Varying Regulatory Landscape in US for Nurse Practitioner Practices

There is little doubt that nurse practitioners (NPs) are getting are huge demand, and the career path for NPs is supercharged with possibilities. Many states today, which have a shortage of doctors, are allowing NPs to set up practice independently, with no doctor or hospital supervising them. But there is a good deal of controversy in some states in allowing nurse practitioners to work on their own without any direct supervision by physicians.

The American Association of Nurse Practitioners map below

shows how policies about NPs vary from state to state. Overall, it seems that states in the West are the most friendly to NPs working on their own, while it is more restrictive in the Southeast.

Copy-of-AANP-state-policy-map

An article by the Wall Street Journal recently highlighted this issue and showed that a total of 17 states currently let NPs work on their own and treat patients without direct doctor supervision. In five states – PA , CA, MI and MA among them – there is a showdown happening among the supporters of NPs and doctors groups and politicians who are considering legislation that will allow NPs to have full autonomy and set up their own practices. NJ also would allow NPs to be independent after they had spent two full years working with a doctor or a nurse of advanced practice with an MSN degree.

Highest Demand States for Nurse Practitioners

  • California
  • New York
  • Florida
  • Ohio

There was an increase in nurse practitioner demand , both in academic programs and in employment numbers, before the Affordable Care Act passed, but now the new models of care that are outlined in that law, including patient centered medical homes and accountable care groups, will be relying on NPs and physician assistants to staff them. The fast growth of drugstore and grocery store health clinics that are staffed by NPs also is increasing demand.

The Senate in CA did approve a bill that grants more autonomy to NPs to deal with the shortage of doctors in 58 counties in that state. However, the California Medical Association is lobbying hard against that bill because of the fear that it will reduce the quality of care in CA. In a compromise, a committee is proposing changes to the bill that would mandate that NPs have to do at least 6000 hours of supervised work before they can be fully independent of doctor supervision.

This large question about how independent NPs should be has been so contentious that Nevada deal with the issue for over six years, before the governor of that state finally allowed it in June. The reason for this? In Nevada, there is a strong doctor shortage, with the 5th fewest doctors per capita in the nation.