Where’s the Beef 2: Impact of State Scope of Practice Laws (another straw man)

This project explored the effects of nurse practitioner (NP) scope of practice (SOP) legislation on the distribution and practice patterns of NPs as well as their billing practices. The goal was to understand where and how NPs are practicing, identify barriers that limit the degree to which NPs are practicing to the full extent of their education and training, and to inform policymakers as they seek to remove barriers in order to fully utilize NP to support healthcare delivery in the United States.1

            Seems fair right? But in this first statement of the document, you can already see the bias being set up: “practicing to the full extent of their education and training.”If you stop right there, the assumption being made at this point is that practicing to the full extend of ones education and training effects “distribution and practice patterns.” This seems consistent with mid-level groups talking points and rhetoric. As a former RN for 10 years followed by being an NP for 8 years, and now an MD, I never understood nor still don’t understand, and haven’t found an answer as to what comprises practicing to the full extent of their education and training. I’ve been licensed as a NP in states both with and without full practice authority (FPA) and found little difference on things I was and wasn’t able to do. Scopes of practice are delineated in the various nurse practice acts making scope of practice contingent on legislation and not education and training. It seems that if more scope of practice is desired, then a subsequent increase in education and training is warranted to make it so.  But this isn’t the case. Case in point, California2and Kansas3. Both states looking for FPA through legislation and NOT through education and training. As I’ve written about before4, this document attempts to use the straw man argument in support of FPA by purporting increased access to care with FPA, and that not having FPA is somehow a barrier. This document doesn’t delineate exactly what the barrier is other than not having FPA. How exactly is not having FPA a barrier in and of itself?  But this is the straw man and very easy to become caught up in arguing this debate. The debate at hand is not FPA to improve access to care rather whether or not NPs should have FPA in the first place or to practice with MD supervision/collaboration. As such, this document doesn’t opine. Have a blessed day. 


  1. https://aspe.hhs.gov/system/files/pdf/167396/NP_SOP.pdf
  2. https://www.chcf.org/wp-content/uploads/2019/05/ExpandingNPRuralCommunities.pdf
  3. https://www.kcur.org/post/nurse-practitioners-try-shake-free-doctors-kansas-physicians-resist#stream/0
  4. https://authenticmedicine.com/straw-man-the-dishonesty-needs-to-stop/

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135840cookie-checkWhere’s the Beef 2: Impact of State Scope of Practice Laws (another straw man)