8 states considering scope of practice changes

Eight states are considering changes to advanced practitioners' scope of practice and practice requirements to address the ongoing staffing crisis.

States have turned to advanced practitioners as a solution to hospital and private practice staffing issues as thousands of nurses and physicians leave medicine. 

Nationally, two bills have been proposed that would expand the authority of nurse practitioners and other advanced practice registered nurses. The American Medical Association is also tracking about 60 bills that seek to broaden pharmacists' scope of practice, which "would allow pharmacists to prescribe medications to patients based solely on a test performed at the pharmacy."

Many medical associations have spoken out against expanding practitioners and pharmacists roles, citing patient safety concerns.

Here are eight states considering expanding practitioners' scope of service:

  1. Illinois is considering five bills that would amend current legislation to allow nurse practitioners to prescribe schedule II drugs without physician consultations, as well as expand NP scope, hold multistate licenses, remove the requirement for physicians to be in the same specialty area, and practice in their home.

  2. Montana is considering a bill that would allow physician assistants to practice without a supervision agreement.

  3. Colorado legislators have put up for the third time a bill that would replace physician supervision for physician assistants with collaborative agreements.

  4. In New Jersey, a bill currently in committee seeks to increase an advanced practice nurses' scope to include writing prescriptions and practice as a physician. If the legislation passes, APNs in New Jersey with more than 24 months or 2,400 hours of licensed, active, advanced nursing practice will be authorized; APNs without this experience will need another provider to supervise.

  5. Missouri lawmakers filed a bill in January seeking to lift restrictions to allow nurse practitioners to care for patients without a physician.

  6. Two Pennsylvania senators are seeking to remove the requirement for nurse practitioners to collaborate with two physicians. Instead, practitioners would fulfill a three-year, 3,600-hour physician collaboration period before practicing independently.

  7. Texas is debating the HEAL Texans Act, which would allow APRNs to practice primary care services, such as diagnosing illnesses and prescribing medications, without physician supervision.

  8. South Carolina is considering a bill that would allow physician assistants to work in clinics in areas without physician supervision.

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