1. Sofer, Dalia


An old debate heats up again.


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In November 2017, the American Medical Association (AMA) adopted Resolution 214 opposing the APRN Compact, which allows an advanced practice registered nurse (APRN) holding a multistate license to practice in states belonging to the compact. The compact will be implemented when 10 states have adopted it. Three states-Idaho, North Dakota, and Wyoming-have thus far signed on.

Figure. Cindy Zeller... - Click to enlarge in new window Cindy Zeller, a pediatric NP, is opening a pediatric practice in Woodsboro, Maryland. Although she was previously limited by a Maryland law that required NPs to have physician oversight to see patients, a law passed in 2015 now allows trained NPs to open independent offices. Photo courtesy of the Frederick News-Post.

The AMA's opposition to APRNs practicing without physician supervision is not new. In 2015, the group released the report Physician-Led Health Care Teams, arguing that "nurses are indispensable, but they cannot take the place of a fully trained physician." The following year, the association opposed a decision by the Department of Veterans Affairs (VA) to allow most APRNs within the VA to practice independently. And, through its Truth in Advertising campaign, the AMA has proposed model legislation that seeks to ensure that clinicians "clearly and honestly state their level of training, education and licensing."


Nursing organizations have denounced Resolution 214. The American Association of Nurse Practitioners referred to it as a "physician protectionist" resolution that uses "fear mongering" and the American Nurses Association called it "blatantly dishonest."


In its 2010 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) called on states to eliminate "outdated regulations and organizational and cultural barriers that limit the ability of nurses[horizontal ellipsis] to practice to the full extent of their education, training, and competence." But regulations remain far from uniform. For example, NPs-of whom nearly 98% hold graduate degrees-have full practice privileges in only 22 states and the District of Columbia.


"Resolution 214 contends that in multicompact states, APRNs must obtain additional licensing to provide care independent of a supervisor or physician," Beverly Malone, chief executive officer of the National League for Nursing (NLN), told AJN. "This implies that APRNs have not completed the fundamental preparation to provide primary care to patients. NLN supports the IOM report[horizontal ellipsis] and strongly recommends that AMA revise Resolution 214 and recognize that when APRNs are able to practice to the full extent of their education and training, patients, other providers, and our health care system benefit."


Various organizations, including the Kaiser Family Foundation, have argued that NPs could help meet the demand for primary care, which is rising owing to a growing and aging population and improved access to health care under the Affordable Care Act. With nearly 66 million Americans currently living in areas designated by the Health Resources and Services Administration as primary care Health Professional Shortage Areas, isn't it time for better collaboration?-Dalia Sofer