessary and removing them has the potential to improve quality of care and patient outcomes. The regulatory and policy changes that have occurred as a result of COVID pandemic provide a pathway forward for promoting full practice authority for primary care NPs across the U.
These changes are occurring during the COVID pandemic when most clinicians are facing daunting challenges in establishing and maintaining safe clinical care. Post-COVID, we will need to optimally use all health care resources to ensure fair and equitable access to all healthcare but especially primary care.
Supporting full practice authority of NPs was brought forth by executive orders and will likely revert to pre-COVID regulations when the orders expire. Now is an important moment to make these changes permanent through legislative action. The Academy of Nursing has a strong record of providing effective nursing leadership to advance health policy and nursing practice to serve the health care needs of the public.
As such, COVID presents an opportunity for the Academy to continue this work by collaborating with other nursing organizations to support continued expansion of NP SOP to help address our nation's growing healthcare needs.
Furthermore, the Academy should engage other national associations e. A policy advocacy strategy should include priority engagement with the Centers for Medicare and Medicaid services, which has been a useful approach for advancing policy focused on expanding APRN privileges for elderly and disabled patients. Advocating for changes in CMS policies so that the most vulnerable in a pandemic or other crisis will have readier access to needed care.
Research has shown that NP practice can be more constrained by individual institutions than state SOP regulations Chapman et al. Institutional policies, procedures, and privileging systems can restrict NP practice by creating additional burdens such as requiring physicians to co-sign or review visit notes or hold more supervision sessions than required by state regulations Chapman et al.
The COVID waivers for full practice authority of NPs can provide the impetus and energy to examine and change internal barriers within practices to facilitate NP practice. Health care organizations must work toward the development of work environments that support NPs working at full practice authority and to ensure that they are able to deliver high quality care Poghosyan et al.
Practices must foster strong physician-NP relationships and ensure that NPs have proper visibility within their practices Poghosyan et al. Previous studies have shown persistently poor relationships between NPs and administrators who often do not have clear understanding about NP competencies or roles.
In addition, many practice administrators do not share organizational resources and information with NPs to support NP care delivery. Nursing leaders must invest in efforts to increase awareness among administrators about the NP role to ensure that regulations are well implemented within practices. While the evidence is clear about the positive impact of full practice authority for NPs on healthcare access with no adverse impact on quality or increased costs, more research is needed to continue further advocating for removing unnecessary state-level SOP restrictions.
Ongoing research will be needed to track the effects of full practice authority for NPs on patient outcomes after the pandemic. Researchers should design robust longitudinal studies to demonstrate the effect of SOP changes on patient access to care, outcomes, and cost of care. The temporary expansions of SOP regulation have created a window of opportunity for nurses to conduct APRN health outcomes studies to support policy changes.
Advanced practice nursing has proven itself to be one of the most flexible and versatile occupations within the primary healthcare workforce through the additional roles and responsibilities it assumes in a crisis. In the years since Florence Nightingale laid the groundwork for modern nursing, the nursing profession has reinvented itself a number of times as society and technology have changed Institute of Medicine, The removal of local, state, and federal restrictions on NP SOP represents the next chapter in nursing's evolution.
In contemporary collaborative models of practice, it is imperative that healthcare professionals practice to the fullest extent of their education and training to optimize the efficiency and quality of services for patients, especially those in underserved communities.
Such full practice authority will allow to create interprofessional collaborations and care delivery models to make transformative change.
The evidence is strong about the potential benefits of full practice authority for NPs in primary care. COVID highlighted the opportunities to expand the scope of practice policies to grant NPs full practice authority across federal and state governments and within healthcare systems.
Rather than reverting back to pre-pandemic restrictive laws, state policymakers should utilize the momentum created by the pandemic to permanently eliminate practice barriers.
Grant R. Amy L. National Center for Biotechnology Information , U. Nurs Outlook. Garrett K. Has PDF. Publication Type. More Filters. View 1 excerpt, cites background. Digging deeper: nurse excess or shortage? The effect on a new nurse. Journal of professional nursing : official journal of the American Association of Colleges of Nursing. Registered nurse supply grows faster than projected amid surge in new entrants ages Health affairs.
How new graduates can gain a competitive edge. Providing regional projections of the RN workforce will allow underlying differences in the age structure of the RN workforce to become more visible. By providing regional-level projections, it will … Expand. View 2 excerpts, cites background and results. Growing ambulatory care nurse leaders in a multigenerational workforce. A retrospective study of a nurse residency program and reports of job satisfaction, organizational commitment, and turnover.
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The following information is required and must be completed in order to submit a comment:. Thank You. Your comment submission was successful. Please allow up to 2 business days for review, approval, and posting. Nobody in the press is talking about Respiratory Therapists! Who do you think is managing the ventilator care? I know we have hospitalists, and pulmonary residents now that also can manage the vents, but when I worked nobody but RT's knew really how to run the vents.
But that's beside the point. The point is there is a third clinician that everyone overlooks and doesn't get "thank for your service" and is taking a huge risk! So, please at least mention us in your comments and if you have the chance, mention us to the press. Peter Buerhaus and colleagues articulate the dilemmas faced in deploying older clinicians to help tackle the surge of Coronavirus Disease COVID Experience on the front-line is always invaluable, but so also is the ability to strategically evaluate the battle from a distance.
Older clinicians are in the crucial position of being able to mentor younger clinicians, both in the fight against COVID, and also, in due course, in rebuilding many of the shattered services that have been put on hold as staff and resources are deployed into the front-line. The three pillars of mentoring: Support, Challenge and Vision will be extremely important in the coming months and years. It is vital that we carefully assess the risks involved in deploying our most senior clinicians into high-risk areas of front-line practice - the knowledge loss if we get the balance wrong in many cases will be irreplaceable.
The challenge is to harness the technological advances of the 21st century and enable the transmission of critical information from the front-line - and in doing this, help to ensure that we benefit from the knowledge of our senior clinicians, but with acceptable risk as we reduce the contact time they need to spend directly on the front-line.
What I find fascinating: not only are older physicians providing much of the care, but many are being persuaded to come out of retirement to help out.
I've yet to read anyone calling on nurse practitioners to go to bat. We've come off legislation implying that NPs are the future of medicine, are in many ways equivalent to physicians, and can direct their own practices. We've seen large numbers of physicians let go and replaced by NPs. I would guess that at least some chose to retire rather than seek other employment. Now's really the chance for those "equivalent" nurse practitioners to step up to the plate and show what they're made of.
Looking forward to their help! We should not forget the many other health professionals facing danger in the current situation. On Thursday last week, the ambulance service of the New York Fire Department answered over calls. While not on the same scale, the tens thousands of paramedics, EMTs and other healthcare professionals who answer emergency calls throughout the country are similarly exposed to potential COVID cases.
Many of these individuals are volunteers who perform this service from a sense of duty alone. The article is very timely and reflects the sentiments of thousands of physicians in the US and beyond. The sad news of Dr.
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