Success in today’s healthcare environment is complicated. You need to provide excellent care but at a good value. You need to provide specialty care but create a sustainable model. You need to provide cutting edge services while maintaining financial flexibility. At the heart of these seemingly conflicting notions, is access to care and the current staffing crisis.
In some ways, we are in a patient bottleneck of our own creation, but the existing system limits our ability to solve the problem. There are ways to increase access for patients—notably, better utilizing advanced practice professionals (APPs). Instead, we have inconsistent regulations in the U.S. around what level of care APPs can deliver to patients and what M.D. oversight is required.
There are three main practice models for integrating APPs, which the American Association of Nurse Practitioners (AANP) lays out:
Full Practice
State practice and licensure laws permit APPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing.
Reduced Practice
State practice and licensure laws reduce the ability of APPs to engage in at least one element of APP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the APP to provide patient care, or it limits the setting of one or more elements of NP practice.
Restricted Practice
State practice and licensure laws restrict the ability of APPs to engage in at least one element of APP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the APP to provide patient care.
These vary greatly by state as you can see in the AANP’s map of state practice environments. In many cases and locations, APPs are not allowed to practice to the top of the license. That is both inefficient and unfortunate because it truncates our ability to deliver care to patients.
Historically, most people in healthcare think of physicians when they think of locum tenens, but that is starting to change. More hospitals are recognizing the opportunity associated with integrating APPs into the care model on a full time and temporary basis, but to maximize that investment we need to think about how to create a sustainable healthcare system.
That means talking to our legislators and leaders and urge them to create a consistent set of regulations that free up APPs to care for patients, instead of restricting access to care. Healthcare is experiencing a staffing crisis, if we are not doing everything we can to improve the situation, we are indirectly harming patients.
