Varying Regulatory Landscape in US for Nurse Practitioner Practices

Varying Regulatory Landscape in US for Nurse Practitioner Practices

Nurse practitioners (NPs) are in high demand and have a promising career path. Some states, facing a shortage of doctors, are permitting NPs to establish independent practices without direct physician or hospital oversight. However, this practice has sparked controversy in certain states, where opinions on NPs working without physician supervision differ. The American Association of Nurse Practitioners’ map illustrates the diversity of NP policies across states. Generally, Western states are more supportive of NPs practicing autonomously, while the Southeast is more restrictive.


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The Wall Street Journal recently covered this topic, revealing that 17 states currently allow NPs to treat patients and work independently. In several states like PA, CA, MI, and MA, there’s a debate between NP supporters, doctors’ groups, and lawmakers regarding legislation to grant NPs full autonomy and the ability to establish their practices. In NJ, NPs can achieve independence after two years of working under a doctor or an advanced practice nurse with an MSN degree.

The states with the highest NP demand are California, New York, Florida, and Ohio. Nurse practitioner demand grew before the Affordable Care Act due to new care models outlined in the law, such as patient-centered medical homes and accountable care groups, which rely on NPs and physician assistants. The expansion of health clinics in drugstores and grocery stores staffed by NPs has also increased demand.

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In California, the Senate approved a bill addressing the doctor shortage in 58 counties by granting NPs more autonomy. The California Medical Association opposes the bill, fearing it could compromise care quality. A proposed compromise suggests that NPs must complete 6,000 hours of supervised work before achieving full independence from doctor supervision. The question of how independent NPs should be has been contentious, as seen in Nevada’s six-year-long deliberation on the matter. Nevada’s decision to allow it was driven by a severe doctor shortage, ranking fifth lowest in doctors per capita in the nation.

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