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Scope of Practice Overview

Scope of Practice Overview

Material added Sept., 2013

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Contact NCSL staff for more information.
It is estimated that up to thirty four million Americans will join the ranks of the insured once the Patient Protection and Affordable Care Act (PPACA) is fully implemented, while the number of health care providers, including primary care providers, is not anticipated to drastically increase. It is fact that the health care workforce will be stretched to its limits, an issue that states must soon, if not already,  address.  Many state legislatures are redefining some of the parameters—the scope and standards of practice—for several medical professions.  What a health professional can and cannot do to or for a patient is dependent on that health professionals scope of practice (SOP), which is defined by state boards of medicine, boards of nursing, etc., oftentimes with the guidance or instruction (via statute) of the state’s legislature.  

State legislatures consistently consider health care professional’s ability to prescribe, dispense and/or administer drugs, to sign evaluations and/or certifications (such as death certificates), to allow admitting or clinical privileges at a health care facility, how a health professional can be addressed and what information they must wear on their badge, how they are reimbursed, whether they can independently run a health clinic, how they can maintain licensure, where they can practice, which board they fall under and whether to create or dismember other medical boards, the ability of the health professional to advertise and what that advertisement can or cannot look like, etc.

NEW!  Meeting the Primary Care Needs of Rural America. "The availability of accessible and efficient primary care in rural America is a substantial and growing concern that is heightened by a combination of demographic trends. Physician supply in rural areas is already low, compared to non-rural areas of the country. Only about 11 percent of the nation’s physicians work in rural areas, despite nearly 20 percent of Americans living there.Moreover, physicians providing care in rural areas often serve large geographic areas that require long travel times. These areas may be substantially underserved by hospitals and other health care facilities. Demographic shifts, such as the aging rural physician workforce and the growth in the rural elderly and near-elderly population will increase demand for primary care services. One approach to meeting this increased demand that is under consideration in many state legislatures is a redefinition, and often expansion, of the scope and standards of practice for non-physician practitioners. A recent survey found that 41 percent of rural Medicare beneficiaries saw a physician assistant or nurse practitioner for all (17 percent) or some (24 percent) of their primary care in 2012. In the 2012 session, NCSL tracked 827 bills to redefine providers’ scopes of practice in 29 states, 154 of which were enacted in 24 states and the District of Columbia."

Table 1. 2013 Enacted Legislation  -  (last updated July 1, 2013)

