The American Medical Association (AMA) has called for the licensing and regulation of advanced practice registered nurses (APRNs), including NPs, certified registered nurse anesthetists, nurse midwives, and clinical nurse specialists, to be done jointly by state medical and nursing boards. In doing so, the physician organization's house of delegates amended a more moderate policy urging collaboration between state medical and nursing boards on regulatory matters. The tougher stance is necessary, the AMA contends, to prevent the "scope creep" of APRNs into care that must be overseen by physicians.

The National Council of State Boards of Nursing immediately issued a statement opposing the amendment. It quotes the council's chief officer of nursing regulation, Maryann Alexander, who said, "Best practice dictates that regulation of APRNs should be within the purview of nursing regulatory bodies." The American Association of Nurse Practitioners was also swift to condemn the AMA's stance, chastising the organization for having "once again dusted off its old protectionist playbook and demonstrated its commitment to put profit and power plays ahead of patients and their access to high-quality health care."

The AMA has consistently opposed state and national legislation to expand the independent practice of certified APRNs. It has invested millions of dollars in lobbying and has generally disparaged care delivered without physician supervision. "Patients deserve care led by physicians-the most highly educated, trained and skilled health care professionals," the organization reported to members in a recent newsletter. "The AMA vigorously defends the practice of medicine against scope-of-practice expansions that threaten patient safety."

Among the AMA's arguments are that APRN care without physician supervision endangers patients and increases health care costs through overutilization of tests and procedures. Emerging research, however, has refuted some of these claims, finding that costs associated with APRN care in certain areas-in primary, urgent, and geriatric care settings or in diabetes management, for example-are either lower or on a par with physician care and quality is comparable. Researchers have also found that states that approved full scope of practice for APRNs also improved access to care, especially in rural and underserved areas. Finally, several studies have measured higher patient satisfaction with APRNs who generally spend more time and investigate symptoms more thoroughly than physicians.

The American Nurses Association (ANA) noted in its opposition to the AMA's new policy that "the licensing and regulation of APRNs do not and have never required the oversight of state medical boards." Joined by organizations representing nurse anesthetists, hospice and palliative nurses, and pediatric NPs, the ANA argued that only state nursing boards have the knowledge and understanding of nursing to oversee its practice. Moreover, the administrative burden of joint licensing and regulation while the U.S. health care system is experiencing severe clinician shortages would likely result in patient harm by limiting access to care.-Karen Roush, PhD, RN, FNP-BC, news director