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Article
Nurse Practitioners Challenge AMA on Practice Authority, Care Access
Challenging the Nurse Practitioner Role on Practice Authority
An article in the media that was published by Heath (2020) in the Patient Engagement HIT periodical reports how nurse practitioners are challenging the American Medical Association on full practice authority. (Heath, 2020). This is a significant claim especially at a time when there is a current shortage of healthcare workers, especially advanced practice providers to administer care for those vulnerable patients lacking access to basic healthcare services. (Chesney, 2017). Full practice authority (FPA) means that physician involvement is not required for a nurse practitioner to administer such care, and that NP practice is determined by “the sole authority of the state Board of Nursing.” (Brom, Salsberry, & Graham, 2018). Chesney (2017) suggests that the movement for states to realize the seriousness of the matter would be a very long and slow process, especially with the complicated politics and lobbying involved with passing state legislations. (Chesney, 2017). Furthermore, the direct opposition by specific organizations such as the American Medical Association, is inhibiting this progression. (American Medical Association, 2021) There is also an article posted on the American Medical Association’s website claiming that expanding APRN scope of practice, in their perspective, is a bad idea. (Robeznieks, 2020). The article follows to claim that expanding the scope of nurse practitioners would somehow drive higher healthcare costs and lead to decreased patient safety, who would otherwise benefit from the care administered by a physician led team. (Robeznieks, 2020). The AMA (2021) also claims that they have demonstrated that the expansion of scope of nonphysician providers, including nurse practitioners, does not expand access to care for patients. (American Medical Association, 2021). The AMA (2021) further suggests that even though the numbers of nurse practitioners are increasing across the United States, healthcare shortages are still persistent, even in full practice authority (FPA) states with nurse practitioners that maintain full independent practice. (American Medical Association, 2021).
However, in opposition to these unfounded claims, an open letter from the American Association of Nurse Practitioners (AANP) (2019) was drafted by Dr. Sophia L Thomas DNP, the AANP President. (Thomas, 2020). As president she advocates for nurse practitioners in moving towards full practice authority, and contests the claims made by the AMA. (Thomas, 2020). To address the direct opposition and claims made by the AMA, the AANP counters that by adopting FPA for NP’s, this effort can actually improve access to care, by creating more healthcare providers available especially in diverse, minority, underserved, vulnerable, and rural communities. (American Association of Nurse Practitioners, 2022). Furthermore, in a study reported by Plemmons et al., (2022) their research has found that even though there is an underrepresentation of nurse practitioners from “communities of color” their analysis suggests that states without FPA do not have high representation of a diverse set of nurse practitioners relative to the population. (Plemmons, et al., 2022). Thus, by expanding nurse practitioner FPA, we may forecast that there will be an increase in the number of minority representation of care by nurse practitioners. (Plemmons, et al., 2022) The AANP also counters with an assertion that FPA will help to decrease costs by avoiding duplication of services and excessing billing practices associated with physician oversight, repetitive orders, and excessive office visits and services, that have affected states that did not adopt FPA. (American Association of Nurse Practitioners, 2022). Furthermore, to counter the AMA’s stance on decreased patient safety, the AANP claims that FPA will increase safety by streamlining care and making care deliver more efficient, which leads to safe patient outcomes. (American Association of Nurse Practitioners, 2022). FPA will essentially decrease delays in care and outdated healthcare delivery practices. (American Association of Nurse Practitioners, 2022).
Dr. Thomas also clears up any rhetoric that the AMA is suggesting in slanderous media campaigning that NPs are promoting a tagline of “brain of a doctor, heart of a nurse.” (Thomas, 2020). Also addressed in the open letter, Thomas (2020) has reported that nurse practitioners across the nation have provided care to billions of patient visits each year, which have been safe, expanded access, and was of high quality. This would not have been possible without the support of passing of expanded practice authority of more than 22 states including the capital. (Thomas, 2020). Brom et. al, (2018) also adds that influencing the conversation of full practice authority would not only benefit nurse practitioner, but it would also help to spread a broader understanding of its importance in society, in order for legislative change and public interest to shift in its progression. (Brom, Salsberry, & Graham, 2018). Brom also claims that “by remaining organized as a profession and consistently framing the need for FPA with regard to patients’ needs, NPs will continue to make progress in achieving FPA in all 50 states”. (Brom, Salsberry, & Graham, 2018).
References
American Association of Nurse Practitioners. (2022, October 1). Issues at a Glance: Full Practice Authority. Retrieved from American Association of Nurse Practitioners: https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief
