For many NPs, the demands of practice, family, and other responsibilities leave little room for professional advocacy. The thought of carving out more time from a busy schedule seems almost impossible. Recognition and respect for the NP profession has improved, but many unreasonable practice restraints remain. Even those who have made it their full-time or part-time job to tear down the barriers feel overwhelmed by the task at times. It's no wonder that those who feel overrun by their daily responsibilities can't fathom how they might work on all the issues NPs face. However, it is essential that NPs continue to devote time to removing barriers to practice.

Advocacy in small doses

There are over 125,000 NPs nationwide and approximately 6,000 new NPs prepared each year.1 Because NP numbers are growing rapidly, professional advocacy may effectively be spread out among greater numbers of NPs, allowing each advocate to focus on a single issue or a small portion of an issue.

The amount of time devoted to the chosen issue can be as little as the time it takes to make a phone call or write a letter. With this strategy, the time you have to allot is not the significant factor-the passion to improve the profession is of greater importance. The effect of more than 125,000 NPs passionately working on an issue could be huge.

Issues affecting NPs

Here are some of the current matters where NPs are focusing efforts. On the federal level, national NP organizations, such as the American Academy of Nurse Practitioners and the American College of Nurse Practitioners, are working to change laws that restrict NP practice by preventing NPs from ordering home health services. Recent changes in Medicare permit NPs to be the primary care providers for hospice patients. However, NPs still cannot order the hospice service.2

The Medicare Improvement for Patients and Providers Act of 2008 included language to expand the Medicare Medical Home Demonstration project. NPs were not specifically included, but the Act did include provisions for the Centers for Medicare and Medicaid (CMS) to write rules concerning the demonstration projects.3 Senators Bingaman, Collins, Harkin, and Murkowski engaged in a colloquy in support of including NPs as part of the Medical Home projects on the floor of the Senate. This colloquy can be used to strongly influence the rules developed by CMS.

On the state level, there are also barriers to practice that need to be removed. Florida and Alabama NPs still do not have authority to prescribe scheduled drugs. In many states, NPs are not included as primary care providers by Medicaid; regulations to govern convenient care clinics are being debated and written; and in some states, NPs are not permitted to sign forms authorizing handicapped parking permits. Some states require physicians to supervise NP practice. This supervisory language restricts NPs from being considered licensed, independent practitioners and thus prevents us from receiving direct reimbursement from some insurers.

What can I do?

Contact your state or national professional organizations to learn more about the issues they are working on concerning NPs, or examine your own practice for barriers that are preventing you from delivering care to your patients. Once you identify an issue, look for ways to bring about change.

Remember that advocating a cause doesn't always require devoting large amounts of time. Write a letter, talk to your legislators, make a phone call, or educate people about the contribution of NPs to healthcare. Your efforts can play a significant part in bringing about change. So, pick your issue and advocate!!

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