Nearly half the states allow broad practice authority for nurse practitioners. Some of their limitations were also loosened in response to the COVID-19 pandemic.
What restrictions, if any, do you believe should be part of licensing nurse practitioners?
Sophia Thomas: We concur with state nursing laws, which specify NPs must practice within the scope of their education and certification. NP licensure should require a Bachelor of Science in nursing granted by an accredited institution; an active registered nurse license; a graduate degree from an accredited NP program and university; and evidence of passing the national NP certification exam.
Dr. Susan Bailey: Nurse practitioners should be licensed to provide care only for which they’re educated and trained. Two to three years and 500 hours of education and training is insufficient to practice independently. Patients agree. In one recent poll, 68% said it’s very important for a physician to be involved in their medical diagnosis and treatment decisions. That’s why the AMA supports physician-led teams.
Is the state-by-state system the best approach to licensing nurse practitioners?
Thomas: State-based licensure allows states to balance public protection with local oversight. One challenge is the unnecessary variation in state laws. Twenty-three states and Washington, D.C., allow patients full and direct access to NPs. In the remaining states, patient access to NPs is limited by outdated licensure laws. To fix healthcare, we must end this patchwork.
Bailey: The AMA supports state-based licensure for all healthcare professionals, recognizing the valuable and primary role of state boards in protecting the health and safety of the public. Alternatives raise serious problems related to enforcement and applicability of practice acts, and state laws related to liability, age of consent, abortion and end-of-life issues.
How do you believe the growth in nurse practitioners has affected access to healthcare services?
Thomas: Decades of studies show NP-delivered care improves outcomes, helps manage costs and improves patient engagement in their care. States with full practice authority attract more NPs, achieve better outcomes and expand care where patients need it most—from retail clinics to home visits. More accessible care can mean earlier detection, illness prevention, improved quality of life and lower costs.
Bailey: Data confirms, irrespective of state laws, the growth of nurse practitioners has not increased access to care in rural or underserved areas. We have seen a proliferation of online-only NP programs, newly graduated NPs with less RN experience, exacerbating the shortage of needed RNs without improving access to care.
