A Look at the NP's Scope of Practice in PA

Nurse practitioner (NP) is one of the 10 fastest-growing occupations in the U.S. With a growth rate of 28%, the job outlook for NPs is almost unmatched. NPs are prepared to perform many of the same services as primary care physicians, with the current physician shortages creating a high demand for nurse practitioners.

La Salle University offers a Master of Science in Nursing Family Nurse Practitioner (MSN FNP) online program that prepares nurses for national FNP certification. Graduates can go on to provide primary care in hospitals and private practices, the largest employers of NPs, as well as in clinics, outpatient care centers and other healthcare settings.

What Is the Role of a Family Nurse Practitioner?

In many ways, the role of an FNP is similar to that of a primary care physician. In fact, most states explicitly identify NPs as primary care providers, and patients are increasingly likely to have FNPs as their primary care providers.

A study commissioned by the Robert Wood Johnson Foundation (RWFJ) shows how similar the two primary care roles are. Looking at Medicare services provided by physicians and NPs — also physician assistants and certified nurse midwives — the study found little variation in the complexity of care among providers. A high majority of primary care services, regardless of practitioner, were of low to moderate complexity.

Like primary care physicians, FNPs:

  • Evaluate patients
  • Order, perform and interpret diagnostic and laboratory tests
  • Diagnose and manage acute and chronic conditions
  • Emphasize health promotion and disease prevention, such as through patient education
  • Prescribe medicine and non-pharmacologic therapies, such as physical and occupational therapy
  • Maintain patient health records

What Is the Demand for FNPs?

Over 87% of NPs are certified in an area of primary care, and over 72% deliver primary care. When it comes to addressing the growing primary care shortage, NPs are prepared to play an important role in increasing access to care, especially in rural areas.

The Association of American Medical Colleges (AAMC) projects a deficit in primary care of up to 35,600 physicians by 2025. While some states are projected to have a surplus, Pennsylvania is one of 37 states where a primary care physician shortage is expected.

The need for FNPs in medically underserved areas is especially high. According to the Center for Rural Pennsylvania, of the 48 rural counties and 19 urban counties in Pennsylvania, most have designated health professional shortage areas.

According to the American Association of Nurse Practitioners (AANP), a majority of NPs (89%) are prepared in a primary care focus. Nearly 50% choose a Family NP (FNP) focus. The solution to easing Pennsylvania's primary care physician shortage seems straightforward: Hire more FNPs.

However, Pennsylvania law currently gets in the way of an NP's ability to effectively expand healthcare services, particularly in rural areas.

How Does NP Scope of Practice in PA Compare With Other States?

The American Nurses Association describes scope of practice as the "who, what, where, when, why and how" of nursing practice. While NPs are nationally credentialed, scope of practice laws that govern NP practice vary from state to state.

Generally, scope of practice covers the following three areas:

  1. Nurse Practitioners as Primary Care Providers: Whether a state explicitly identifies NPs as primary care providers.
  2. Practice Authority: The degree to which NPs can practice without physician oversight.
  3. Prescriptive Authority: NP prescribing privileges and whether physician oversight is required.

The AANP provides an overview of NP scope of practice in the U.S. Not all states recognize NPs as primary care providers. However, Pennsylvania and its neighboring states all agree that NPs are identified as primary care providers. From there, the exact details for practice and prescriptive authority may differ.

Under Pennsylvania law, for example, NPs are regulated through a "collaborative agreement" with a physician to provide patient care. A plan for prescribing must be outlined in this written collaboration. NPs in New York, Ohio, West Virginia, Delaware and New Jersey also have "reduced practice" authority in this regard.

Maryland, by comparison, is one of more than 20 states that grant NPs full practice authority. The AANP defines full practice as:

"State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing."

As nurses are being called on to achieve higher levels of education and to "practice to the full extent of their education and training," the ability to practice independently will go a long way toward easing the primary physician shortage.

The Institute of Medicine (IOM) — now the National Academy of Medicine — called restrictive scope-of-practice regulation "one of the most serious barriers to accessible care." The good news is that more states are moving toward full practice authority, or at least "barrier reduction."

Pennsylvania has a full practice authority bill moving through the legislature. With the ability to practice to the full extent of their education and training, FNPs can help fill the state's growing primary care gap. The impact could be life-changing for the state's rural and underserved communities.

Learn more about La Salle University's Master of Science in Nursing Family Nurse Practitioner online program.


Sources:

U.S. Bureau of Labor Statistics: Fastest Growing Occupations

U.S. Bureau of Labor Statistics: Occupational Outlook Handbook - Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners

NCBI: The Future of Nursing: Leading Change, Advancing Health

American Association of Nurse Practitioners: NP Fact Sheet

Association of American Medical Colleges: AAMC Research Confirms Looming Physician Shortage

HRSA: State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025

The Center for Rural Pennsylvania: Rural/Urban PA

Rural Health Information Hub: Health Professional Shortage Areas: Primary Care, by County, 2017 - Pennsylvania

American Nurses Association: Advanced Practice Registered Nurse (APRN)

AANP: State Practice Environment

National Academy of Sciences: The Future of Nursing: Leading Change, Advancing Health

NCBI: Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus


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