Health Policy$ense

Evidence Supports Giving Nurse Practitioners Full Practice Authority

Pennsylvania Senate to Consider Landmark Bill

[Editor's Update: On May 18, 2016, the Pennsylvania State Senate’s Professional Licensure Committee voted (12-1) to advance SB 717 out of committee and on to the Senate.]

This week the Pennsylvania State Senate’s Professional Licensure Committee will vote on a bill (SB 717) that would remove the requirement for nurse practitioners (NPs) to maintain written collaborative agreements with physicians for practice and prescriptive authority. This bill, along with the companion HB 765, has tremendous potential to improve primary care access and delivery in the Commonwealth.

Newly published research from the Center for Health Outcomes & Policy Research at the University of Pennsylvania School of Nursing supports the removal of collaborative agreement requirements. This study,  partially funded by the Robert Wood Johnson Foundation, found that NPs were 13% more likely to work in primary care in states that required no collaborative agreements for practice or prescribing. For Pennsylvania, removing the requirement for collaborative agreements could increase the number of NPs by 13% and lower health care costs by $6.4 billion over the next ten years.

Required collaborative agreements create barriers to optimal use of NPs, who have been shown to provide high-quality, cost-effective care. Without one of these physician contracts, an NP in Pennsylvania cannot practice nor render any healthcare services in an advanced capacity. This results in the loss of that NP as an advanced provider, a loss that is especially impactful in rural areas and other shortage areas.

Twenty-one states plus the District of Columbia already allow NPs to practice to the full extent of their licenses and education. Currently, there are 668 bills in state legislatures that aim to modernize NP licensure and remove practice restrictions. These bills run the gamut from prescribing controlled substances to signing death certificates to ordering home care services. Recent articles in The New York Times and The Washington Post have highlighted the problem. Allowing NPs to practice to the full extent of their licensure aligns with national recommendations from the Institute of Medicine,  the Federal Trade Commission, the National Governors Association, and most recently, the Hospital & Healthsystem Association of Pennsylvania.

In preparing to vote SB 717 out of Committee and towards a full senate vote, it is important to realize how NPs can help alleviate provider shortages, particularly in primary care and in rural areas. State regulations that put unnecessary limits on their practice may undermine full utilization of these providers and limit access to care. The removal of collaborative agreements will allow NPs to work fully within the discipline in which they were educated, trained, and certified.