A "landmark" Supreme Court decision about teeth whitening service providers and scope of practice laws has national implications for nurses, too, says the American Nurses Association.
What do inexpensive teeth whitening, the Supreme Court, and antitrust laws have to do with advanced practice nurses? A lot, says Maureen Cones, associate general counsel for the American Nurses Association.
Maureen Cones |
It all starts with the North Carolina Board of Dental Examiners, which didn't like that non-dentists were offering cheaper teeth-whitening services than they were. To put a stop to it, the board issued "official cease-and-desist letters to non-dentist teeth whitening service providers and product manufacturers, often warning that the unlicensed practice of dentistry is a crime," according to a Supreme Court opinion about the case.
Citing Antitrust Law, SCOTUS Backs FTC in NC Dental Board Suit
The threats worked. But after the non-dentists stopped offering teeth whitening, the Federal Trade Commission stepped in, filing an administrative complaint that the dental board's actions were anticompetitive and unfair. On February 25, the Supreme Court agreed.
So again, the question: What does this have to do with APRNs? According to Cones, this ruling essentially means that state licensing boards can't engage in conduct that limits the scope of practice for other professions "unless their actions embody the clearly articulated policy of the state and is done with state supervision."
Scope of practice. State policy. Sound familiar?
An ANA statement about the ruling drew parallels to the nursing profession, saying that this "anti-competition case has far reaching implications beyond dentistry and will have a significant, positive impact for nursing practice: It ensures nurses can work to the full extent of their education and training, unrestricted by unlawful anti-competitive interference."
"I would call this a landmark ruling," Cones says.
There are unmistakable echoes here of physician claims that limiting APRN's scope of practice is a patient safety issue. The North Carolina Board of Dental Examiners claimed that its teeth-whitening battle was about patient safety, but the FTC rejected that notion, pointing to "a wealth of evidence… suggesting that non-dentist provided teeth whitening is a safe cosmetic procedure," according to the Supreme Court opinion.
"It's not a patient safety issue, people do teeth whitening at home," Cones says.
It's really about financial stakes and competition.
Cones says boards are intended to regulate their own professions. Although the ANA believes this to be an incredibly important function, scope-of-practice overlap can cause substantial friction when one profession thinks another is cutting into what it considers its exclusive practice. But "the intent is for regulatory boards to regulate themselves, not other professions," Cones says.
The million dollar question then, is who gets to decide on the exclusive practice for one profession or another.
"The state gets to decide, the elected officials," Cones says. She says states will need to establish a supervisory structure so action taken by boards can be reviewed.
This is good news for consumers because those responsible for articulating the policy of the state have electoral checks and balances in mind, rather than the best interests of a certain profession. If action someone is taken against, it will truly be in the best interest of patient safety, rather than the financial interests of a certain profession, Cones says.
And that's where this decision will have national implications: There are medical boards and nursing boards in all 50 states, and scope of practice overlap battles are occurring with increasing frequency.
"The Supreme Court decision protects patients' right to have access to healthcare providers of their choice," Cones says. "That's really important at a time when we have countless folks entering the world of the insured."
Alexandra Wilson Pecci is an editor for HealthLeaders.
