A new year will bring new regulations for nurse practitioners in New York, many of whom will no longer require a physician's supervision to practice.
Nurse practitioners in New York with over 3,600 hours of clinical practice under their belt, beginning Jan. 1, will no longer be required to have a written collaborative agreement with a physician, nor will they be required to submit patient charts to a physician for review. Instead, experienced practitioners will only be required to have an established relationship with a physician or hospital for referral or consultation.
The new rules are a part of the Nurse Practitioner Modernization Act, signed into law with the state's budget in April. The law does not change the rules for nurse practitioners with less than 3,600 hours of practice. They will still be required to have a written agreement with a supervising physician.
The new rules mean a nurse practitioner with about two years of full-time clinical practice would meet the requirement.
New York will join 19 other states and the District of Columbia that have passed similar legislation creating what the American Association of Nurse Practitioners calls “full practice” environments, in which regulations do not reduce or restrict nurse practitioners' practices.
The law isn't without opponents, however. During a legislative hearing earlier this year, Elizabeth Dears, senior vice president and chief legislative counsel for the Medical Society of the State of New York, voiced the society's strong opposition to the bill, noting that the increasing use of nurse practitioners does not lower costs and that patients of nurse practitioners tend to have higher utilization rates.
“We can fathom no instance where the quality of patient care can reasonably require the elimination of the written practice agreement and protocols,” she said in prepared testimony (PDF).
Michigan doctors have opposed similar efforts in their state, noting that they blur the line between nurse practitioners and physicians, allowing nurse practitioners to practice to the same extent as a physician with less training.
By eliminating the required agreement, the state of New York has eliminated financial barriers to entry for aspiring nurse practitioners, said Stephen Ferrara, executive director of the Nurse Practitioner Association New York State. Many nurse practitioners have to make payments to doctors to form collaborative agreements.
“We believe that it's going to open up access points to care where there are provider shortages, and there are plenty in New York state,” said Ferrara, a practicing nurse practitioner who is also associate dean of clinical affairs at the Columbia University School of Nursing in New York City.
Some nurse practitioners have left New York state or declined to renew their license, dissuaded by the regulations or unable to find a stable physician relationship, which can be especially difficult in rural areas, Ferrara said. The new agreement ensures that nurse practitioners are no longer dependent on a physician's practice, but are able to consult one if needed, he said.
“This is an acknowledgement of using the whole healthcare community—our whole idea that we're not going to practice in a vacuum, a silo, that we're going to collaborate with all members of the healthcare team as needed,” Ferrara said.
Follow Adam Rubenfire on Twitter at @arubenfire