State Bill Associate Bills Author (s) Title Date Introduced Date of Enactment Chapter Number Summary (StateNet)
CO H 1063   Garcia (D) Critical Care Endorsement 1/9/2013 03/08/2013 - Enacted 14 Directs the Executive Director of the Department of Public Health and Environment or, if the director is not a physician, the Chief Medical Officer, to adopt rules establishing standards for the critical use of endorsement for emergency medical service providers.
KY H 217   Stumbo (D) Controlled Substances 2/5/2013 03/04/2013 - Enacted 2 Relates to controlled substances and declaring an emergency, modifies the diagnostic and treatment protocols for controlled substance prescribing, clarifies the educational requirements for certain pain management facility employees, allows hospitals and long-term-care facilities to have Kasper accounts, modifies the scope of Board of Medical Licensure regulations and makes the criminal record check required for licensure of persons prescribing or dispensing controlled substances a statutory requirement.
NJ S 298   Pennacchio (R) Dental Hygienists and Dentist Statutes 1/10/2012 08/07/2012 - Enacted 2012-29 Provides that any person who has graduated from a school or college of dental hygiene approved by any of specified entities may practice dental hygiene, stipulates that a licensed dental hygienist shall not perform any intra-oral service, other than administering preventive measures, relates to supervision of dental hygienists, authorizes the administration of local anesthesia by a dental hygienist under direct supervision, forbids certain actions relating to dental practice unless authorized to practice.
SD H 1044   Health and Human Services Cmt Optometry Practice 1/8/2013 02/01/2013 - Enacted Revises certain provisions regarding the practice of optometry, adds new terms to the unprofessional conduct list for such practice, relates to the reinstatement of certification and the payment for benefits of a optometry professional corporation.
VA H 98   Bell Ri (R) Athletic Training 1/11/2012 03/30/2012 - Enacted 399 Relates to athletic training, amends the definition of the practice of athletic training so that licensed physical therapists may no longer direct such practice.
VA H 266   Peace (R) Surgery Definition 1/11/2012 02/28/2012 - Enacted 15 Relates to definition of surgery, defines surgery and provides that no person other than a licensed doctor of medicine, osteopathy, or dentistry, a licensed nurse practitioner, or a person who is acting pursuant to the orders and under the appropriate supervision of a licensed doctor of medicine, osteopathy, or dentistry shall perform surgery.
VA H 346   O'Bannon (R) Nurse Practitioners Practice 1/11/2012 03/10/2012 - Enacted 213 Amends provisions governing the practice of nurse practitioners, provides that nurse practitioners shall only practice as part of a patient care team, which shall include at least one licensed patient care team physician, relates to persons licensed to practice osteopathy when taking blood or giving injections, relates to fitting artificial limbs, requires professional liability insurance, relates to prescribing controlled substances.
VA H 543   Robinson (R) Massage Therapists Certification 1/11/2012 04/18/2012 - Enacted 764 Relates to the certification of massage therapists, amends the certification qualification factor that requires the passage of a certification examination administered by an acceptable provider to include additional acceptable providers.
VA H 1107 VA S 656 - Identical Greason (R) Public Schools 1/11/2012 04/18/2012 - Enacted 787 Relates to public schools and administration of auto-injectable epinephrine, provides that local school boards may develop policies to maintain a supply of auto-injectable epinephrine, provides that the school nurse, or a trained and authorized school board employee would be able to administer or provide auto-injectable epinephrine to a student with a prescription on file or a student believed to be having an anaphylactic reaction, provides that such person shall not be liable for negligence.
VA H 1291   Gilbert (R) Governors Reorganization of Executive Branch 1/24/2012 04/18/2012 - Enacted 803 Relates to the Governor's reorganization of the executive branch of state government, reorganizes the executive branch of state government, transfers certain powers and duties, provides for deregulation of the professions of hair braiding, mold inspectors and mold remediators.
VA H 1444   O'Bannon (R) Administration of Medications Liability 1/9/2013 03/12/2013 - Enacted 183 Relates to administration of medications by employees or contract service providers of providers licensed by the Department of Behavioral Health and Developmental Services, provides that employees of or persons providing services pursuant to a contract with a provider licensed by the Department of Behavioral Health and Developmental Services who are trained in how to administer insulin, glucagon, and epinephrine are exempt from liability if the product is administered according to specified procedures.
VA H 1499   Stolle (R) Administration of Medications 1/9/2013 03/12/2013 - Enacted 191 Relates to administration of medications, clarifies the circumstances under which emergency medical services personnel which are certified and authorized to administer drugs and devices may administer medications, provides that emergency medical services personnel may administer medications pursuant to an oral or written order or standing protocol.
VA H 1501   O'Bannon (R) Pharmacy 1/9/2013 03/12/2013 - Enacted 192 Relates to pharmacy, relates to collaborative agreements, clarifies parties with whom a pharmacist may enter into a collaborative agreement, provides that a patient who does not wish to participate in a collaborative procedure must notify the prescriber of that decision, provides a prescriber may elect to have a patient not participate in a collaborative agreement by contacting the pharmacist or his designated alternative pharmacist or by documenting his decision on the patient's prescription.
VA H 1672   O'Bannon (R) Naloxone 1/9/2013 03/13/2013 - Enacted 267 Relates to naloxone, relates to emergency administration in cases of opiate overdose, provides that an unlicensed individual may administer naloxone to a person experiencing an anaphylactic reaction or life-threatening opiate overdose, provided the unlicensed person has completed an approved training program, requires cooperation with law-enforcement agencies to develop a pilot program, exempts such emergency medical care from liability, exempts emergency care of a pregnant woman from liability.
VA H 1759   O'Bannon (R) Administration of Medications 1/9/2013 03/06/2013 - Enacted 114 Relates to administration of medications, relates to the percutaneous endoscopic gastric tube, provides that nothing shall prevent the administration of drugs to a person receiving services in a program licensed by the Department of Behavioral Health and Developmental Services via percutaneous endoscopic gastric tube, when such drugs are administered by a person who has completed a training program approved by the Board of Nursing.
VA H 2161   O'Bannon (R) Nurses Oxygen Administration 1/9/2013 03/06/2013 - Enacted 132 Relates to nurses, relates to nursing authority to possess and administer oxygen to treat emergency medical conditions, provides that a prescriber may authorize registered nurses and licensed practical nurses to possess oxygen for administration in treatment of emergency medical conditions.
VA S 146   Puckett (D) Practice of Dental Hygienists 1/11/2012 03/06/2012 - Enacted 102 Relates to dental hygienists and their scope of practice, expands an earlier trial program to allow licensed dental hygienists employed by the Department of Health to provide educational and preventative dental care pursuant to a standing protocol.
VA S 384 VA H 344 - Identical McEachin (D) Dental and Dental Hygiene School Faculty 1/11/2012 03/06/2012 - Enacted 116 Relates to dental and dental hygiene school faculty licensure, clarifies what patient care activities are allowed for a person enrolled in a Virginia dental education program who has a temporary license to practice dentistry while in the program, clarifies requirements for the Board to issue a faculty license to a qualified person from out of state to teach dentistry or dental hygiene in a Virginia dental school or program.
VA S 543   Martin (R) Surgery Definition 1/13/2012 03/06/2012 - Enacted 124 Relates to definition of surgery, defines surgery and provides that no person other than a licensed doctor of medicine, osteopathy, podiatry or dentistry, a licensed nurse practitioner, or a person who is acting pursuant to the orders and under the appropriate supervision of a licensed doctor of medicine, osteopathy, or dentistry shall perform surgery, includes a licensed midwife under certain circumstances.
VA S 656 VA H 1107 - Identical McEachin (D) Auto-injectable Epinephrine Injections 1/20/2012 04/18/2012 - Enacted 833 Relates to public schools, relates to administration of auto-injectable epinephrine, provides that local school boards may develop policies to maintain a supply of auto-injectable epinephrine, provides that the school nurse, or a trained and authorized school board employee if a nurse is unavailable, would be able to administer or provide auto-injectable epinephrine to a student with a prescription on file or a student believed to be having an anaphylactic reaction, provides immunity from civil damages.
VA S 678   McDougle (R) Governors Reorganization of Executive Branch 1/25/2012 04/18/2012 - Enacted Relates to governor's reorganization of executive branch of state government, reorganizes the executive branch of state government, provides for transfer of powers and duties, provides for deregulation of the professions of hair braiding, mold inspectors and mold remediators.
VA S 773   Blevins (R) Medications Administration 1/9/2013 03/13/2013 - Enacted 328 Relates to administration of medications, clarifies the circumstances under which emergency medical services personnel may administer medication, drugs and devices, provides that emergency medical services personnel may administer medications pursuant to an oral or written order or standing protocol, provides for training, relates to state-owned facilities and respiratory care practitioners.
VA S 790   Stuart (R) Emergency Medical Care Services 1/9/2013 03/13/2013 - Enacted 331 Relates to emergency medical care services, relates to recertification and appeals, directs the Board of Health to include an appeals process in its regulations regarding certification and recertification of emergency medical services providers and removes the requirement that the Board's regulations include certain testing and other requirements for recertification, requires reporting of aged or incapacitated adults.
WY S 74   Joint Interim Trans, Highways & Military Professions and Occupations 1/8/2013 03/13/2013 - Enacted 197 Relates to professions and occupations, provides for the issuance of professional and occupational licenses to military spouses, provides for temporary practice permits, requires rulemaking.



