WASHINGTON For years, nurses have been subordinate to doctors
both in the exam room and the political arena.
But aided by new allies ranging from AARP to social workers to
health-policy experts, nursing groups are pressing ahead in a bid to
persuade state lawmakers to shift the balance of power.
In 11 states, they are pushing legislation that would permit
nurses with a master's degree or higher to order and interpret
diagnostic tests, prescribe medications and administer treatments
without physician oversight. Similar legislation is likely to be
introduced soon in three other states.
If the proposals, which face vehement opposition from some
physicians groups, succeed, the number of states allowing nurses to
practice without any type of physician supervision would increase to
30 from 16, in addition to the District of Columbia.
The broader authority being proposed around the country could
spur tens of thousands of nurses to set up primary-care practices
that would be virtually indistinguishable from those run by doctors.
Currently, about 6,000 nurses operate their own independent primary-
"We have a ready-made, no-added-cost workforce in place that
could be providing care at a much higher level if we modernize our
state laws," said Taynin Kopanos, director of health policy and
state issues for the American Association of Nurse Practitioners.
"So the question for states is, are you going to fully deploy this
resource or not?"
Efforts to loosen restrictions on advanced practice nurses in
Missouri failed last year. Illinois is considering a measure to give
nurses more autonomy this year.
The nurses' last big legislative push, a state-by-state effort
that began in the late 1980s, sputtered by the early 1990s. This
time, however, the campaign is being coordinated nationally by the
nurse practioners association and other nursing groups and is
getting a critical boost from consumer advocates and state officials
concerned about the 2010 health-care law's impact on the
availability of doctors.
Beginning in January, about 27 million uninsured Americans are
expected to get coverage under the law, contributing to a projected
shortage of about 45,000 primary-care physicians by 2020, according
to the Association of American Medical Colleges.
Claudio Gualtieri of AARP's Connecticut branch said it makes
sense to empower qualified nurses to step into the breach.
"These are actually good ideas that we should have put into
practice a long time ago," he said. "But now, with the timetable for
the (health-care law) rolling out, there's an extra impetus to do
The nurses have won the support of faith-based organizations,
social workers, patients groups and the National Governors
Association. Perhaps the most valuable endorsement came from experts
convened by the National Academy of Sciences' prestigious Institute
of Medicine. That panel, in a report issued in 2010 after the
adoption of the health-care law, found no evidence that nurse-run
practices were unsafe and concluded that "now is the time" to allow
nurses to practice to the full extent of their education and
training without limitations by doctors. …