Nurse practitioners need to be 'in'

Nurse practitioners need to be 'in'
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We are losing nurses and doctors to this pandemic on a daily basis. As they battle the coronavirus on the frontlines, more and more are testing positive and becoming ill, without a reserve workforce to step in for them.  

At this critical time the public needs access to health care providers, including nurse practitioners (NPs). Not only do we need them for our overflowing hospitals battling the coronavirus, but also to care for those who have other ongoing health care needs. People still need treatment for urinary infections, asthma, seasonal allergies, heart conditions and more. Health promotion activities, such as well-child care, should not be curtailed. None of these needs go away during pandemics.

Every day, in nursing homes, rural clinics and in acute care institutions, NPs are serving the public. Study after study has identified NPs as highly qualified and effective health service providers, but not everyone has access to the full range of services that NPs can provide.


In more than half of the United States, restrictive state regulations prevent NPs from providing needed services to patients in rural and poor urban areas, large acute care institutions, small community hospitals and everywhere in between. 

The American Academy of Nurse Practitioners (AANP) urges governors with restrictive regulations to lift these very roadblocks that hamper patients’ access to care providers. 

Many of these states still require nurse practitioners to have a legal supervisory contract with physicians in order to practice. These contracts put people in these states at risk. Without a contract, NPs may not be able to prescribe certain categories of drugs, admit patients to hospitals, fill prescriptions, refer patients to nursing homes or order equipment for rehabilitation services.

Our lives must go on and our health conditions will still exist when this pandemic subsides. Without a state-required physician supervision contract, the NP cannot practice or fully serve their patients. In many areas there are not enough physicians to create the needed contract. Critical and important care will be delayed or not provided.

In Tennessee, Gov. Bill Lee (R) took early initiative on March 20 to remove the requirements for supervisory contracts for NPs through an executive order. NPs in Tennessee are now free to practice without restrictions and more easily care for those with chronic illnesses, perform routine health screenings, while others engage in the daily battle to save people from the coronavirus.  

Other states, such as Massachusetts, have followed the same course. The Centers for Medicare and Medicaid Services (CMS) has also pushed the “pause button” by issuing temporary waivers to allow NPs to practice to their full scope without requiring physician supervision for prescriptive activities and for institutions to hire NPs from other states without breaking Medicare rules.

On the other hand, although Pennsylvania Gov. Tom Wolf (D) lifted some of the regulatory roadblocks, he has not removed the requirement for the 14,000 NPs in Pennsylvania to work under a physician supervision contract. Failure to remove this regulatory barrier continues to restrict the public’s access to needed health services and delay their needed care. Patients may go without or experience a delay in obtaining medications, such as inhalers or antibiotics, and equipment necessary to function safely in homes, like walkers.

Two policy changes should be made now as we plan for the post-pandemic environment: all states and CMS should immediately waive all restrictive physician supervisory regulations for NPs, and these waivers, both by states and CMS, should be made permanent. State and CMS “pause buttons” need to become standard practice. If our NPs are good enough to provide needed care during the pandemic they will be just as good when this pandemic is over.

We need to ensure NPs are “in” and able to care for our most vulnerable citizens and those who routinely need our care now and in the future.  

Julie A. Fairman PhD. RN, FAAN, is the Nightingale professor of nursing, Director Emerita, Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania, School of Nursing.

Cynthia Connolly PhD, RN, FAAN is a professor of nursing, Rosemarie B. Greco Endowed Term Chair in Advocacy and the associate director, at the Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania, School of Nursing.

Patricia D’Antonio PhD, RN, FAAN is a professor of nursing and director of the Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania, School of Nursing.