The Nurse Practitioner Scope of Practice Debate Hits Close to Home

Sitting at the airport a few weeks ago, I scrolled through my Facebook feed to pass the time. Quickly, I noticed a desperate plea for help from a former NP school classmate. Her post warned of legislation proposed to limit the scope of practice for nurse practitioners working in Tennessee. As an NP practice owner, the legislation could force her to shut down the clinic she has worked tirelessly to build.

The scope of practice debate in Tennessee mirrors that across much of the nation. Physician and nursing interest groups are at odds, each lobbying for their own political agendas. For example, the Tennessee Nurses Association introduced the Nurse Independent Practice/Full Practice Bill which would give advanced practice nurses the ability to treat and prescribe without physician oversight. In response, the Tennessee Medical Association brought a competing bill before the legislature, The Healthcare Improvement Act. The act proposes, among other things, that nurse practitioners practice exclusively as part of a physician-led patient care team.

Both the Tennessee Nurses Association and Tennessee Medical Associations argue that their own approach would lead to improved models for patient care. Each backs its argument with supporting statistics regarding nurse practitioner’s ability to provide safe and accessible patient care (see the debate in detail, Should nurses be allowed to fill gaps left by physician shortages?).

In Tennessee, at least for now, the advanced practice nursing scope of practice legislation battle appears to have reached a stalemate. The Healthcare Improvement Act favoring patient care led by physicians, has been put on hold as a task force is created to review the matter and provide recommendations for the future of Tennessee’s healthcare system. The battle between provider interest groups is set to resume next January.

As an individual nurse practitioner, it’s easy to feel powerless or indifferent when it comes to state scope of practice discussion. Getting involved in the debate takes time and energy that many of us don’t have. Affecting the direction of the political healthcare landscape seems unlikely as an individual. Furthermore, changes to laws concerning advanced practice nurse practitioners may not have a direct impact on our own current job descriptions or responsibilities. Without the immediate threat of change, action takes a backseat.

Personally, I find it difficult to muster the energy or interest required to become politically involved in the scope of practice debate in my state. Cases like that in Tennessee where nursing and physician interest groups constantly argue back and forth with little effort to understand the other’s position are like fingernails on a chalkboard. My inclination is to turn a blind eye and use my spare time to pursue other, less bureaucratic interests.

While disengagement is the temptation for many of us when it comes to the scope of practice debate, as nurse practitioners we must think with a broader perspective. Many of us had dreams of owning our own practices when we were in school. Most of us have not realized these dreams, but we owe it to our colleagues who have to at the very least stay informed.

Look beyond where your nurse practitioner career is now to what you want your career and profession to look like in ten years. How will proposed scope of practice legislation affect your vision and goals? A broader perspective may motivate you to get involved.

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