APNs, who have a proven track record of providing needed care across a range of patient populations and practice settings—and this in spite of the regulatory obstacles with which they have had to contend. Freeing APNs from the unnecessary constraints I have identified (which are at bottom nothing more than the historical artifacts of medical preemption) will achieve two important objectives. First, it will better enable Americans, wherever they are situated, to receive muchneed health services at a cost they can afford. Second, it will begin to remedy the systemic unfairness that has distorted many aspects of the healthcare delivery system, and will serve as a model for comprehensive reform of our entire regulatory framework by focusing on the evolving ability and competence of all providers rather than on rigid proprietary prerogatives.


AAFP (American Academy of Family Physicians). 2010. Colonoscopy (Position Paper). http://www.aafp.org/online/en/home/policy/policies/c/colonoscopypositionpaper.html.

AAHC (Association of Academic Health Centers). 2008. Out of Order, Out of Time: The State of the Nation’s Health Workforce. Washington, DC: AAHC. http://www.aahcdc.org/policy/AAHC_OutofTime_4WEB.pdf.

AAP Committee on Pediatric Workforce. 2003. Policy statement on scope of practice issues in the delivery of pediatric health care. Pediatrics 111(2):426–435.

AMA (American Medical Association). 1998. Staff privileges E-4.07. In: AMA policy compendium. Chicago, IL: AMA.

AMA. 2006. Board of Trustees Report 24—A-06, Subject: Limited Licensure Health Care Provider Training and Certification Standards. http://www.ama-assn.org/ama1/pub/upload/mm/471/bot24A06.doc

Anderson, J. 2009. AAP plans to clarify role of nurse practitioner. Pediatric News 43(4):1.

APRN Consensus Work Group and National Council of State Boards of Nursing APRN Advisory Committee. 2008. Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. https://www.ncsbn.org/7_23_08_Consensue_APRN_Final.pdf.

ASA (American Society of Anesthesiologists). 2004. The Scope of Practice of Nurse Anesthetists. http://www.asahq.org/Washington/nurseanesscope.pdf.

Dower, C. 2008. Pulling regulatory levers to improve health care. In From Education to Regulation: Dynamic Challenges for the Health Workforce, edited by D. E. Holmes. Washington, DC: Association of Academic Health Centers.

Eiber, C. E., P. S. Hussey, M. S. Ridgely, and E. A. McGlynn. 2009. Controlling Health Care Spending in Massachusetts: An Analysis of Options. Santa Monica, CA: RAND Corporation. www.rand.org.

Engelberg Center for Health Care Reform at Brookings. 2009. Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth. Washington, DC: The Brookings Institution.

Finocchio, L. J., C. M. Dower, N. T. Blick, C. M. Gragnola, and the Taskforce on Health Care Workforce Regulation. 1998. Strengthening Consumer Protection: Priorities for Health Care Workforce Regulation. http://futurehealth.ucsf.edu/Public/Publications-and-Resources/Content.aspx?topic=Strengthening_Consumer_Protection_Priorities_for_Health_Care_Workforce_Regulation.

Freidson, E. 1970. Profession of Medicine: A Study of the Sociology of Applied Knowledge. Chicago: University of Chicago Press.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement