Linda J. Pearson, DNSc, FPMHNP-BC, FAANP
Family Psychiatric Mental Health NP
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For the past 22 years, I have written an annual report that summarizes nurse practitioner legislation in each state. This annual report includes a review of pertinent state legislation and of rules and regulations that affect NPs, along with pertinent government, policy, and reimbursement information. The report continues to be widely disseminated, discussed, and utilized to promote legislation to allow NPs to practice to their full potential..
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This 2010 Pearson Report Summary presents an overview of all 50 states and the District of Columbia in five areas: whether a Doctorate NP can legally be addressed as Dr, which NP titles are legally recognized, whether physician involvement is required for NP diagnosing and treating, whether physician involvement is required for NP prescribing, and whether any expansion in the NP SOP occurred in 2009. Consistent with the trend observed over the past 30 years of legislative or regulatory SOP role expansion for NPs, the following states succeeded in obtaining various degrees of additional SOP expansion: ALABAMA, ALASKA, ARIZONA, CALIFORNIA, COLORADO, FLORIDA, GEORGIA, HAWAII, IDAHO, KENTUCKY, LOUISIANA, MAINE, MISSISSIPPI, MONTANA, NEW HAMPSHIRE, NEW JERSEY, NEW MEXICO, NEW YORK, NORTH DAKOTA, OHIO, OKLAHOMA, OREGON, PENNSYLVANIA, RHODE ISLAND, SOUTH DAKOTA, TENNESSEE, TEXAS, UTAH, VIRGINIA, WASHINGTON, and WEST VIRGINIA.
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On first inspection of these ratios, skeptical observers might challenge that (1) MDs and DOs handle riskier cases; (2) MDs and DOs have a broader SOP than do NPs; and (3) the total numbers of providers on which these ratios are based may not be accurate. Responses to these arguments are as follows: (1) Although many DOs and MDs handle a difficult caseload, one cannot discount the fact that a broad, deep, and consistent difference exists in the number of reported malpractice events (and HIPDB occurrences) among the providers, a difference that cannot be fully explained by difficulty of cases (also, NPs are practicing independently in increasingly stressful, complicated, and difficult positions and situations); (2) At the very least, these solid NP safety ratios demonstrate that the requirement for NPs to have physician supervision for safetys sake is baseless; and (3) The lack of precision regarding the number of active providers likely applies evenly across all three professions.
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NPs must use these malpractice and malfeasance ratios and figures to show legislators that the rationale for physician supervision over NPs is unfounded.
NPs have been providing safe, top-notch primary care for decades. As FactCheck.org has explained, humans tend to cling to previously held beliefs and reject or ignore new ideas offered by a new person. This propensity undoubtedly explains, at least in part, why healthcare policy analysts sometimes exclude NPs from serious discussions about healthcare reform and problems related to the lack of primary care providers. NPs must remind all policymakers of their value in helping solve the nations healthcare crisis. As President Obama persuasively articulated, "Yes We Can!"
NPs must continue to strive to remove statutory restrictions that prohibit NPs with earned doctorates from being addressed as doctor." Many states have no requirement that doctorally-prepared NPs declare or clarify that they are NPs, and I also commend those states that have legislatively allowed qualified NPs to be addressed as doctor in the clinical setting as long as these doctorally-prepared NPs clarify that they are NPs. My concern centers on the eight states Arkansas, Connecticut, Georgia, Maine, Mississippi, Ohio, Oklahoma, and Oregon that have statutory restrictions against doctorally-educated NPs being addressed appropriately as Doctor NP. Kudos to Iowas NPs and legislature, who removed this legislative restraint in 2008.
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Conclusion
Nurse practitioners, as part of the nursing profession, rate among the most trusted healthcare providers because we have earned consumers trust. NPs must continue our crusade to increase NPs legislatively sanctioned autonomy. Lack of NP practice autonomy robs citizens of a solution to some of the nations worst healthcare problems: access, quality of care, and affordability.
In 2009, 31 states reported some degree of an expanded legislative or regulatory NP SOP (See Summary Table 1). This number is up from 22 states that expanded their NP SOP in 2008 and 19 states that did so in 2007. We are moving in the right direction. The road map has been created by the Consensus Document to guide future regulatory directions. We must continue to encourage our legislators to do what is best for our nationremovingallbarriers to autonomous NP practice.
Nurse practitioners are powerfully important healthcare providers who are available to help our nation improve its healthcare outcomes and lower healthcare costs. We are almost 160,000 strong! One unwavering, fervent goal continues forThe Pearson Reportthat NPs will share this annual updated legislative information with their legislators to help promote the truth that NPs are safe, competent, accessible, affordable, and high-quality healthcare providers. Barriers to fully autonomous NP practice mustbe removed to afford our citizens the care they deserve and desire from nurse practitioners.
