{ Scopeofpractice } Three out of every five NPs work either in rural settings or in inner cities, where critical preventive care is needed most but is often difficult to come by. Moreover, the problem could get much worse as budget cuts may make access to healthcare services even more limited. Nurse practitioners serve a very necessary role in our existing healthcare system, particularly in these urban and rural communities. Here’s the problem we currently face: California is the only state in the country that does not have a defined scope of practice for NPs. That means state law does not explicitly authorize us to diagnose patients, order tests, or refer patients to specialists. These functions are performed on an ad hoc or case-by-case basis and often mean significant delays or outright denial of care. In other words, bureaucratic and outdated regulations prohibit us from providing care that we are trained and qualified to perform. The lack of a de-
Increasing access to preventive care, which keeps people healthy and saves the system money, should be a top priority. fined scope of practice also means we cannot order “durable medical goods” for patients. That sounds arcane, but let me tell you what it means for patients: • NPs cannot order a walker or wheelchair for a patient who needs one to get around; • NPs cannot order diapers or formula for a newborn baby; • NPs cannot order a blood-pressure cuff for a patient who needs it to manage his or her condition. State law requires a defined scope of practice in order for insurance companies, Medicaid or Medi-Cal to directly reimburse healthcare providers for their services, meaning more delays and barriers to delivering important patient care. Without a defined scope of practice, nurse practitioners are finding it difficult and cumbersome to be reimbursed for the services provided, which in turn results in fewer opportunities for nurse
practitioners to provide care. Some of you may ask, how effective are nurse practitioners? Studies have been done by prestigious medical journals about the quality of NP care and the research is clear: NPs provide highquality care, have high rates of patient satisfaction, and already work in many of the most underserved areas in California. In January 2008, an issue brief was released by the California Healthcare Foundation on scope-of-practice laws for nurse practitioners. The brief highlighted a state-by-state survey on varying scope-of-practice laws conducted by The Center for Health Professions at the University of California, San Francisco. The survey found that “NPs deliver comprehensive medical services in a variety of settings and specialties, which are largely comparable to physicians, both in scope and medical outcomes.” Freeing us from needless bureaucracy will enhance our ability to continue to meet the needs of the patients we already serve and allow us to meet the needs of so many more. Defining a scope of practice is simple and, at the same time, a catalyst for dramatic change. It codifies much of the work we are already doing, such as diagnosing patients and referring them, when necessary, for more specialized treatment. Unfortunately, current law requires separate “standardized procedures” be developed for every healthcare facility around the state. These “standardized procedures” can and do vary from facility to facility, creating inconsistencies and gaps in care. By having one state standard, we will provide certainty and consistency where it is desperately needed. Having a scope of practice for nurse practitioners will also strengthen the requirements to be an NP in the state of California and provide more consumer protection by clarifying the responsibilities of the role NPs play in the current healthcare system. By creating a formal “scope of practice,” NPs will be directly reimbursed for the care they provide to patients — once again, a positive change that will lead to J an u ary
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better, faster care and an increased ability for NPs to see more patients. Nurse practitioners are fighting for a defined scope of practice in order to make the system more efficient. Nurse practitioners are focused on providing preventive care to ensure patients are healthy and receiving quality care. Expanding access to nurse practitioner services will improve the overall health of patients across the spectrum and minimize the occurrence of more serious conditions that rise from a lack of ongoing preventive care. A healthier population is less likely to utilize the most expensive emergency-room care, improving treatment times for serious emergencies and decreasing the cost to provide such coverage. After all, providing quality healthcare for patients is what physicians and nurse practitioners strive for on a daily basis.
Ms. Olmstead is president of the California Association for Nurse Practitioners. She g r a du a t e d from California State University in Long Beach in 1997 with a master’s of science degree in nursing and a nursepractitioner certificate. She practices full time in Southern California for St. Joseph Heritage Health Foundation in Fullerton. She was recently awarded the American Academy for Nurse Practitioners’ 2007 Astra Zeneca grant for developing a nurse practitioner-directed program for a “community-outreach program for improving colon cancer screening for the underserved and uninsured population.” She is a current member of the board of directors for the California Colorectal Cancer Coalition (C4), www.cacoloncancer.org.
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