A policy analysis of nurse practitioner scope of practice in Massachusetts

Abstract

Nurse practitioner (NP) practice has evolved since inception of the role in 1965. Educational requirements have been standardized requiring a master's degree, yet variation in NPs scope of practice exists across the United States. As the population ages and more Americans have health insurance coverage, the demand for health care continues to increase. Shortages of clinical providers and changes in hospital models of care continue to burden the health care system. Nurse practitioners have been found to provide safe, high-quality patient care and are a potential solution to ease the burden on our health care system. Nurse practitioner scope of practice restrictions limit the ability for NPs to practice independently. The purpose of this article was to analyze the advanced practice registered nurse's (APRNs) scope of practice policy in Massachusetts (MA) where APRNs just recently obtained full practice authority. Legislation to remove NP scope of practice restrictions in MA had been presented several times but was met with resistance from physician advocacy groups stating that NPs lack the education requirements to practice independently. A recent report from the MA Health Policy Commission demonstrates the impact that NPs have on lowering health care costs and servicing individuals in underserved areas of the state. During the pandemic, restrictions on NP scope of practice in MA were temporarily removed. It was realized that if NPs can practice independently during a pandemic, then they certainly are competent to practice independently at other times. A reassessment of NP scope of practice to allow for full authority should be completed nationally.

Practice pathways, education, and regulation influencing nurse practitioners’ decision to provide primary care: a rapid scoping review

“…In the US, the scope of NPs practice reflects state regulations, which have either full, reduced or restricted practice authority, determining how independently an NP can practice [ 32 ]. Much of the literature suggests that full-practice authority is required for primary care NPs if they are to: improve patient access to primary care [ 28 , 30 , 33 , 46 ], particularly in low socioeconomic and rural areas [ 10 , 41 , 42 ], reduce hospitalisations [ 27 , 44 ], and reduce healthcare and training costs [ 1 , 11 , 33 , 44 , 88 ]. Strong organisational support for independent practice increases NP’s capacity to provide effective primary care, and improves teamwork among NPs and physicians [ 89 – 91 ].…”

Feasibility and efficacy of a nurse practitioner-and pharmacist-led hypertension clinic

“…This exploratory analysis supports that an NP/PharmD HTN clinic is feasible and provides care that is equitable to physician-led care. The role of the advanced practice nurse is ever-evolving (Coote et al, 2022; Cuccovia et al, 2021). Previous studies have also shown that NPs, PharmD, and interdisciplinary teams provide care for HTN and other chronic diseases that is equitable to that of physicians (Brown, 2017; Himmelfarb et al, 2016).…”

Advocating, implementing, and supporting the journey to full-practice authority in a large healthcare system

“…Notwithstanding these strides, FPA barriers continue, which include administrative issues, therapy restrictions, physician signature requirements and ongoing opposition (including lack of collegiality), prescribing concerns, uneven reimbursement, physician-only procedures, telehealth problems, and the end of emergency waivers 9,10. Some states are lagging in FPA advancement due to lack of cooperation between nursing, medicine, and policy makers or a dearth of regulatory self-advocacy and engagement on the part of APRNs 11-13.…”