The State of the Nurse Practitioner Profession

In this highly political climate, and in recognition of Nurse Practitioner Week, I think it’s important that we take a minute to look at the state of the nurse practitioner profession in our country. What changes were made to scope of practice legislation in 2016? What changes can we expect on the horizon? Nurse practitioners’ ability to practice is highly dependent on state legislation. So, as NPs we must keep up to date with the latest in politics. How does the NP profession look in 2016?

There are a number of states that have made legislative changes to the nurse practitioner role this year, some more impactful than others. Overall, state legislators are voting to increase the scope of practice of NPs – a big win for the state of the nurse practitioner profession as a whole. Here’s a quick look at some of the state-to-state rulings that have helped (or hindered) this wave of momentum for nurse practitioners. 


Scope of Practice Scorecard: Loss

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Mid-March 2016, it became apparent that Arizona’s Senate Bill 1473 was dead. The proposed legislation would have granted nurse practitioners practicing in the state full scope of practice authority. Further lobbying efforts advocated for a paired down version of the bill, House Bill 2236, which changed some of the language by which nurse practitioners collaborate. The revised bill was too withdrawn when lawmakers could not come to a consensus as to what that language should look like. 


Scope of Practice Scorecard: Loss

A bill proposing nurse practitioner autonomy also fizzled in California. The bill was scheduled to be heard by an Assembly committee in July, but was pulled after the author of the measure, Senator Ed Hernandez, determined the bill would not have enough votes to pass. Nurse practitioners in California have resorted instead to updating the regulations surrounding nurse practitioner education and qualifications for certification. While the proposed changes do not affect scope of practice, the California Board of Nursing believes the measure is much needed to modernize certification standards. 


Scope of Practice Scorecard: Win

Among a few other favorable legislative changes, nurse practitioners may now apply for independent practice in Delaware after practicing in an ‘integrated’ clinical system for at least two years, and a minimum of 4,000 hours. An integrated clinical setting is defined as one with collaboration between a physician or licensed Delaware healthcare delivery system, and an advanced practice nurse. 


Scope of Practice Scorecard: Win 

Notorious for restrictive scope of practice regulations, Florida NPs enjoyed a major victory in 2016. Legislation signed by the state’s governor goes into effect in January 2017 and will allows nurse practitioners to prescribe controlled substances. Finally!


Scope of Practice Scorecard: Win

Lawmakers in Illinois recently passed Public Act 99-0173. The Act clarifies that nurse practitioners do not need a collaborative practice agreement if scope of practice and prescriptive authority are outlined in the clinical privileges given to the NP by a hospital or affiliate. The Act also eliminates the requirement for monthly physician consultation, unless a Schedule II controlled substance is prescribed. 


Scope of Practice Scorecard: Win

Chapter 468, passed in Maryland, modified the state’s collaborative practice requirement for nurse practitioners. The ruling removed the mandate for widespread collaborative practice, reducing the required collaboration period to just 18 months with a physician mentor for NPs who have not been certified as nurse practitioners by any board of nursing. 


Scope of Practice Scorecard: Win

Michigan nurse practitioners are one step further on the path to autonomy. House Bill 5400 passed unanimously in September in the House Health Policy Committee. The bill, which would make prescribing laws more favorable, as well as allow nurse practitioners to prescribe physical therapy and speech therapy, is awaiting further consideration by the state House of Representatives. 


Scope of Practice Scorecard: Win (ish)

Despite updated regulations stating that nurse practitioners may practice within 75 miles of a collaborating physician rather than the previous 15, NPs in the Mississippi continue to practice in a restrictive environment. The Mississippi Legislature opted not to move forward with a proposed bill that would have allowed nurse practitioners with 3,600 hours of clinical practice to work under less restrictive guidelines. 


Scope of Practice Scorecard: Win

Senate Bill 717, which grants nurse practitioners graduated practice authority, overwhelmingly passed in the Pennsylvania Senate this year. The Bill requires that NPs work under a collaborative agreement with a physician for a three-year, 3,600 hour transition period after which they would have full practice authority. 

West Virginia 

Scope of Practice Scorecard: Win

After a nine-year legislative showdown, West Virginia has become the 22nd state to allow nurse practitioners to practice independently. HB 4334 was signed into law on March 27, 2016, and removes the restrictive requirement for a collaborative agreement with a physician. The bill also allows NPs more prescriptive freedom. 

What does the 2016 state of the nurse practitioner profession look like in your location? 

Happy Nurse Practitioner Week!


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