While I knew, desired, and accepted the need for collaboration with physicians because there are things that fall outside of my scope of practice, the rules and regulations set forth impede my ability to have autonomy and practice to the full extent of my abilities.
Beverly Roseberry, Clinical Instructor at Georgia State University
For nurse practitioners (NPs) across the nation, the struggle for full practice authority remains one of the most contentious issues in healthcare today. Defined as the ability of an APRN to practice to the full extent of his or her education and credentialing, practice authority conditions vary widely by state, from restricted to full practice. Georgia is notorious for being the last state in the country to grant NPs prescriptive privileges, and it remains one of the most restrictive regions for these healthcare professionals in the country. Hindering NPs’ abilities to work autonomously is unnecessary given the abundance of evidence that they provide safe, cost-effective, and quality healthcare, with patient outcomes similar to (or better than) their physician colleagues, particularly in primary care environments. Furthermore, these prohibitive regulations are exacerbating a looming shortage of qualified healthcare providers.
In fact, the situation is even more dire in the “Empire State of the South.” Georgia currently ranks 39th in the number of physicians per capita, and 49th in the number of primary care doctors. One report estimated that by the year 2020, Georgia was expected to rank dead last in the absolute number of physicians despite being the ninth most populous state in the country. These trends could prove disastrous for Georgia, and it’s up to legislators to take action which will expand the pool of qualified primary care providers by extending full practice authority to NPs across the state.
Fully 89.2 percent of NPs are certified in an area of primary care, and 97.7 percent have graduate degrees. Despite their advanced training, the prescriptive authority for NPs is regulated by the Georgia Composite Medical Board, and NPs must have a “protocol agreement” in place with a physician; these agreements are based largely on a template and many NPs believe them to be a bureaucratic formality. Additionally, Georgia NPs are severely limited in their ability to order certain diagnostic tests (e.g., MRIs, CTs) and cannot prescribe Schedule II controlled substances at all.
Fortunately, there’s a group of professionals, scholars, and tireless advocates who are working to change these restrictive conditions. Beth Stephens, JD published a detailed report entitled Perspectives on Advanced Practice Registered Nursing in Georgia. It argued that APRNs will be better able to serve patient primary care needs if they’re granted full practice authority. She pointed out that over 80 percent of the state’s counties have “substantial populations without a consistent source for primary care.” Furthermore, there are 63 counties without a pediatrician; 79 lacking an OB/GYN; and 78 without a psychiatrist. Overall, the state should allow non-physician healthcare professionals such as NPs to practice more autonomously to alleviate some provider shortages, particularly in rural regions or those with high-risk populations. Tay Kopanos, the VP of the American Association of Nurse Practitioners (AANP), summed up the problem, stating that working in a restricted practice state is like “having a driver's license but needing permission from someone in your neighborhood before you can drive.”
NursePractitionerSchools.com has interviewed 35 NP professors across the country on the issue of FPA in 2017. Through two new interviews with exceptional NP professors in Georgia, this article aims to advance the argument for full practice authority in this state and beyond.
The following interviews have been lightly edited for length and clarity.
We can manage, diagnose, and treat patients in a safe manner and have proven that we are as good or better than physicians in multiple studies. We should be allowed to practice to match the highest level of our education.
Dr. Imelda Reyes, Emory University
With the wealth of evidence that nurse practitioners provide high-quality, safe, and cost-effective healthcare, the time is now to advance full practice authority in Georgia and across the country. Requiring a written protocol with a supervising physician and preventing NPs from ordering certain diagnostic tests have impeded the abilities of these skilled clinicians. These prohibitive and outdated laws can increase healthcare costs; inconvenience patients; lead to confusion with insurance disbursements; present snags in the continuity of care; and worsen the shortage of primary care providers, especially for underserved populations.
For these reasons and more, there are countless organizations which support granting FPA to nurse practitioners nationwide. These include the Bipartisan Policy Center; the AARP; the Federal Trade Commission; the Department of Veterans Affairs; the National Governors Association; the National Conference of State Legislatures; and the Institute of Medicine, among many others.
In sum, granting full practice authority to Georgia’s NPs can make services more cost-effective and increase access to healthcare across the state. Here’s only a handful of the active professional associations fighting tirelessly to advance the cause: