As attorney Barbara Safriet has often pointed out, this is a double-sided scope of practice problem, with those deemed independent providers legally able to perform acts that may have no relation to their training or skill set, while other providers are hamstrung for no evidentiary reason.
Dr. Kim Curry, Associate Dean and Professor at the University of Florida
While most people are aware of the looming primary care provider shortage across the country—especially in Florida—many aren’t aware of a solution which can help alleviate that problem: extending full practice authority (FPA) privileges to NPs. In fact, FL alone will need an additional 4,671 PCPs by 2030—an increase of 38 percent over the 2010 workforce—to keep up the current rates of service utilization. Despite the crisis on the horizon, several U.S. states including Florida place undue burdens on patients and healthcare providers by limiting the autonomy of NPs.
Nurse practitioner practice authority varies widely among U.S. states. In states such as Oregon, Arizona, Colorado, Minnesota, Iowa, and Wyoming, NPs are able to work in accordance with their advanced level of preparation, experience, and certification; in the most populous states such as California, Texas, and Florida, however, NPs are limited in their abilities to provide care. They may be expected to secure expensive “collaborative agreements” with supervising physicians to prescribe even basic medications; they may need doctor approval to order basic diagnostic tests or otherwise take on responsibilities for which they are fully equipped.
The Florida Association of Nurse Practitioners (FLANP 2017) points out that a shortage of PCPs coupled with an aging Baby Boomer population can result in limited access to care, skyrocketing healthcare costs, and a lessening quality of life for all. Furthermore, FLANP stated that, “Changing restrictive nurse practitioner licensure laws has been demonstrated in other states to increase primary care access and reduce costs.” Having a more welcoming practice environment also can attract more NPs to this high-need state and add to local economic activity.
In a Tampa Bay Times (June 2017) letter to the editor, Naomi Grasso rightly argues that FL is one of only 11 states which restricts NPs’ ability to practice, and many patients aren’t even aware that their NP is expected to maintain cumbersome supervision agreements in place because they typically never meet with the “collaborating physician.”
Perhaps most importantly, there’s a wealth of evidence showing that NPs provide safe, high-quality, and cost-effective healthcare with outcomes on par with physicians. The Advance Healthcare Network (Feb. 2017) stated that 50 percent of PCPs in the United States are NPs. Tay Kopanos, the vice president of the American Association of Nurse Practitioners (AANP), argued that living in a restricted practice state is akin to “having a driver’s license but needing permission from someone in your neighborhood before you can drive.”
Fortunately, there are some glimmers of hope in Florida. By illustration, the state’s Nurse Practice Act was amended in 2016 allowing NPs to prescribe controlled substances; it’s worth adding that Florida was the 50th and last state in the country to do so. And they still require physician oversight and often can give no more than a seven-day supply.
As of July 2017, 21 states and Washington DC had FPA. During the first half of this year, NursePractitionerSchools.com has interviewed nearly 30 prominent NP professors across the country on their FPA views; all but one have been in support of FPA, advocating to let these healthcare professionals work to the full extent of their education, credentialing, and training. This piece explores this important issue through the eyes of two exceptional NP professors in Florida.
The following interviews—the first conducted by email and the second conducted by phone—have been lightly edited for length and clarity.
They must hear the message from constituents until it can no longer be ignored, or muffled by the sounds of dollar bills flowing in from opposing groups.
Dr. Kim Curry, Professor and Associate Dean and the University of Florida
Given the overwhelming evidence demonstrating the quality and cost-effectiveness of nurse practitioner care, it’s time for Florida to move forward by extending full practice authority rights across the state. In the Sunshine State and beyond, it’s clear that restricting the ability of NPs to fulfill their functions as healthcare providers not only increases costs and inconvenience for patients, but it also encourages NPs to seek out states with more modern, accommodating laws, places which enable NPs to work to the full extent of their training and education.
As mentioned in both interviews, there’s one powerful group that’s staunchly opposed to granting NPs FPA: medical associations and their lobbies. It’s crucial to convince physicians that NPs aren’t in competition with them, but rather they seek to work in a collaborative environment as part of a team; at the same same, NP should be able to work as independent providers with full prescriptive authority, the ability to create treatment plans, the authority to sign death certificates, and otherwise be free from the hassle of expensive “collaborative agreements.”
Nurse practitioners can take several actions to promote the FPA cause in Florida. Both interviewees mentioned the importance of remaining politically active through local and national NP associations; calling legislators; and educating the public about the role of NPs and the invaluable primary care services they provide. There’s evidence that states with FPA for NPs not only boast savings in healthcare, but also have lower hospitalization rates and better health outcomes. These findings are echoed in a 2015 study from Columbia University, which found that NPs in primary care roles performed on par with doctors, but they spend more time with patients and didn’t add extra costs; furthermore, the patients NPs treated required fewer overall primary care visits.
In sum, the abundance of evidence showing the effectiveness of NPs has convinced countless national organizations to support FPA. These groups include:
Ultimately, extending FPA in Florida will likely bring down costs, iron out confusion with insurance reimbursements, make services more efficient, and increase overall access to healthcare, particularly in rural and other underserved areas. Here are some organizations to help Florida NPs and others join the cause: