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Trends in scope of practice expansion

This article from The National Law Review details trends influencing scope of practice expansion for advanced practice providers (APPs). In response to the COVID-19 pandemic, many states granted expanded scope of practice to AAPs to meet demand for healthcare services, and some of those temporary orders have been signed into permanent legislation. The opioid crisis has likewise increased demand for healthcare services, and prescriptive authority of nurse practitioners has been expanded under federal law to include addiction treating drugs. Another increase in demand for health services comes from aging rural populations, with some states allowing independent practice for certain APPs to meet this need.

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APRN scope of practice expansions fail in 8 states

Legislation to expand scope of practice for Advanced Practice Registered Nurses has been approved this year in Delaware and Utah but failed in Florida, Kansas, Kentucky, Louisiana, Maine, Mississippi, Tennessee, and Texas. The American Medical Association has led advocacy efforts against the scope of practice expansions.

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California expands optometrist scope of practice

Two bills signed into law in California expand optometrist scope of practice. Optometrists will be authorized to administer COVID-19 vaccinations and perform COVID testing. The list of allowed drugs and conditions is also expanded to allow optometrists to treat all noncancerous anterior segment conditions, including all types of inflammation and treatment with all antivirals and antifungals. Medical assistants will be allowed to perform subjective refraction procedures.

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New research on nurse independent practice and effect on opioid deaths

New research published by the Mercatus Center at George Mason University shows that allowing nurse practitioners to practice without physician supervision reduced opioid-related deaths by 9.3%.  Specifically, prescription-opioid-related deaths were reduced by 7.6%, and illegal-opioid-related deaths were reduced by 5.5%. The reduction is more pronounced in rural counties, with opioid-related deaths reduced by 14-28%. Contrary to claims that granting nurse practitioners independent practice authority would result in more opioid prescriptions, opioid prescriptions actually decreased. The changes to nurse practitioner authority also increased access to care and treatment options for opioid use disorder.

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Researchers propose framework for reshaping the health workforce

Researchers with Health Affairs Journal have proposed a health workforce policies framework to "ensure that the significant investments of public funds into various health workforce programs are spent effectively and yield improved patient and population health outcomes." The framework focuses on the production of healthcare workers to address population health priorities, workforce distribution and expansion of telehealth to address gaps by specialty and setting, workforce resilience by addressing financial and emotional security and safety of health workers, and maximizing potential by addressing scope of practice and reconfiguration of teams within health systems.

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Delaware grants full practice authority to nurse practitioners

New legislation in Delaware grants full practice authority to nurse practitioners. Twenty-four other states, the District of Columbia, and two US territories have already granted FPA to NPs. The National Academy of Medicine recently released a report with recommendations to allow nurse practitioners "to practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving health care access, quality, and value."

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Indiana: federal court strikes down abortion law restrictions

A federal judge in Indiana has struck down a ban on using telemedicine for abortion care. Abortion providers will now be able to offer medication abortion via telemedicine and informed consent documentation via virtual care. Patients will no longer have to have an in-person physical exam before a medication abortion, and advanced practice clinicians such as physician assistants and nurse practitioners will have authority to dispense abortion-inducing drugs. Also, doctors will no longer be required to provide patients with certain pre-care information that the judge found to be without scientific evidence and misleading.

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Nova Scotia expands pharmacist scope of practice

The scope of practice of pharmacists in Nova Scotia has been expanded to include checking for ticks and tick bites and prescribing an antibiotic to prevent Lyme disease. The expanded scope of practice is in response to increased incidence of ticks and Lyme disease in Nova Scotia and the associated strain on emergency departments and clinics. Pharmacists must attend a professional education session on tick identification and information on diagnosis and treatment of Lyme disease.

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Michigan expands nurse anesthetist scope of practice

A new law in Michigan will allow certified registered nurse anesthetists to plan and administer anesthesia care without the supervision of a physician. The registered professional nurse must hold a specialty certificate as a nurse anesthetist with three years of experience and maintain appropriate malpractice insurance. The expanded scope of practice only applies to CRNAs practicing collaboratively in a patient-centered care team with a licensed physician immediately available for any emergency situations.

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NCSBN issues study on APRN prescribing of opioid treatment buprenorphine

The National Council of State Boards of Nursing has published a study on Advanced Practice Registered Nurses' participation in medication treatment for opioid use disorder. The study concludes that "requirements that physicians oversee APRN prescribing of buprenorphine may have slowed the growth of the opioid treatment workforce." APRNs are eligible for Drug Enforcement Administration waivers to allow them to prescribe buprenorphine, but physician oversight requirements correlated with fewer waivers being sought in those states.

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