December 28, 2016

There has been a huge gap between the healthcare demands and the availability of Primary Care providers in the United States. Following the passage of the Affordable Care Act, hundreds of thousands of citizens are now seeking healthcare facilities offered by the government which leaves an even further gap in the number of available Primary Care Providers. The main objective -to provide quality healthcare facilities at reasonable prices- can be met by ramping up the type and numbers of providers manifold.

In order to deal with the growing number of consumers medical professionals nationally pointed the spot light on the Nurse Practitioner Program which was formed in 1965 and has rapidly advanced in the last 52 years allowing Nurse Practitioners to act as Primary Care Providers. Several studies have proven that NPs provide dependable high-quality care, at par with physicians. However, most initiatives that empower NPs have been debated by physician organizations on the grounds that lower levels of education for NPs make them unqualified for patient care independently. There are a lot of arguments to the contrary indicating since NPs or Midlevel providers must obtain Certification and a Masters Level education and complete Clinical Rounds of the same caliber (but not the same length) as a Physician they should be afforded the same autonomy and freedom. Additionally as our Medical Climate changes additional Certification and Advanced Education and Subspecialties are now available to NPS. One example is the DNP (Doctor of Nursing Practitioner), however, they have the same advanced primary, acute and specialized training as NP with the exception that they are typically more often in an Education or Scientific environment and have their education finely tuned to include more investigative and Administrative routes.

In the United States, each state decides the scope of treatment that can be provided by nurses. The state can choose to give NPs the full right to provide care to patients, making them equivalent to physicians, or severely restrict their ability to do so. An intermediate degree of practice can also be allowed by the state governments. Note, however, that Blue Cross Blue Shield does not allow nurse practitioners to practice independently, no matter which state they are in. Here, we bring to you the major laws and regulations set by the states with regard to NPs.

Presently, 21 states and the District of Columbia grant Full Practice status to NPs, which according to the American Association of Nurse Practitioners means that “State practice and licensure laws provide for nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the of the state board of nursing.” Please note that each of these states have their own individual rules but as a “Commonality” all require a Collaborative Agreement to be filed with the state. A Collaborative Agreement means that a Doctor of Medicine (MD) agrees to practice in collaboration with the Nurse Practitioner to review records once per month or as required by each state. Additionally, depending on the state there may be a requirement for a Nursing Protocol which defines what acts or procedures a Nurse Practitioner will be allowed to perform based on their agreement with the Collaborating Physician Provider. Nurse Practitioners may also prescribe “legend” drugs as long as they follow the guidelines approved by the board of nursing which are also referenced in the Nursing Protocol. This means the provider can also hold a DEA License. The following states allow full practice authority to NPs:

  • Alaska
  • Arizona
  • Colorado
  • Connecticut
  • District of Columbia
  • Hawaii
  • Idaho
  • Iowa
  • Maine
  • Maryland
  • Minnesota
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Mexico
  • North Dakota
  • Oregon
  • Rhode Island
  • Vermont
  • Washington
  • Wyoming

The intermediate level of Reduced Practice states that “State practice and licensure law reduces the ability of nurse practitioners to engage in at least one element of NP practice. State law requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care or limits the setting or scope of one or more elements of NP practice.” The Reduced Practice norms apply to the states of:

  • Alabama
  • Arkansas
  • Delaware
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Mississippi
  • New Jersey
  • New York
  • Ohio
  • Pennsylvania
  • South Dakota
  • Utah
  • West Virginia
  • Wisconsin

Finally, the Restricted Practice means that “State practice and licensure law restricts the ability of a nurse practitioner to engage in at least one element of NP practice. State requires supervision, delegation, or team-management by an outside health discipline in order for the NP to provide patient care.” This means there must be a Medical Physician (MD) on the site at the time the Nurse Practitioner is actively seeing patients. The states that adhere to the Restricted Practice policy are:

  • California
  • Florida
  • Georgia
  • Massachusetts
  • Michigan
  • Missouri
  • North Carolina
  • Oklahoma
  • South Carolina
  • Tennessee
  • Texas
  • Virginia

With the rapidly growing state legislature in place we will find in the next 5 years that all Nurse Practitioners will be able to practice independently and will be able to open their own Group Practices. If you need assistance in setting up your practice, negotiating insurances, applying for State or DEA Licensing then CredAxis is your source for all of your Credentialing Needs. We will continue to bring education and news to all providers to bridge the gap on a national level.

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