Support for Expanded Scope of Practice for Nurse Practitioners

Some individual physicians support expanded scope of practice for NPs. The Robert Wood Johnson Foundation Nursing Research Network (described in Appendix A) conducted a survey of 100 physician members of the online physician site Sermo.com20 and found that more than 50 percent of respondents agreed either somewhat or strongly that “allowing NPs to practice independently would increase access to primary care in the U.S.” (RWJF, 2010e). As Figure 3-4 shows, however, physicians were more skeptical that expanding NPs’ scope of practice in this way would decrease costs, and they feared a decrease in average quality of care provided to patients.

In addition to support for expanded scope of practice for NPs among some physicians, public support for NP practice is indicated by satisfaction ratings for retail-based health clinics. Approximately 95 percent of providers in these clinics are NPs, with the remaining 5 percent comprising physician assistants and some physicians.21 According to a survey of U.S. adults by the Wall Street Interactive (Harris Interactive, 2008), almost all respondents who had used a retail-based health clinic (313 total) were very or somewhat satisfied with the quality of care, cost, and staff qualifications (see Figure 3-5). Such public support can be backed up with high-quality clinical outcomes (Mehrotra et al., 2008).

Despite opposition by some physicians and specialty societies, the strong trend over the past 20 years has been a growing receptivity on the part of state legislatures to expanded scopes of practice for nurses. There simply are not enough primary care physicians to care for an aging population now, and their patient load will dramatically increase as more people gain access to care. For example, in 2007 Pennsylvania Governor Edward Rendell announced a blueprint for reform, known as Prescription for Pennsylvania (Rx for PA), to promote access to care for the state’s residents and reduce health care expenses (see the case study in Chapter 5). One initiative under Rx for PA was expanding the legal scope of practice for physician assistants, APRNs, CNSs, CNMs, and dental hygienists. This initiative has had an important impact on access to care. Outcome data after the first year of Rx for PA show an increase in the number of people with diabetes receiving eye and foot examinations and a doubling of the number of children with asthma who have a plan in place for controlling exacerbations (Pennsylvania Governor’s Office, 2009).

The experience of states that have led these changes offers important reas-

20 respondents are all members of the online community members are distributed across age, gender, geography, and specialty groups in patterns that mimic those of the U.S. population. For this study, respondents were randomly recruited to participate in the IOM survey activity via e-mail; others were allowed to join the survey by volunteering when they visited the site. The majority of respondents have specialties in cardiology (6 percent), family medicine (35 percent), internal medicine (26 percent), and oncology (4 percent). The remaining physicians surveyed are distributed across a wide range of specialties.


Personal communication, Tine Hansen-Turton, CEO, National Nursing Centers Consortium, and Vice President, Public Health Management Corporation, August 6, 2010.

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