Two states

March 5, 2007 -- Recent editorial pieces have argued strongly for reducing regulatory barriers that limit the ability of nurse practitioners (NPs) to give affordable, high-quality care to a U.S. population increasingly in need of it. On January 22, 2007, The Philadelphia Daily News published "Nurse Practitioners Reporting for Duty," an op-ed by Tine Hansen-Turton, executive director of the National Nursing Centers Consortium. Hansen-Turton expressed support for a new plan by Pennsylvania Gov. Ed Rendell to reform the state's health care financing system in part by expanding access to NP care. Today, The Atlanta Journal-Constitution ran an editorial by Mike King called "Patients will lose out." The Journal-Constitution forcefully opposed a legislative proposal to roll back the statutory prescription authority Georgia NPs finally won last year, and to make it so difficult for physicians to work with NPs that it could end their relationships--which we assume could mean the end of NP practice in Georgia. We commend the authors and the newspapers for their efforts.

Hansen-Turton's January 22 op-ed in the Daily News praises Rendell's "ambitious plan" to expand health insurance coverage in Pennsylvania by controlling costs. She notes that with nearly 50 million uninsured in the U.S., "the need for accessible, affordable and quality health care has never been greater." She argues that the plans to "increase access to nurse-practitioner care" are especially important, since more than 141,000 NPs nationwide help fill the "growing gap in primary health and preventative care." She explains that the federal government and "most states" recognize that NPs are highly qualified primary care providers, as research has shown. Indeed, NPs can "prescribe many medications in virtually every state." Although NPs provide comprehensive care in a variety of settings, including "nurse-managed centers," Hansen-Turton notes that "they continue to hit arbitrary practice, reimbursement and regulatory barriers." She could have been more specific about what these barriers are and why they are arbitrary, but she makes a powerful argument for the value of NPs, and the key role they play in helping the U.S. grapple with its health care financing crisis.

Today's Atlanta Journal-Constitution editorial provides a great example of the kind of regulatory barriers Hansen-Turton is talking about. Mike King's piece notes that last year, Georgia became "the last of the 50 states to grant nurses supervised prescription-writing privileges." The piece explains that the legislative change was long overdue because of the shortage of primary care services and the growing number of Georgians without health insurance. However, it says, "the state's physicians are still trying to reverse that hard-fought victory." In particular, it argues that the "doctor-dominated board that licenses health care professionals" has drafted new regulations that require so much oversight of NP practice by affiliated physicians that health advocates say the rules are designed to push physicians to "give up the cooperative agreements they have with advanced practice nurses"--presumably leaving the NPs with no way to practice in the state.

The editorial notes that NP opponents have placed many of the restrictions in a state Senate bill, which would put them beyond the ability of any future health board to change. The piece suggests that the Medical Association of Georgia supports that bill, citing patient safety concerns. The group's executive director, David Cook, is "openly contemptuous of advanced practice nurses who, he claims, 'would like to set up their own primary care clinics without having to go to medical school.'" The piece says such "arrogance is typical of the physicians' union," but that "[n]o real safety or quality of care problems have surfaced in other states where advanced practice registered nurses are allowed to write prescriptions," noting that advanced practice nurses have the equivalent of a master's degree, and that they often see more patients than the physicians "they work for." The piece closes by urging passage of a competing bill that would require the medical board to conform to, rather then subvert, the intent of last year's law expanding NP practice rights.

Both of these pieces do a good job advocating for expanding access to affordable, quality health care by allowing NPs to do what studies show they are well-qualified to do. The Journal-Constitution piece is more forceful and specific in its defense of NP care, but that is because it confronts unusually aggressive hardball tactics by some Georgia physician representatives, who have long fought to prevent NPs from practicing effectively. The pieces might have noted that research actually shows that NP care is at least as good as that of physicians. In our experience, opponents of NP practice in the U.S. (including the American Medical Association) never cite research or any credible patient safety concerns, so it is difficult to see what drives their opposition, if not regressive anti-nurse bias and/or fear of competition. A wonderful example of such bias appears in Mr. Cook's statement about NPs' supposed need to attend medical school in order to run primary clinics, which assumes, with no evidence, that attending medical school is the only way to become a skilled primary care provider.

We thank those responsible for these pieces.

See "Nurse Practitioners Reporting for Duty" in the Philadelphia Daily News. Please send letters to Tine Hansen-Turton at