1. Alexander, Mary MA, RN, CRNI(R), CAE, INS Chief Executive Officer, Editor

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I have written several times about the need for collaboration and cooperation among nurses, physicians, and other healthcare professionals to provide the best patient care possible. Recently, however, a resolution was adopted by the American Medical Association (AMA) and other physician groups that could result in limiting collaboration as well as patients' choice of healthcare practitioner. Resolution 814 supports studying and reporting on "the qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of the limited licensure healthcare providers, and limited independent practitioners."1 At the same time, the AMA announced the formation of a "Scope of Practice Partnership (SOPP)," which is to serve as a source of information for physicians, state legislatures, courts and regulatory agencies, and others when they consider public safety and qualifications in relation to limited licensure healthcare providers. In effect, the physicians' groups are attempting to determine what is best for other licensed healthcare professionals, which undermines the professionalism of advanced practice nurses and other healthcare providers.

Figure. Mary Alexand... - Click to enlarge in new windowFigure. Mary Alexander MA, RN, CRNI(R), CAE, INS Chief Executive Officer

In response, the American Nurses Association (ANA), at its House of Delegates meeting in Washington, DC, in June, voted to oppose any maneuvers by the AMA or other physician groups that would limit the services and care advanced practice and other nurses provide-policies that could deny patients access to quality, affordable health services. Rebecca M. Patton, MSN, RN, CNOR, the newly elected president of ANA, spoke out against the Resolution 814 and the SOPP:


For many years, registered nurses and advanced practice registered nurses have been successfully meeting patients' primary and specialized healthcare needs. We've earned the public's trust, and often we are the only health care professionals willing to care for people living in rural and other underserved areas. We believe the public is best served when healthcare professionals work together, and when patients determine who most effectively can meet their healthcare needs.2


The ANA was not the only organization alarmed by the proposal. The Coalition for Patients' Rights (CPR), an alliance of 25 organizations representing a variety of licensed healthcare professionals who provide an array of safe, effective, and affordable healthcare services to millions of patients, delivered a joint statement opposing Resolution 814 and the SOPP. The coalition questioned the motives of the AMA and other physician organizations when they seek to advise consumers, regulators, policymakers, and insurers on the ability of other healthcare professionals to offer the services they are allowed by law to provide. The organization noted that people who live in rural areas rely on a wide array of practitioners to meet their healthcare needs.


Resolution 814 and the SOPP are an affront to nurses who continually seek ways to address the needs of today's patients. Rather than question their professionalism, physician groups should commend the nurses who pursue advanced education as APRNs (eg, nurse-practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists) or become certified in their specialty. These nurses greatly enhance their skills and develop new capabilities that result in improved care as well as more healthcare provider options for patients.


Infusion nurses should be aware of the consequences of Resolution 814 and the SOPP. Should this attempt to control and constrain the practice of licensed healthcare professionals succeed, you and your colleagues could find it significantly more difficult to extend or expand scope of practice. The value of efficient and safe advanced practice nursing would be diminished, as would the status of nurses as well educated, autonomous healthcare professionals.


In national polls and surveys, the nursing profession consistently ranks high in consumer confidence. Every year the Gallup Organization conducts a poll about the honesty and ethical standards of professionals. In the 2005 survey, nurses once again claimed the top spot out of 21 professions.3 Clearly, patients depend on nurses to provide high-quality care in a variety of settings-hospitals, clinics, long-term care facilities, hospices, and the home. They trust nurses to provide education about their care, as well as to advocate on their behalf. Nurses have been successful in meeting patients' needs and are highly regarded by the public. Therefore, physician groups should not be the ones defining our scope of practice, or limiting patients' access to qualified healthcare providers.


Infusion nurses collaborate with many other healthcare professionals, and in order for a healthcare team to be successful, each member of the team must recognize others' expertise within their scope if practice. Doing so results in a smoothly functioning, respectful group that ultimately delivers quality, safe patient care.


The AMA reports that 31 states and the District of Columbia are expected to face scope of practice legislation in 2006. Therefore, your action and participation at the state level will have the most impact on these issues.


Mary Alexander, MA, RN, CRNI(R), CAE, INS Chief Executive Officer




1. Coalition for patients' rights: joint statement. Available at Accessed July 13, 2006. [Context Link]


2. American Nurses Association. RN delegates to ANA's annual meeting take action to protect the public's health." June 27, 2006. Press release. [Context Link]


3. Jones JM. Nurses remain atop honesty and ethics list. Available at: Accessed July 13, 2006. [Context Link]