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Removing restrictions on nurse practitioners' scope of practice in New York State

Physicians' and nurse practitioners' perspectives

Poghosyan, Lusine PhD, RN, FAAN1; Norful, Allison A. PhD, RN, ANP-BC2; Laugesen, Miriam J. PhD3

Journal of the American Association of Nurse Practitioners: June 2018 - Volume 30 - Issue 6 - p 354–360
doi: 10.1097/JXX.0000000000000040
Qualitative Research

Background and purpose: In 2015, New York State adopted the Nurse Practitioners Modernization Act to remove required written practice agreements between physicians and nurse practitioners (NPs) with at least 3,600 hours of practice experience. We assessed the perspectives of physicians and NPs on the barriers and facilitators of policy implementation.

Methods: Qualitative descriptive design and individual face-to-face interviews were used to collect data from physicians and NPs. One researcher conducted interviews, which were audio-taped and transcribed. Twenty-six participants were interviewed. Two researchers analyzed the data.

Results: The new law has not yet changed NP practice. Almost all experienced NPs had written practice agreements. Outdated organizational bylaws, administrators' and physicians' lack of awareness of NP competencies, and physician resistance and lack of knowledge of the law were barriers. Collegial relationships between NPs and physicians and positive perceptions of the law facilitated policy implementation.

Conclusions: Policy makers and administrators should make efforts to remove barriers and promote facilitators to assure the law achieves its maximum impact.

Implications for practices: Efforts should be undertaken to implement the law in each organization by engaging leadership, increasing awareness about the positive impact of the law and NP independence, and promoting relationships between NPs and physicians.

1Columbia University School of Nursing, New York, NY

2Columbia University School of Nursing, Columbia University Medical Center Irving Institute for Clinical and Translational Research

3Department of Health Policy & Management, Columbia University Mailman School of Public Health

Correspondence: Lusine Poghosyan, PhD, RN, FAAN, Columbia University School of Nursing, 630 W. 168th Street, Mail Code 6, New York, NY 10032. Tel: 212-305-7081; Fax: 212-305-0722; E-mail:

Funding: The study was funded by the Robert Wood Johnson Foundation, the National Institute of Nursing Research (T32NR014205), and the National Institute of Health (TL1TR001875).

Presentation: The study was presented as a poster at Annual Research Meeting at AcademyHealth in June 2017.

Competing interests: The authors report no conflict of interests.

Authors' contributions: Lusine Poghosyan (data analysis; manuscript writing; editing and revisions); Allison A. Norful (interviewer; data analysis; manuscript writing; editing and revisions); Miriam J. Laugesen (manuscript writing; editing and revisions).

Received August 9, 2017

Received in revised form October 30, 2017

Accepted November 20, 2017

© 2018 American Association of Nurse Practitioners
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