Making the Case for Expanded Nurse Practitioner Scope of Practice

Expanding nurse practitioner scope of practice is the first step to empowering advanced practice providers (APPs) in leading patient care and ultimately addressing gaps in patient access to care, according to a paper in the International Nursing Review.

Specifically, the paper’s authors contend that the COVID-19 outbreak has laid the groundwork for permanently expanding nurse practitioner scope of practice. Through a review of literature accessed via PubMed, Google Scholar, the ICN, World Health Organization (WHO), United Nations (UN), as well as the professional experiences of the article authors, the researchers asserted that it is high time the international medical community, including leaders in the US, embrace full practice authority for nurse practitioners.

Nurse practitioners, the authors stated, are advanced practice providers (APPs) with highly specialized medical skillsets. Nurse practitioners and other APPs are increasingly proving their worth, the authors argued, although they are not realizing the benefits through expanded scope of practice.

This has been brought to bear during the COVID-19 pandemic, when healthcare organizations and systems around the globe have been confronted with unimaginable circumstances. Even in highly developed nations, like the US, resources have been scarce and patient access to care has been challenging.

“How healthcare systems are leveraging their workforce skills is accelerating not only COVID‐19 identification and treatment but also bringing us closer to the ideals of [university health care] for all people,” the researchers wrote.

In the US, nurse practitioners have been instrumental in dealing with these challenges.

“For example, amid the resource constraints during this pandemic, a number of state‐level governments in the United States have suspended the requirement for APNs to hold collaborative practice agreements with physicians, thereby granting nurse anaesthetists and NPs full practice authority,” the authors continued. “This allows clinicians, such as NPs, to perform at the highest level of their training and competency and respond accordingly to the emerging needs of the public – duties they have been both prepared for and licensed to fulfill.”

Tapping their own practical experience, the article authors explained that nurse practitioners have been overextended during the COVID-19 crisis and have played an important role in leading care teams in highly specialized care for extremely sick patients.

That level of knowledge is going to be instrumental moving forward, leaving nurse practitioners in an important position to contribute to innovative care delivery in the future. This will only be made possible if all nurse practitioners enjoy expanded scope of practice, the authors suggested.

Of course, nurse practitioners have been key leaders in patient-centered care even before the COVID-19 outbreak, the authors continued. In a world where nearly 400 million people don’t have access to basic medical care—a problem that’s pervasive even in highly developed nations like the US—experts have long pondered the effectiveness of deploying more nurse practitioners as patient care leaders.

Separate studies have corroborated this. In 2018, United Health Group said nurse practitioners and other APPs could reduce the physician shortage by nearly 70 percent. A 2019 Annals of Family Medicine showed that advanced practitioners like nurse practitioners have been instrumental in meeting overwhelming patient access to care needs following the Affordable Care Act implementation.

“Systematic analyses suggest NP performance leads to comparable physician outcomes with improved access for rural and remote populations and increased cost‐effectiveness,” the researchers added. “NPs also demonstrate high rates of patient satisfaction, spend more consultation time with patients and are likely to have an increased number of return visits when compared to other primary care providers.”

The researchers also remarked on the contentious debate about granting broader nurse practitioner scope of practice, particularly the critique issued by some physician groups when the industry broaches the topic of scope of practice.

“Contrary to much debate, it is not about a contest among professions: NPs vs. physicians. The essential goal is that of achieving trans‐disciplinary partnership to deliver high‐quality and cost‐effective UHC in alignment with the WHO,” the researchers said.

To deliver on a future where nurse practitioners can lead care teams using their unique expertise, the researchers said the industry needs to take three collective steps.

First, APPs and nursing leaders need to educate the medical industry and other practitioners about how nurse practitioners can expand access to healthcare. This effort should emphasize the holistic nature of nurse care practices.

Second, healthcare organizations need to facilitate the policies that would enable broader scope of practice and more practice authority, the authors said. Central to this will be offering appropriate compensation to nurse practitioners.

Third, healthcare organizations need to offer titles to their clinician employees that accurately reflect their level of expertise.

“Descriptions such as ‘physician extenders’, ‘task shifting’ or ‘mid‐level providers’ do little to instill patient trust nor do they empower NPs to provide optimal, autonomous and evidence‐based care services,” the researchers asserted. “They should be referred to in the literature and across care domains as ‘Nurse Practitioners’ to reflect their unique contribution and professional preparation.”

As the healthcare industry continues to work toward equitable access to care, patient-centered care, and more holistic treatment solutions, there is a place for nurse practitioners to be care team leaders, the authors pressed.

“Their training in advanced clinical care positions them to respond to individual and community‐based needs for the public, particularly during the COVID‐19 era and in the likely event of future public health emergencies,” the report authors concluded. “Ongoing empirical data and health policy that supports the safe expansion of NPs’ practice is critical to determining their influence in the future.”