Both of the bills look to remove the requirement that advanced practice RNs need to have doctors sign off on prescriptions before prescribing them to patients. In its letters, the FTC pointed to research indicating that advanced practice RNs are as safe and effective as independent doctors and that autonomous advanced practice RNs and doctors have comparable prescribing patterns and ultimately patient outcomes.
While regulators acknowledged that certain professional licensure requirements and scope-of-practice restrictions may protect patients, excessive restrictions on advanced practice RNs' autonomy can hurt competition, exacerbate physician shortages, inflate the cost of advanced practice RN services and impede team-based care.
Regarding HB 2412, the FTC urged the Kansas Legislature to rescind a requirement that advanced practice RNs must have a written agreement with a physician to prescribe medications. The agency also advised against adopting a proposed amendment that would "require all APRNs to be under the regulatory control of the physician-controlled Kansas Board of Healing Arts rather than the Kansas Board of Nursing where they are currently regulated."
The FTC did not support the provision that would require a period of transition to independent prescribing for advanced practice RNs who have "less than 4,000 hours of licensed active practice as an advanced practice registered nurse," citing a lack of evidence for those requirements.
Regulators also relayed that Ohio's HB 177 should be passed to expand advanced practice RNs scope of practice and end the mandatory written collaborative requirement with physicians that's currently needed for advanced practice RNs to prescribe drugs and devices.
The bills have been referred to House subcommittees in their respective state legislatures.
Many physician groups have pushed backed against proposals to broaden advanced practice practitioners' scope of practice. Physician groups claim that patient safety is jeopardized when advanced practice practitioners practice without physician oversight. Advanced practice practitioners counter that their care is at least as safe or safer and that full autonomy would plug access gaps and corral costs.
In the letter, the FTC cited research from the Institute of Medicine and FTC staff urging state legislators to avoid imposing restrictions on advanced practice RNs' scope of practice because they are "safe and effective as independent providers of many healthcare services within the scope of their training, licensure, certification and current practice."
Advanced practice RNs play a critical role in alleviating physician shortages and expanding access to the underserved, according to the report. Physician supervision requirements also create an uneven playing field, giving doctors a competitive edge that harms consumers, researchers said.
Twenty-two states and the District of Columbia currently permit independent prescribing by advanced practice nurses.
Only a handful of states have enacted the Advanced Practice Registered Nurses Compact, an initiative by the National Council of State Boards of Nursing that allows advanced practice RNs with one state license to practice in multiple states without physician supervision.