Friday, September 21, 2012

Repost: Different States, Different Rules

One of the biggest areas of frustration for students, stakeholders, and nurse practitioners are the seemingly lack of consistency among state regulations regarding NP practice. The rules in one state may not necessarily apply in the next (and even neighboring state). I have known NPs that lived near state borders, licensed in both states, yet had completely different sets of rules regarding what they can/can't do, requirements for collaboration versus autonomy and prescribing ability.

Barton Associates created this free interactive tool that lets you visually compare all 50 states' (plus DC) NP scope of practice. It is ultra handy and can help one decide whether to practice in one state that is very prohibitive compared to one that offers autonomy.

 There is also a push for the APRN Consensus Model whose aim is to have consistency among the states when it comes to regulations.  

 If moving out of the state isn't feasible, well, the alternative is to become involved, active, and supportive of  a national and local  nurse practitioner organization (it is helpful to be supportive whether your state is autonomous or not since there are constant threats to your practice!)

 An example of the advocacy that membership affords was evidenced this past week. The American Academy of Family Physicians (AAFP) put out their white paper, "Primary Care for the 21st Century." I looked forward to reading this report based on the title and hoped that I would find innovation and new ways of enhancing care for our patients based on the primary care model. To my surprise (and dismay), I found myself reading the executive summary and seeing terms like "nurse practitioners are not doctors"   and "the ideal practice ratio of nurse practitioners to physicians is 4:1" and on. Huh? "How is this a report about primary care?" I thought.

 Then I realized that it wasn't, it was an attack on a profession by another wrapped in a pretty looking monograph with old data. It might as well have been called "Lets Denigrate the NPs Under the Auspices of Solving the Ills of the Health Care System Report." At least I would have known what to expect.

 To be completely honest, I really couldn't read it beyond the executive summary (I looked at the Table of Comments and further became ill). Luckily, one of our national NP organizations (the AANP) did read the whole thing (I am unsure if they became ill or not) and responded. Here is one of the benefits of advocacy for nurse practitioners that benefits all nurse practitioners.

 All areas of the health care sector must better work together to achieve outcomes that are truly patient-centric. Do reports like the one referenced above help? I am highly doubtful. We have real issues to deal with and turf wars will continue to distract from them.

This post was first published at Online Nurse Practitioner Programs


PediNP said...

Nice response. I had trouble getting through the statement myself, but I wanted to respond to it. Like I said in my blog post, the AAFP would be better served using their energies to expand their numbers, if that is their concern, rather than tearing us down. Why are we such a threat? Could it be...we do a good job?

Anonymous said...

I agree. I am a new grad NP and have heard everything from NP being called "meat momovers" to physicians speaking about their NP's and PA's like they own them. Recently in a coorporate lunchroom the cashier said "Oh yes your lunch is covered it says MD you are a real doctor." While as a provider my meal was not covered. I find all of this so very frustrating as a young professional and find the general lack of respect disheartening. Often wondering why I decided to make the move into the NP role.

Anonymous said...

Without NP's,family medicine will still be at war. What NP's are to Family medicine is what family medicine is the other specializations, competition. For is'nt it true that family medicine itself intrudes on the roles of other specialties? Family medicine is supposed to be able to care for patients, "throughout the lifespan." This effectively steps on the toes of adult medicine, pediatrics, OBG, and others. Where does family medicine draw the line? As so called mid-level providers, we need to focus on strengthening our place in patient, and cease worrying about what some MD's think. They will always find somethingbto gripe about anway. It's human nature.

Health Connect said...

Great point, this is something critical that nurse practitioners should pay attention to when considering job locations as well. I've been a nurse practitioner recruiter for many years and advise job candidates on these complexities on a daily basis.