Nursing is one of the most influential disciplines in medicine. According to the National Council of State Boards of Nursing, the current agenda among many nursing advocates is to promote a uniform scope of practice. By encouraging all state boards to adopt the Consensus Model for APRN Regulation, the American Association of Nurse Practitioners (AANP) hopes to increase health care quality among underserved populations. While sticking points vary among state legislatures, the following nine laws and regulations exemplify a few of the issues in question.
Issue 1: The Authority of Nurse Practitioners (NPs) to Certify Patients as Home Health Care Eligible
Medicaid authorizes nurse practitioners to refer patients to specialists only with physician approval. The physicians must provide documentation, even if they did not participate in the exam. AANP believes that rescinding this regulation will improve access to specialty home medical care.
Issue 2: Promoting Access to Diabetic Shoes Act
The current diabetic footwear approval process, which requires physician intervention, takes undue time. The delay increases the cost to deliver service, causes unnecessary discomfort and puts patients at risk. As such, the AANP lobbies for NP authority to independently certify the need for patient diabetic footwear.
Issue 3: Current Medicaid Incentives Exclude Nurse Practitioners
In the past, Medicaid has come under fire for issuing lower incentives than Medicare, an issue that legislators have since resolved. However, independent nurse practitioners do not qualify for any incentives, thereby rendering the program ineffective for communities serviced by private practice NPs. The AANP recommends Congress include independent NPs in the Medicaid incentive scheme.
Issue 4: The Authority of NPs to Certify Hospice Care
Current regulations allow nurse practitioners to recertify patients for hospice care, but NPs cannot issue initial certifications. For this, a physician must assess patients at additional costs. The AANP appeals to Congress to authorize NPs to conduct Medicare-eligible initial hospice care assessments.
Issue 5: Medicare Approval for Independent Nurse Practitioner Medical Staff Participation
Medicare excludes NPs from participating in managed hospital teams, effectively eliminating nurse specialists for consideration in primary care roles. A national uniform practitioner assessment system that considers NPs for service will benefit patients and service providers. As such, the AANP promotes Medicare NP certification to provide timely patient care and allow nurse specialists to compete in the health insurance marketplace.
Issue 6: Funding for Nurse Education
Curtailing the impending nursing shortage requires ongoing educational funding that is critical for the survival of medical training programs. To support community wellness, legislators must protect these programs from spending cuts. The AANP recognizes that advanced practice training, clinical training, and nurse educator programs require continued fiscal support to serve America’s growing health care needs.
Issue 7: Stalled Veteran’s Administration NP Practice Scope Expansion
The Veteran’s Health Administration (VHA) and Congress have let plans stall that would allow nurse practitioners to deliver more comprehensive medical services to veterans. More than 5,000 independent NPs deliver primary health care services to U.S. veterans throughout the VHA network. The organization is well aware of scientific studies that prove that NP service is as effective as physician treatment. Resuming the process of expanding the scope of NP practice among VHA services will improve health care access for our country’s veterans.
Issue 8: Medicare Excludes Independent NPs From ACO Participation
Although Medicare recognizes independent nurse practitioners as Accountable Care Organization professionals, the agency does not accept independent NP clients into ACO programs, requiring a physician to reassess patients before admittance. Medicare also prohibits qualified NPs from leading, designing, managing or operating a patient-centered medical facility. Amending this law will save time and expenses.
Issue 9: Medicare Limits NP Practice in SNF Facilities
Medicare does not authorize nurse practitioners to conduct admission exams or monthly assessments at skilled nursing facilities (SNFs). NP certification at SNF facilities will increase the resources available to nursing home patients.
Nurse Practitioner regulations typically originate from the Nurse Practice Act and various state nursing boards.  The American Nurses Association reaffirms that where the Nurse Practice Act only offers vague direction, state regulatory boards provide opinions on an as-needed basis. Because these interpretations vary, it is important that NPs understand the exact scope of practice as applied in their service areas. This information is available from:
- Nursing associations
- State nursing boards
- The AARP Foundation
- The American Association of Nurse Anesthetists (AANA) State Government Affairs Division
- The Citizen Advocacy Center
- The Pearson Report
The role that nurse practitioners play in patient well-being requires them to advocate for change while evolving with the medical field. As such, NPs regularly commit to long-term development and political activism to ensure public health.
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National Council of State Boards of Nursing, “The Consensus Model for APRN Regulation, Licensure, Accreditation, Certification and Education”
American Association of Nurse Practitioners, “Federal Issue BriefsInforming NPs on Health Policy, Sharing the NP Perspective”
American Nurses Association, “State Law and Regulation”