As the debate over expanding advanced practice professionals’ scope of practice continues nationwide, nurse practitioners (NP) in Maryland are asking for changes in state laws and regulations that limit their ability to practice independently as primary care providers. They are also seeking more standardization of regulations regarding NPs.
Seventeen states and the District of Columbia have loosened restrictions on NPs; while 12 states still have very tight limits (including Maryland). Among the strict limits in Maryland are prescription requirements. Although verbal orders are allowed for certain prescriptions and other patient needs, many written orders require a physician sign-off on the request. Another hurdle is that each NP in the state must have a letter of attestation signed by a physician, even though the physician writing the letter may have little or no experience with general practice.