Full practice authority: California leads the way, but the fight continues

2020 has been a difficult year for NPs and everyone. But not everything is bad news. A very important bill in California it’s on its way to become law. We’re talking about AB 890, written by assembly member Jim Wood (D-Santa Rosa). This new bill would give full practice authority (FPA) to nurse practitioners in the state of California.

A recent press release detailed the lawmaker’s intention for this bill. He remarked that “nurse practitioners who receive additional appropriate education and experience can provide the quality care that Californians deserve.”

The ever present fight for full practice authority

Nurse practitioners continually struggle to get FPA in many states. Some allow NPs to work independently after completing a number of hours under physician oversight. Others require them to wait for a number of years. As of this date, 28 states allow NPs to practice without the need for oversight.

Many nurse practitioners argue that scarcity is the primary motivator to implement FPA. There is a shortage of primary care providers in the US, and APRNs can help bridge that gap. Doctors argue otherwise, which has made this issue controversial.

The main point of conflict, according to physicians, is that nurse practitioners don’t have the same standard of education. They can’t be expected to perform the same job. However, the fight continues. Many NP organizations suggest that it isn’t about taking work from physicians. It’s all about letting NPs practice to the best of their ability, especially during a pandemic.

What AB 890 could mean for nurse practitioners in the US

So far, the bill has been amended twice in the Senate. We will have to wait a little longer to see where this path ends. There are no similar bills currently making the rounds, but the shortage of primary care providers has given this one a lot of momentum.

The bill would require the Board of Nursing “to define minimum standards for a nurse practitioner to transition to practice independently,” which is a good starting point.

Assembly member Wood also urged legislators to take this matter seriously, noting that “California has always been a policy leader” and that they have “more than two dozen” organizations supporting the new bill. If the Senate approves the bill, that could set a good precedent for other states to do the same.

Full practice authority: what are the facts?

Two years ago, the California Health Care Foundation released a document detailing the impact that practice laws have on their healthcare. The research drew findings from a variety of sources, including some already mentioned here.

Some of them included the fact that NPs are especially important for underserved communities and minorities, also noting that states with full practice authority have better healthcare outcomes than their counterparts.

Wood himself, and other recent news articles, have cited a very popular 2015 study as their argument for FPA in the state of California. The authors of said research concluded that “there were few differences in primary care provided by APNs and physicians; for some measures APN care was superior.”

This isn’t the first time a peer-reviewed publication has come to this conclusion. In 2005, another research team found that “appropriately trained nurses can produce as high quality care as primary care doctors and achieve as good health outcomes for patients.”

Another one, this time from 2020, noted that “patients reassigned to NPs experienced similar outcomes and incurred less utilization at comparable cost relative to MD patients.” These findings led them to declare that “NPs may offer a cost-effective approach to addressing anticipated shortages of primary care physicians.”

Opposition to FPA: the current arguments

You might be asking yourself: why is there opposition to FPA? There is already hard proof that nurse practitioners can and do provide a high standard of care. The answer to this question is complex, but we could start by naming some of the leading points that they have made.

The first one is education. The time and effort that takes to become an NP is significantly lower than the time it takes to become a physician. MDs have to complete at least 13,500 clinical hours more than NPs before they can practice. There are also a couple of studies that defy the idea of nurse practitioners reducing healthcare costs.

However, the main point of view against full practice authority is not that all NPs should have their practice reduced, or restricted. Some organizations, especially the American Medical Association, have called for all healthcare personnel to work together in “physician-led teams.”

They argue that MDs are natural leaders and guides, and also suggest that “nurses are indispensable” but that they can’t “take the place of a fully-trained physician.”

Where do we go from here?

It’s been some time since the issue of full practice authority made headlines around the country. The last occurrence was 2016, when the Department of Veteran Affairs granted FPA to three distinct roles of APRNs, excluding only CRNAs.

It can be easy to suggest a dire outlook for the future of nurse practitioners, but the reality is that there has been significant progress. Opposition by physicians is nothing new.

COVID-19 has changed the landscape of healthcare, which brought about some changes in scope of practice, and continued research on the effect that NPs have on healthcare might lead to other bills and new studies.

In the meantime, it would be best not to antagonize MDs. As we saw earlier, they have their own ideas regarding full practice authority, and nurses can only respond by continuing to grow as nurses.

To conclude, there’s still a long way to go for qualified NPs to provide the assistance and care that this country so desperately needs, but we’re getting there. AB 890 is a good milestone, and the fact that it went to the Senate is even better.

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