Advanced Practice Nurses: Pushed Forward by Health Reform Advocates, Pushed Back by Physicians over Turf – Enough Already!

By Shawn Kennedy, MA, RN, AJN editor-in-chief

As we’ve noted in past posts on this blog and in AJN editorials in August 2006 and August 2008, organized medicine does not want to acknowledge that nurses can practice independently.  And now the turf war between advanced practice nurses (APRNs, which include nurse practitioners, nurse anesthetists, nurse midwives and clinical nurse specialists) and physicians is heating up.

In California, physicians are suing the state for allowing nurse anesthetists to practice without supervision, using patient safety as a reason. In Kentucky, physicians are opposing legislation to expand the scope of practice for NPs—at issue is whether NPs should need a signed collaborative arrangement with a physician (even though the physician does not supervise the NP). According to an article by a Louisville, Kentucky, newspaper, the Courier-Journal, the physicians charge high fees for their signature or demand a percentage of the practice.  The bill, though, passed the state House committee on March 4, with several members questioning the ethics of physicians’ requiring fees.

Nurses have been and continue to fight for the right to practice, and during this period where the government is seeking solutions to health reform, this is a battle that shouldn’t have to happen—a view shared by Stephen Ferrara, NP, at A Nurse Practitioner’s Place (“I have tried to refrain from taking the bait from some recent negative opinions regarding nurse practitioner delivered care”).

In an address March 5 to the Virginia Council of NPs, the president of the American Nurses Association, Becky Patton, told the group, “Allowing APRNs to simply do what they have been educated and trained to do benefits patients by providing them with increased access to affordable, high-quality health care. If this is not the overarching objective of health care reform in this country, it should be.”

And it’s not just nurses singing this tune. Last week the Josiah Macy, Jr. Foundation released a report from a multidisciplinary panel calling for the removal of “legal, regulatory and reimbursement barriers that prevent NPs and physician assistants from providing primary care.” It also calls for more investment in educating primary care providers and creating an infrastructure to better support primary health care (funding all types of primary care is the solution emphasized by physician blogger KevinMD). Former U.S. Health and Human Services Secretary Donna Shalala and Pennsylvania Governor Ed Rendell “get it” too—and have voiced strong support for increasing the role of nurses in health care.

The monopoly that medicine has had in controlling health care delivery serves only itself; it has forced legislation that keeps physicians in control of reimbursements, creating an illusion that they supervise nursing practice. Yet nurses have set up many of the health care delivery systems in this country. We run the systems and make them work. Nursing practice goes on around physicians, without them, and sometimes despite them. Research has proven over and over that NPs and other advanced practice nurses, when acting within the scope of their practices, have as good outcomes as physicians (and sometimes better). It’s time to stop the debate and move on.

Bookmark and Share

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Puji October 4, 2011 at 1:44 pm

    I currently work in an ED in Miami, FL. We currently have a minimum of two NPs present at all times. These NPs are vital to the flow of the ED and are of great assistance to the Emergency Physicians who often times are overwhelmed with the workload presented to them. By broadening the NPs scope of practice it could further assist in the responsibility of the care, which will serve to increase the efficiency and results throughout the ED, benefiting patient outcomes. At the end of the day, we are here to serve the patient and provide great quality service and NPs have proven through evidence based practice for this to be the case.

  2. Kentucky RN March 12, 2010 at 6:08 pm

    I am an RN practicing in the state and am currently enrolled in a bridge program to get my practitioner. With the difficulty to get into a primary care physician, the overcrowding of ERs, the lack of care providers in rural (and urban really) areas, how can someone knowingly argue against this. Family practice cries about taking more medicaid/medicare patients but then cries when a practitioner sees them. It can’t be both ways. This meets a definite need in the state.

Comments are moderated before approval, but always welcome.

%d bloggers like this: