professionals, it also wishes to note why and how the federal government can play an important role in this arena.

The primary reason the federal government has a compelling interest in state regulation of health professionals is the responsibility to patients covered by federal programs such as Medicare and Medicaid. If access to care is hindered, if costs are unduly high, or if quality of care could be improved for these millions of patients through evidence-based changes to the ways in which professionals may practice, the federal government has a right to explore the options and encourage change. An additional reason is the federal government’s unique perspective—somewhat removed from that of the individual states—enabling it to shed light on the value and benefit to all Americans of harmonizing practice regulations among the states.

Certain federal entities may both defer to the states in adopting their own practice regulations and encourage the adoption of regulations that are consistent with current clinical evidence and comparable across the country. Congress, CMS, OPM, and the FTC each have specific authority or responsibility for decisions that either must be made at the federal level to be consistent with state efforts to remove scope-of-practice barriers or could be made to encourage and support those efforts. While no single actor or agency can independently make a sweeping change to eliminate current barriers, the various state and federal entities can each make relevant decisions that together can lead to much-needed improvements.

In addition to regulatory barriers, cultural and organizational barriers constrain nurses’ ability to identify solutions and implement them quickly, knowing that patients’ lives and well-being are at stake. Moreover, an important priority in national health care reform is achieving better value for the expenditures made on health care services. Since health care is labor intensive, getting more value from the health care system will depend in large part on enhancing the productivity and effectiveness of the workforce. Nurses therefore represent a large and unexploited opportunity to achieve greater value in health care.

The committee believes that any proposed changes in the responsibilities of the nursing workforce should be evaluated against their ability to support the provision of seamless, affordable, quality care that is accessible to all. In particular, the committee argues that now is the time to finally eliminate the outdated regulations and organizational and cultural barriers that limit the ability of nurses, including APRNs, to practice to the full extent of their education, training, and competence. The committee also believes that nurses must be allowed to lead improvement and redesign efforts (see Chapter 5).

Specifically, in order that all Americans may have access to high-quality, safe health care, federal and state actions are required to update and standardize scope-of-practice regulations to take advantage of the full capacity and education of nurses. Cultural and organizational barriers should also be eliminated. States and insurance companies must follow through with specific regulatory,



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