IOM calls for removal of restrictions on nurse practitioners’ scope of practice

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IOM calls for removal of restrictions on nurse practitioners’ scope of practice

AAFP, TAFP reject committee recommendations that fail to ensure patient safety

posted 10.07.10

A new report from the Institute of Medicine and the Robert Wood Johnson Foundation recommends numerous changes to the education and regulation of nurses so they can play a more central role in the delivery of medical care. The report has drawn immediate criticism from AAFP, TAFP, the American Medical Association, and a host of other medical organizations because of its recommendation that state laws restricting the scope of practice of advanced practice nurses be removed.

“The report simply says, ‘Do away with all blocks on full scope of practice. Do away with anything that prohibits an advanced nurse practitioner from having direct patient care or direct licensing,’” said AAFP President Roland Goertz, M.D., M.B.A., in an Oct. 6, 2010, AAFP News Now report. “It doesn’t mention anything about how to maintain competencies or ensure patient safety.”

The report, entitled “The Future of Nursing: Leading Change, Advancing Health,” also calls on nurses to achieve higher levels of education and training through an improved education system, and it promotes the establishment of a nurse residency to increase the clinical education of nurses and facilitate the transition from the classroom to the exam room.

“Considering our current and projected shortage of nurses, I agree with the report’s recommendation to increase the number of doctorate level nurses so that there are enough professors of nursing to produce an adequate number of nurses,” said TAFP President Melissa Gerdes, M.D. “However, I do not support this report’s suggestion that advanced practice nursing should be an alternative pathway to the practice of medicine.”

When the IOM published its groundbreaking 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” the organization identified the inconsistent and often poor quality of care patients receive in the fragmented and chaotic U.S. health care delivery system. Since then, organized medicine and health reform advocates have worked at a feverish pace to increase quality standards; facilitate coordination of care through collaborative, team-based models like the patient-centered medical home; and eliminate disparities among patient populations.

“The recommendations found in this latest IOM report to lower the standard of training required to practice medicine and further fragment our nation’s medical care delivery system by inserting another echelon of independent clinicians flies in the face of its earlier call for improved quality and coordination,” Gerdes said.

Currently 16 states and the District of Columbia allow nurse practitioners to diagnose, treat, and prescribe without any physician oversight. Nurse practitioner organizations in Texas have made known their intentions to press for the revocation of all state regulations requiring NPs to collaborate with physicians when treating patients. When the Texas Legislature convenes in January 2011, this issue will be among TAFP’s top priorities.

For a grassroots legislative advocacy primer for family physicians that lists several ways you can help the Academy stave off dangerous legislation and promote bills that will protect your patients and your practice, check out the latest edition of Texas Family Physician. You can also sign up to be a TAFP Key Contact, and to serve as the Family Physician of the Day at the state Capitol during the session. Also, if you have a story to tell about how the independent practice of nurse practitioners could harm patients, please e-mail them to TAFP Communications Director Jonathan Nelson at