Scope of Practice Laws – Expertise or Economics?

By Marjorie Stiegler on April 19, 2013 in Uncategorized
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An article entitled “Stiff resistance: Docs fight encroachment in turf war with nurses” from ModernHealthcare.com today discusses expanding scope of practice laws for nurses, citing a few key phrases that warrant a closer look.

“Physician groups continue to resist sweeping measures that would expand the allowed scope of practice for licensed nurses with advanced medical training.”
Sweeping measures? For nurses with advanced “medical training”? The author cites two years of post-graduate training for these nurses, but two years of post-graduate training still represents considerably less training than even the shortest medical residencies. And perhaps more importantly, it represents nursing education, not medical education.

And why shouldn’t both physicians and patients be concerned about laws that expand the allowed scope of practice? There is a very common axiom taught to medical students: “you don’t know what you don’t know” – meaning you are not even aware of the vast scope of knowledge that is unknown to you. For example, many people take a college level physics course, which doesn’t even scratch the surface of what is known about physics by experts in the field. This is a dangerous combination – legislative fighting to expand a scope of practice in which the providers may not know what they don’t know.

“There are implications for costs even when nurse practitioners are paid as much as primary-care physicians. Research has shown they tend to order fewer tests and diagnostic procedures. ”
I’m not sure this is necessarily a good thing; it would depend of course upon what diagnoses are being entertained and excluded or confirmed. What is very concerning, however, is that a purely economic focus drives this benefit. Simply because advanced practice nurses spends less on health testing or procedures does not make their diagnostic skills or clinical acumen equivalent to their physician supervisors. The assertion that this would all be resolved by a simple “matter of education for our physician colleagues” is pure rhetoric and condescension.

I value our nurses and their important role in the health care system. But education, experience, and expertise should drive scope of practice parameters. Economy and lobbyists should not. Truth, transparency, and team work are the core fundamentals of patient safety, and our patients deserve this. They should not be misled or deceived by confusing terminology or scope of practice laws.

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