“It’s like moving a boulder uphill.”
-Dr. Nancy George, Wayne State University
As of February 2017, 21 states and the District of Columbia allow ‘full practice authority’ for nurse practitioners. In other words, NPs in these states can examine patients, diagnose illnesses, prescribe medications, and manage treatments under the exclusive authority of their local board of nursing. The FPA model is recommended by several prestigious organizations, including the Bipartisan Policy Center, the Institute of Medicine, the National Governors Association, the AARP, and the Federal Trade Commission, among others. Notably, the Department of Veterans Affairs granted FPA to NPs across all of its facilities in late 2016 to meet the swelling national demand for healthcare services. In spite of the overwhelming evidence that NPs provide affordable, resource-efficient healthcare with excellent outcomes, states such as Michigan—those which operate under the yoke of ‘restricted practice’— still limit the ability of these advanced practice nurses to work autonomously in accordance with their level of training and education.
Interestingly, MI is unique in that its NPs are not governed under a nursing practice act. In fact, they work under the authority of the Public Health Code (1978) along with 25 other healthcare professions. Also, they hold a ‘specialty RN certification’ under the PHC as opposed to a state license. While Michigan NPs still need physician oversight to prescribe schedule 2-5 controlled substances and cannot sign death certificates or workers’ compensation claims, there has been one recent legislative victory to expand their ability to practice: MI HB 5400. This bill was signed by governor Rick Snyder in January 2017, and it allows NPs to prescribe nonscheduled drugs, as well as to dispense complimentary starter doses of qualifying pharmaceuticals; go on hospital rounds; perform independent house calls; and order physical or speech therapy without a collaborating physician.
Ryan S. Petty, a pediatric nurse at the University of Michigan Mott Children’s Hospital who is nearing completion of his DNP-FNP program, wrote an op-ed on the benefits of extending FPA to Michigan’s NPs. He noted that not only are NPs highly educated and boast significant clinical training prior to receiving their degrees, but they can also help fill the need for healthcare providers within MI. As proof of point, he stated that there was a projected shortage 8,000 to 12,000 physicians in the state, 4,000 of those in primary care. Further modernizing the scope of practice of NPs in the state would be a cost-effective method of addressing the growing demand for healthcare services.
Also, two experts from the RAND Corporation (Sept. 2016)—including Dr. Grant Martsolf, who graciously gave NPS an exclusive interview—recently examined the potential impact of giving FPA to NPs in Michigan. In this groundbreaking literature review and analysis, the RAND researchers found that a more generous scope of practice for NPs in MI “could possibly increase access to care, improve favorable utilization of care, decrease unfavorable utilization, and improve patient-centeredness,” all advantageous outcomes. The study estimated that an additional 580,000 adults in Michigan—an increase of 7.5 percent—would be able to schedule medical appointments if NPs achieved FPA. Additionally, the report estimated that the move toward FPA would increase the likelihood that adults would get annual check-ups and reduce the number of emergency care visits.
In addition to Dr. Marsolf, two prominent clinicians and professors in Michigan granted exclusive interviews to NPS and discussed their views on achieving FPA in the state.
The biggest challenge in this fight is getting the physician groups to understand that we are not in competition with them; as NPs, we are members of a healthcare team, which includes our physician colleagues and other healthcare professionals the patient may need. As a team, we need to work collaboratively in order to improve the health of our patients.
-Dr. Denise Hershey, 2017
Without a doubt, Michigan’s HB 5400 represents a giant leap forward in the fight for full practice. Not surprisingly, there has been opposition from groups such as the Michigan State Medical Society, which represents 15,000 doctors in the state. In its own professional interests, the MSMS believes that healthcare teams should be primarily physician-led, arguing that NPs don’t have adequate training to provide safe care in a full practice environment. It’s worthy of note that evidence is scant to support the MSMS’s claims; on the contrary, more restrictive practice environments for NPs have been associated with decreased access to healthcare services, less consumer choice, higher costs, problems with insurance reimbursements, and inefficiency in the delivery of care, among other complications.
One way for local activists to get involved is to attend the MI Board of Nursing meetings, which occur the first Thursday of every month in Lansing. Overall, only when NPs in Michigan and beyond have achieved full practice authority will they be able to provide seamless, cost-effective, and quality healthcare services to meet a growing demand.
Other local and national resources to assist people in achieving a full practice environment for NPs include: