Much has been written over the past several years about the importance of nurse practitioners (NPs) lobbying for legislative change. NPs have become strong advocates for the profession not only in their legislative activities, but by demonstrating that they are educated providers of quality healthcare. The profession has advanced in many positive ways in a relatively short period of time.
NPs must continue to be proponents for removing practice barriers. For the profession to evolve, it is essential that NPs continue to lobby for changes in the laws and that they join their state and national professional associations. There are still many legal obstacles that hinder NPs from practicing within the full scope of their education and training. Reimbursement and prescribing top the list, but many other issues such as ordering home health, signing disability forms, and approving handicapped parking permits remain problems for everyday practice.
Defending Our Gains
It has also become apparent that NPs must learn to become defenders of the profession. We must always remember that legislative gains made in the past could be reversed. As the public, governmental, and business sectors have become aware of the positive impact that NPs have on healthcare provision, others who feel threatened have taken notice.
The concept of retail clinics has taken off, and the number of clinics has quickly multiplied. Though consumers seem satisfied, some physician groups have voiced objections. The corporate world has defended retail clinics, but NPs must also speak out to protect their role and assure that unnecessary restrictions are not placed on their practice. While corporate CEOs will fight to protect their right to run a profitable enterprise, they may make compromises that impinge on NP autonomy. Without NPs, the clinics will have difficulty surviving.
Victory Through Action
Bills have been introduced in some states that would reverse hard-won legislative victories or established practice norms. Florida NPs have fought off efforts to restrict their practices and increase supervision. Kentucky advanced registered nurse practitioners won authority to prescribe scheduled drugs in 2006, despite opposition from the state medical association. A regulatory change passed in early 2007 however, imposing additional restrictions on prescribing. Most recently, Oregon NPs defeated a measure that would have created a scope of practice review committee consisting of members appointed by the board of medical examiners. Similar bills have been filed in other states.
The American Medical Association (AMA) Scope of Practice Partnership (SOPP) was established in 2006 after many years in the planning. According to the report from the 2006 AMA annual meeting, the purpose of the SOPP is to "concentrate the resources of organized medicine to oppose scope of practice expansions by allied health professionals [horizontal ellipsis] This would be accomplished through a wide range of efforts, including a combination of legislative, regulatory, and judicial advocacy, as well as programs of information, research, and education." As demonstrated by ads placed in the lay literature and on TV, as well as action taken in state legislatures across the country, it is obvious that the SOPP is active.
NPs and all advanced practice nurses must meet these professional challenges by becoming strong advocates and vocal defenders. Remember these words from Loretta Ford, founding mother of the NP profession, sent in an e-mail to the NPINFO electronic mailing list in 2005, "Oh well, round 2, or is it 10, coming up? Hang in there [horizontal ellipsis] Remember what Teddy Roosevelt said, 'Threats are only a tribute to the efficiency (and effectiveness, I add) of our action.' Keep plugging."