Gail Sadler, a nurse practitioner, provides a wide array of primary-care services at her private practice in Carrollwood, Fla., a community that has been buffeted for years by a physician shortage.
But she isn't allowed to write prescriptions for controlled substances—not even cough syrup with codeine. This leaves some of her patients in a difficult spot when they need immediate access to medication.
“Many physician practices are overcrowded as it is, so to have patients go to them just to get a prescription filled is an access-to-care issue,” Sadler said.
Florida, where some counties have a third less physicians per capita than the national average, is the only state in the U.S. that doesn't allow nurse practitioners, who hold at least a master's degree and must be nationally certified, to prescribe controlled substances, even if they have a collaborative agreement with a physician.
But nurse practitioners' struggle to practice to the full scope of their skills and knowledge isn't unique to Florida. For years, advanced nurse practitioners around the country have been fighting for the right to write prescriptions or to operate practices without the need of a collaborative agreement with a physician.
Advocates' efforts to expand nurse practitioners' duties have only intensified since insurance expansion under the Affordable Care Act began. Nearly 18 million Americans have gained coverage. Moreover, a 2015 Kaiser Family Foundation survey found that more than 58 million Americans reside in areas with primary-care physician shortages.
Having a wider scope of practice would also allow nurse practitioners to diagnose patients, order tests, complete death certificates and initiate involuntary psychiatric commitment for unstable patients without the need for a supervisory relationship with a provider.
A 2010 Institute of Medicine report titled “The Future of Nursing: Leading Change, Advancing Health” recommended that nurses be given the right to perform procedures, actions and processes based on their education and training. Restricting their practice, according to the report, undermines nurse practitioners' ability to provide much-needed primary care in areas where there are physician shortages, especially rural areas.