Ornery Opinion: California Should Lift Onerous Nurse Practitioner Limits

I’ve seen this floating around social media recently. I respectfully disagree with the author of the article, physician Kathryn Hallsten that restrictions on nurse practitioners (NPs) in California are onerous. California is one of only 28 states that restricts NPs by requiring that they practice and prescribe with physician oversight. Onerous is defined as “involving an amount of effort and difficulty that is oppressively burdensome.” Ornery is defined as bad-tempered and combative. Nothing about physician collaboration is oppressively burdensome or ornery for that matter. I wish these lies and rhetoric would stop. Here’s where the article turns ornery:

restriction reduces access to care, increases cost, decreases the use of primary care services and boosts hospitalization and emergency department visits

Nothing in this statement is backed by evidence and is simply rhetoric. As is so often the case, these statements are not backed in evidence, but mere rhetoric of a political agenda.

Reduces access – how? I fail to see how safeguards and safer practice by having physician oversight reduces access. 

Increases cost – how? Costs of what? I fail to see how physician oversight on NPs increases costs. 

Decreases the use of primary care services – what the #$#%^?? This is outright BS. Nothing about physician collaboration or oversight decreases patients use of services. 

Boosts hospitalization –  More BS. If anything, physician collaboration reduces hospitalization, but I can’t cite a source on this. But neither does the article. 

“Nowhere is access more affected than in rural areas, which are generally underserved by physicians.” Not true. Other evidence I’ve written about before shows NPs in fact don’t go to rural areas. This is a strawman argument for full practice authority. “So long as California law tethers nurse practitioners to physicians, fewer can serve rural populations.” NPs don’t go to rural areas as the article suggests. And then there is this “A proven solution and a step toward addressing these problems is expanding nurse practitioners’ scope of practice to the level of their training.”  Expanding scope of practice NOT with training, but through legislation is dangerous. 3% the training and education of a physician, but want equal practice capabilities. And the part of that statement that really bothers me is “to the level of their training.” This is akin to “top of their license.” What does that even mean anyway? Part of the article I do agree with, that is often lost and forgotten:

Every doctor and every nurse practitioner has limits to their knowledge and abilities, and knowing these limits and seeking counsel when necessary is one of the most important concepts for any medical professional to grasp.

This is the essence of what the NP role was founded on, by having physician lead health care teams. This is how I practiced what I was an NP. But the article quickly turns to uncited studies:

Studies demonstrate that the quality of nurse practitioner care is comparable to that of physician care; there is no difference in the quality of care when there are no physician oversight requirements.

I’d like to see this study to review. 

Overall the article makes the case for full practice authority based on the author’s positive experience of working with NPs who knew what they didn’t know and were able to collaborate when necessary. How ironic. The very thing being argued against is the very thing that yielded the positive experience. 

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