Expanding Practitioner Scopes of Practice During Public Health Emergencies: Experiences from the 2009 H1N1 Pandemic Vaccination Efforts

Abstract

In a public health emergency involving significant surges in patients and shortages of medical staff, supplies, and space, temporarily expanding scopes of practice of certain healthcare practitioners may help to address heightened population health needs. Scopes of practice, which are defined by state practice acts, set forth the range of services that licensed practitioners are authorized to perform. The U.S. has had limited experience with temporarily expanding scopes of practice during emergencies. However, during the 2009 H1N1 pandemic response, many states took some form of action to expand the practice scopes of certain categories of practitioners in order to authorize them to administer the pandemic vaccine. No standard legal approach for expanding scopes of practice during emergencies exists across states, and scope of practice expansions during routine, nonemergency times have been the subject of professional society debate and legal action. These issues raise the question of how states could effectively implement expansions for health services beyond administering vaccine and ensure consistency in expansions across states during catastrophic events that require a shift to crisis standards of care. This article provides an overview of scopes of practice, a summary of the range of legal and regulatory approaches used in the U.S. to expand practice scopes for vaccination during the 2009 H1N1 response, and recommendations for future research.

Legal Preparedness

“…2 For example, during the 2009 A(H1N1) pandemic, some US states addressed increased demand for pandemic vaccines by temporarily permitting pharmacists, dentists, emergency medical services professionals, or other clinicians to administer vaccine through various legal approaches (eg, executive order, emergency regulation.). 71,72 Although each state independently regulates the practices of its licensed health professionals, significant differences in approaches to scope of practice expansions can contribute to response complexities and confusion when in-state and out-of-state HCWs are involved.…”

Legal Considerations for Health Care Practitioners After Superstorm Sandy

“…Scope of practice refers to the range of services that licensed health care practitioners, such as physicians, nurses, physician assistants, pharmacists, and emergency medical service (EMS) personnel, are authorized to perform. 4 State practice laws and state regulating board rules govern which activities and procedures health care practitioners are allowed to perform, the amount of education and training required, and the level of required supervision or collaboration with a licensed physician or other health care practitioner. 4,5 During and after a disaster, it may become necessary to modify the scope of practice for certain health care practitioners to meet increased demand for services.…”

“…4 State practice laws and state regulating board rules govern which activities and procedures health care practitioners are allowed to perform, the amount of education and training required, and the level of required supervision or collaboration with a licensed physician or other health care practitioner. 4,5 During and after a disaster, it may become necessary to modify the scope of practice for certain health care practitioners to meet increased demand for services. 4,6 This modification can occur through the expansion of permitted activities or expansion of types of practitioners authorized to perform certain activities.…”

“…4,5 During and after a disaster, it may become necessary to modify the scope of practice for certain health care practitioners to meet increased demand for services. 4,6 This modification can occur through the expansion of permitted activities or expansion of types of practitioners authorized to perform certain activities. It can also occur through removal of conditions related to medical control, supervision, documentation, education, and training.…”

Careers in Virology: Public Health Opportunities for Early-Career Basic Scientists

“…There has been work done to encourage nursing and medical students and medical professionals to volunteer for local MRCs (3,4). It would be equally beneficial for basic-science graduate students to volunteer, and research has demonstrated that diversity in responder background during public health emergencies would be beneficial (5). Some efforts have been made to reach out and interact with the scientific community (6), and it is critical that these efforts continue and basic science students and faculty be receptive to the need for volunteers with their backgrounds and skills.…”