NCPA - National Center for Policy Analysis

Nurse Practitioners Fight for the Right to Treat Patients

August 19, 2013

Nurse practitioners (NPs) in five states are fighting for the right to treat patients without oversight from doctors, as they can in many parts of the country. The battle is particularly fierce in California, where a bill that would let some nurse practitioners do their work independently passed a key legislative committee this week. California doctors strenuously oppose the idea, arguing that it could jeopardize patient safety, says the Wall Street Journal.

Other non-physician health professionals around the country also are lobbying to expand their roles, citing the shortage of doctors in some areas and the expected onslaught of millions of patients newly insured under the Affordable Care Act next year.

  • Unlike physician assistants, who are licensed to practice under a doctor's supervision, NPs (who have more training and education than registered nurses) can serve as patients' primary health providers.
  • NPs are trained to examine, diagnose and treat patients, manage acute and chronic illnesses, and can prescribe medications, including controlled substances, in all 50 states.

But states vary widely on how much physician oversight NPs must have.

  • In 17 states and the District of Columbia, NPs can set up practices and treat patients autonomously.
  • Twelve states require them to be supervised, to varying degrees, by a physician or other health authority.
  • In the remaining 21 states, NPs must have a "collaborative" agreement with a physician. Those can vary widely, from stipulating what percentage of patient charts a doctor might review to which tests NPs can order.

In California, the bill that would let NPs practice autonomously passed the state Senate in May. Advocates say the state needs their skills, because only 16 of the state's 58 counties have sufficient primary-care doctors, according to federal surveys. But the California Medical Association, representing some 37,000 doctors, has spent more than $1 million to defeat the bill, arguing that allowing NPs to open practices without physician oversight would "ultimately harm patients and decrease quality of care."

Proposed legislation that would grant NPs full practice authority also is pending in Pennsylvania, Michigan and Massachusetts, while a bill in New Jersey would give NPs autonomy after two years of collaboration with a physician or other advanced-practice nurse.

Source: Melinda Beck "Nurse Practitioners Seek Right to Treat Patients on Their Own," Wall Street Journal, August 14, 2013.


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