Nurse practitioners (NP) and physician assistants (PA) are valuable members of clinical care teams, but they can often be underutilized in their respective roles. In fact, high-functioning clinical care teams made up of multiple types of clinicians often result in improved outcomes, better efficiencies, and increased clinician resilience.
Scope of Practice
Nurse practitioners and physician assistants both undergo extensive training and education. NPs generally adhere to a nursing model, whereas PAs follow a medical model. Nurse practitioners specialize in serving a particular patient “population” that focuses on patients in a certain age range or particular condition status, while PAs are trained as general practitioners across the spectrum of care. This can dramatically influence the daily responsibilities of both positions. While most states require some form of collaboration with a physician, this does not mean the NP or PA cannot work in a remote location independently.
In 24 states and the District of Columbia, nurse practitioners can work independently from a physician if they meet certain criteria. With the help of multiple advocacy groups, state legislatures are gradually changing laws to improve patient access to care.
Other scope of practice requirements include, but are not limited to:
- DEA restrictions
- Chart review and co-signature requirements
- On-site vs off-site supervision and collaboration
- Collaborative practice agreements
It is essential that every clinician understand and work within their scope of practice. Collaborative team practice helps to ensure care teams do just that. By understanding each member’s abilities and limitations, a care team can function at the highest level delivering high-quality cost-effective care.
Facility By-Laws
NPs and PAs need to be aware of what their facility by-laws dictate and what delineation of privileges is required. Some facilities have strict rules and regulations that severely limit the ability for NPs and PAs to practice in the hospital setting. This can sometimes result in increased inefficiencies and increased cost of care while negatively affecting patient satisfaction.
When NPs and PAs are utilized within their scope of practice, it positively impacts their patients’ health and longevity and improves patient satisfaction and experience. Advocating for NP/PA practice that is in line with state laws and mirroring that with the by-laws within the facility allows collaborative team practice to function at the highest level.
NP and PA Advocacy
Nurse practitioner and physician assistant professions were established based on a need for access to quality, equitable health care for all communities everywhere. Taking into consideration the needs of a community and the patients that the community serves should be the top priority while ensuring access to high-quality, affordable health care.
NPs and PAs have been answering this need for decades, especially in states with full practice authority (FPA). This is particularly true in rural and underserved areas, filling the health care gap for these patients who may not be able to access care otherwise. Advocacy efforts at the federal level include adjusting CMS regulations for utilization and reimbursement, qualifying NPs and PAs as primary care clinicians (especially in rural and underserved areas), and comprehensive telehealth reform. Advocacy at the state and federal levels is needed to eliminate the barriers limiting access to care, ease telehealth restrictions, and increase the portability of licensure throughout the United States.
How to Get Involved
There are many organizations, such as the American Association of Nurse Practitioners and the American Academy of Physician Assistants, representing each discipline that are working together to advance patient access to NPs and PAs.
NPs and PAs can join their state and national chapter organization (there are general and specialty membership options), find out what policies are priorities in the state, and make their voices heard in concert with others.
Other advocacy steps not limited to NPs and PAs include:
- Know who your congressperson and senators are.
- Meet and get to know those who hold advocacy offices in national organizations.
- Tell your congressperson and senators what bills you support and why.
NPs and PAs bring immense value to their respective health care organizations, providing skilled patient care and crucial clinical support to care teams. NP/PA advocacy is a way to actively support and achieve greater access to high-quality, equitable care for everyone.
