Several recent reports point to a trend of standardization, and the relaxation of restrictions on nursing scope of practice, Shalala and colleagues wrote.
• The Institute of Medicine report , "The Future of Nursing: Leading Change, Advancing Health" recommended that nurses should practice to the full extent of their education and training, should achieve higher levels of education and training through an improved education system that promotes seamless progression, should be full partners with physicians and other healthcare professionals and that effective workforce planning and policymaking require better data collection and information infrastructure.
• Several states are considering laws that would allow independent practice of nurses.
• The AARP supports an expanded role of nurse practitioners in primary care.
• Research in Massachusetts says the use of nurse practitioners or physician assistants to their full capacity could save the state between $4.2 billion to $8.4 billion over 10 years.
"Despite the robust rationale for broadening nurse practitioners' scope of practice, key medical organizations oppose the idea," including the AMA, the American Osteopathic Association, the American Academy of Pediatrics and the American Academy of Family Physicians, which all support direct supervision of nurse practitioners by physicians, Shalala and colleagues wrote in summary.
But with the growing shortage primary care providers, "fighting the expansion of nurse practitioners' scope of practice is no longer a defensible strategy."