As the demand for health care workers surged with the coronavirus case count, many states lifted restrictions on nurse practitioners, who provide much of the same care as doctors do. But California did not allow nurse practitioners to work without the supervision of a doctor, and most limitations on their practice stayed the same amidst pandemic.
In a March 2020 Gov. Gavin Newsom directed the state Department of Consumer Affairs, which controls professional licensing, the power to change or temporarily waive regulations to let the health care workforce respond to the crisis (Brusie, 2020). That opened the door for nurse practitioners to ask the department to kill the supervision requirements without actually lifting them. It temporarily lifted the cap on how many nurse practitioners each physician could supervise, though it left in place the oversight requirement (Brusie, 2020). Instead of one physician supervising four nurse practitioners, physicians can supervise an unlimited number of nurse practitioners (Brusie, 2020). In addition, on September 29, 2020, AB890 was signed into law by Gavin Newsom and Assembly member Jim Wood (Brusie, 2020). With the passage of AB 890 the Nurse Practitioner may be able to practice independently once certain provisions have been met. This law will come into effect in January 2022. Per AB890, the transition to practice must include a minimum of three full-time equivalent years of practice or 4600 hours (California Board of Nursing, 2021). Upon completion of the transition to practice, a nurse practitioner may practice in limited settings or organizations in which one or more physicians and surgeons practice with the nurse practitioner without standardized procedures (California Board of Nursing, 2021).
A restrictive environment of imposed state laws and regulations reduces nurse practitioners’ level of autonomy in prescribing medications and acts as a barrier to their practicing to full potential. The restrictive practice scope adversely impacts APNs’ ethical practices. For example, the restrictive-level policy is associated with reduced access to care, which goes against the ethical principle of justice. This ethical principle requires nurses to fairly and equitably distribute care to patients. Nevertheless, with the scope of practice limits, APNs might not be in a position to adhere to this policy. According to Patel et al. (2019), restrictive policies inhibit using nurse practitioners’ workforce strategically at their full capacity to improve access to care. As such, it might be challenging for APNs to offer equal care, particularly among patients from low-resource regions. Neff et al. (2018) added that in restrictive nursing practitioner policy states, APNs face restraints to practice to their full capacity and ability to offer the expected care. As a result, it becomes challenging for nurse practitioners to always adhere to the code of ethical practice requiring them to ensure fair and equitable care to all patients regardless of their socioeconomic status.
Brusie, Chaunie (2020). California Grants Nurse Practitioners Full Practice Authority by 2023. Nurse.org. Retrieved June 13, 2022, from https://nurse.org/articles/california-nurse-practitioners-full-practice/
California Board of Nursing (2021). Assembly bill 890. California Board of Registered Nursing. Retrieved June 13, 2022, from https://www.rn.ca.gov/practice/ab890.shtml
Patel, E. Y., Petermann, V., & Mark, B. A. (2019). Does state-level nurse practitioner scope-of-practice policy affect access to care? Western Journal of Nursing Research, 41(4), 488-518. https://doi.org/10.1177/0193945918795168 (Links to an external site.)
Peterson M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the Advanced Practitioner in Oncology, 8(1), 74–81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995533/
The prevailing changes in the context of healthcare practices throughout the world have imposed direct implications on the overall scope of practices among distinct medical providers. Most of the respective changes have led to the substantial evolutions, especially regarding the traditional roles and mandates of nursing practitioners and other non-physicians medical professionals. In this respect, I concur with your indications about the recent significant advancements in the scope of practices and educational frameworks for nursing practitioners, thereby according them sufficient level of expertise to provide almost similar care as typical doctors (Rosa et al., 2020). It is also true that recent COVID-19 pandemic prompted notable changes in the general scope of practice for healthcare providers in certain states, including the policy provision allowing nurses to work independently without the supervision of physicians.
Regardless, some states are yet to realize the emerging evolutions in the sphere of nursing practitioners and their integral roles toward fostering healthcare access among individuals through the implementation of relevant health policy reform. I agree with you that lack of effective policy reforms in some states, enabling nursing practitioners to practice up to their full potential have been a limiting factor and barriers to enhancing improved care access among the members of public (Rosa et al., 2022). It is logical that critical policy changes should be implemented countrywide to recognize the current advancements in the scope of practice for nurses in order to ensure enhanced accessible care among individuals.
However, don’t you think much emphasis should be conducted to determine whether the nurses’ pre-existing levels of healthcare expertise could not only warrant accessible care, but also quality patient care? According to Poortaghi et al. (2021), one of the notable factors that has been dwarfing the adoption of adequate regulations to allow nurses practice at the top of their licenses in certain states includes the risk of patient safety. From this perspective, health policy makers in the region have attempted to overcome the respective challenge through proposing the introduction of patient safety education in the context of nursing undergraduate curriculum, in a bid to ensure quality patient outcomes among future nurses (Mansour et al., 2018).
Mansour, M. J., Al Shadafan, S. F., Abu-Sneineh, F. T., & AlAmer, M. M. (2018). Integrating patient safety education in the undergraduate nursing curriculum: A discussion paper. The Open Nursing Journal, 12, 125. https://doi.org/10.2174%2F1874434601812010125 (Links to an external site.)
Poortaghi, S., Shahmari, M., & Ghobadi, A. (2021). Exploring nursing managers’ perceptions of nursing workforce management during the outbreak of COVID-19: A content analysis study. BMC Nursing, 20(1), 1-10. https://doi.org/10.1186/s12912-021-00546-x (Links to an external site.)
Rosa, W. E., de Campos, A. P., Abedini, N. C., Gray, T. F., Huijer, H. A. S., Bhadelia, A., & Downing, J. (2022). Optimizing the global nursing workforce to ensure universal palliative care access and alleviate serious health-related suffering worldwide. Journal of Pain and Symptom Management, 63(2), e224-e236. https://doi.org/10.1016/j.jpainsymman.2021.07.014 (Links to an external site.)
Rosa, W. E., Binagwaho, A., Catton, H., Davis, S., Farmer, P. E., Iro, E., & Aiken, L. H. (2020). Rapid investment in nursing to strengthen the global COVID-19 response. International Journal of Nursing Studies, 109, 103668. https://doi.org/10.1016%2Fj.ijnurstu.2020.103668