State Practice Laws Case Study Comprehensive Nursing Paper Example

State Practice Laws Case Study Comprehensive Nursing Paper Example

The nurse practitioner (NP) is an advanced practice registered nurse who has obtained additional preparation and skills in health-illness needs management, psycho-social assessment, and physical diagnosis in primary health care. NPs in Connecticut can be the only health professionals seeing a patient and can employ a combination of nursing and medication initiatives. However, NPs working in Connecticut are required to practice under physician oversight for a period of three years, unlike other states like Delaware, the District of Columbia, Hawaii, and Idaho, where NPs have full practice authority (FPA). The Connecticut state law (CGA 20-87a) requires NPs to obtain physician oversight for some time before acquiring FPA (Connecticut State, 2021). They must work with a licensed physician for three years and a minimum of 2,000 hours and can after that practice alone. NPs under physician supervision cannot diagnose patients, prescribe medication, primarily controlled substances, or conduct lab work and x-rays without physician supervision. Requiring a physician oversight places multiple hurdles to the scope of NP practice in Connecticut during the three years of practice because it limits NPs patient access, and NPs should operate within particular locations where the supervising physicians are available. (State Practice Laws Case Study Comprehensive Nursing Paper Example)

How the NP State Practice Law Affect Patient Care

The law to allow NPs to work independently in Connecticut faced a physician opposition, but the lawmakers passed a bill that allows NPs to work independently. However, they are still restricted because they must work under physician supervision for three years, unlike other states that allow NPs FPA. This limitation is still detrimental to the quality of care, especially in areas where most NPs are under supervision or have not attained the 2000 hours mark. NPs are required to collaborate and consult with the physician during referral, patient coverage, and disclosure (Connecticut State, 2021). The NPs are also limited to the medications and controlled substances they can prescribe, medical therapeutics they can review, corrective measures they can apply, and diagnostic procedures they can prescribe, dispense, or administer.(State Practice Laws Case Study Comprehensive Nursing Paper Example)

The scope of practice laws matters because they affect healthcare access, quality, and cost. NP full practice authority has numerous benefits to health care access, quality, and cost-effectiveness. The restrictions the state laws impose on NP practice for the three years under physician oversight limit their market access ability to compete with physicians and other professionals like physician assistants. Patients cannot enjoy the benefits of healthcare providers’ competition. Physician supply will be limited and will not satisfy half of the primary care demand by 2030, raising the need to allow NPs FPA throughout their practice. NPs consider the three years unnecessary or limiting because they have adequate education, training, and regulatory achievement to perform similar tasks as the supervising physicians. The state law restricting NP practice exacerbates staff shortage, leading to care access issues, especially in underserved areas like the rural population (Buerhaus et al., 2015). NPs with a full practice authority without restrictions are more likely to ensure access to Medi-Cal and uninsured individuals than physicians. They are more likely to serve in marginal areas with lower health and socioeconomic status. According to Spetz et al. (2017), allowing NP full practice will increase NPs supply in the state to fill the physician gap.(State Practice Laws Case Study Comprehensive Nursing Paper Example)

The restricted scope of NP practice requiring physician supervision for three years and a minimum of 2,000 hours is set mainly to maintain high care quality. However, studies show that the restrictions can also limit the quality of care because NPs can offer similar primary care quality as physicians if given full practice authority. Evidence shows that NPs full practice authority can help reduce preventable hospitalization, readmission, and emergency room visit rates than physician-managed patients (Buerhaus et al., 2018). Restricting NP practice for some time could also cause higher healthcare costs because patients are more likely to seek more expensive services because of limited access to care (Morgan et al., 2019). Physician supervision also takes much of physician time to care for the patients, reducing the number of patients they can see, affecting their salaries and bonuses. Compensating for this time and loss of bonuses requires physicians to reimburse for the time spent on NPs’ supervision, and the cost is passed to the health care payer, increasing the cost.(State Practice Laws Case Study Comprehensive Nursing Paper Example)

State Practice Laws Impact on the Specific Case

The case study involving the 35-year-old African American male requires a healthcare practitioner to conduct an assessment to gather subjective and objective data, recommend or perform diagnosis, recommend or carry out treatment, which involves prescribing medication, and recommend referrals to other professionals like mental health practitioners that are better equipped at dealing with depression and anxiety. Currently, NPs in the first three years of practice in Connecticut are under a transition period that requires them to have an arrangement with a physician for supervision (Connecticut State, 2021). The state law limits their scope of practice, and in this specific case, an NP who has not attained a full FPA would require physician oversight to develop a care plan that includes patient assessment, diagnosis, treatment, and referral. NPs practice is restricted in this case, and they cannot perform diagnosis, treatment, prescribe medicine, or recommend referrals independently. NPs full practice authority would allow an NP working with the patient to independently assess the patient, diagnose, order, and evaluate diagnostic tests, commence and manage treatment, including medication prescription. (State Practice Laws Case Study Comprehensive Nursing Paper Example)

Conclusion

The Connecticut state law (CGA 20-87a) limits NP practice by requiring them to operate under physician supervision for three years and 2000 hours minimum. (State Practice Laws Case Study Comprehensive Nursing Paper Example) The practice law restricting NP scope of practice significantly impacts care access, quality, and cost-effectiveness. Connecticut introduced the CGA 20-87a to loosen the restrictions, but NPs are still required to undergo a transitional period under physician supervision to qualify for full practice authority. The limitations affect the NPs ability to conduct patient assessments, diagnosis, treatment, and referrals. The scope of practice restrictions’ proponents need to support the CGA 20-87a law to eliminate the need for oversight and allow NPs to practice independently throughout their practice.(State Practice Laws Case Study Comprehensive Nursing Paper Example)

References

Buerhaus, P. I., DesRoches, C. M., Dittus, R., & Donelan, K. (2015). Practice characteristics of primary care nurse practitioners and physicians. Nursing Outlook, 63(2), 144-153. (State Practice Laws Case Study Comprehensive Nursing Paper Example)

Buerhaus, P., Perloff, J., Clarke, S., O’Reilly-Jacob, M., Zolotusky, G., & DesRoches, C. M. (2018). Quality of primary care provided to Medicare beneficiaries by nurse practitioners and physicians. Medical care, 56(6), 484-490. (State Practice Laws Case Study Comprehensive Nursing Paper Example)

Connecticut State. (2021, December 22). Practitioner licensing investigations. Department of Public Health. https://portal.ct.gov/DPH/Practitioner-Licensing–Investigations/APRN/APRN-Practice (State Practice Laws Case Study Comprehensive Nursing Paper Example)

Morgan, P. A., Smith, V. A., Berkowitz, T. S., Edelman, D., Van Houtven, C. H., Woolson, S. L., … & Jackson, G. L. (2019). Impact of physicians, nurse practitioners, and physician assistants on utilization and costs for complex patients. Health Affairs, 38(6), 1028-1036. (State Practice Laws Case Study Comprehensive Nursing Paper Example)

Spetz, J., Coffman, J., & Geyn, I. (2017). California’s Primary Care Workforce: Forecasted supply, demand, and pipeline of trainees, 2016–2030. San Francisco, CA: Healthforce Center at UCSF. (State Practice Laws Case Study Comprehensive Nursing Paper Example)

National Center for Biotechnology Information (nih.gov)