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COVID-19 Brings Changes to NP Scope of Practice

AJN, American Journal of Nursing: August 2020 - Volume 120 - Issue 8 - p 14
doi: 10.1097/01.NAJ.0000694516.02685.29
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Abstract

Figure
Figure:
A map highlighting COVID-related changes in NP practice authority by state, indicating temporarily suspended and waived practice agreement requirements; last updated June 11. Image courtesy of the American Association of Nurse Practitioners.

The federal government and many states have temporarily loosened practice restrictions on NPs and physicians to maximize the availability of clinicians to treat patients during the COVID-19 pandemic.

The Centers for Medicare and Medicaid Services, the nation's largest health insurer, serving more than 140 million Americans through Medicare, Medicaid, the Children's Health Insurance Program, and insurance exchanges, took these steps as cases surged in the spring. NPs were granted approval to provide certain medical services to Medicare patients at skilled nursing facilities; previously, these services were provided only by physicians. Telehealth has also been expanded, with physicians providing care across state lines via phone, via radio, or online, including in states where they aren't licensed. And nonphysician providers can now use telehealth to care for patients at long-term care facilities.

Increasing the clinical autonomy of NPs has long been a goal of the American Association of Nurse Practitioners (AANP). Prior to the pandemic, just 22 states, the District of Columbia, the Department of Veterans Affairs, and the Indian Health Service allowed NPs to provide direct patient care with full clinical autonomy. In the remaining states, NPs were required to practice in collaborative agreements with supervising physicians.

In late May, however, five of the states requiring collaborative agreements—Kentucky, Louisiana, New Jersey, New York, and Wisconsin—temporarily suspended these restrictions, permitting NPs to practice autonomously. An additional 14 states waived some requirements of practice agreements, for example, allowing NPs expanded prescribing authority or reduced supervision. (For the interactive AANP map, go to www.aanp.org/advocacy/state/covid-19-state-emergency-response-temporarily-suspended-and-waived-practice-agreement-requirements.)

Of the nation's 290,000 NPs, 27,000 are in California, where the California Medical Association has lobbied against expanding NP scope of practice. The only pandemic-related change has been to increase the number of NPs a physician is permitted to supervise from four to unlimited—which doesn't affect NP practice or patients.—Joan Zolot, PA

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