*This bill search was powered by StateNet*

As of April 1, 2013, there have been 178 scope-of-practice related bills proposed in 38 states + D.C.

Between January 2011 and December 2012, there were 1795 SOP-related bills proposed in 54 states, territories or the District of Columbia, of which 349 have been adopted or enacted into law.

NCSL's Scope of Practice Legislative Tracking Database


The National Conference of State Legislatures (NCSL) designed and maintained a comprehensive Scope of Practice (SOP) Legislative Tracking Database that tracks current legislation in all 50 states, territories and D.C. dealing with commissions and boards, licensure and credentialing, Medicaid/health insurance plan reimbursement, practice autonomy, prescriptive authority, truth in medical education, and truth in advertising for 22 distinct health care professions. 
NOTICE: As of June 30, 2013 this Database is no longer actively maintained and will be retained online only as an archive.   

This database contains legislation from 2011, 2012 and 2013 legislative sessions, including enacted, pending and failed bills and resolutions.  Bills can be searched by state, topic, keyword, status, and/or primary sponsor. It was updated regularly through June 30, 2013 and remains free to all web users.

There were obvious trends in both 2011 and 2012 sessions.  The most popular SOP-related measures were related to licensure, advanced practice nursing, midwifery, physician assistants, dentistry, prescriptive authority, surgical authority, podiatry, chiropractors, naturopathy, psychology, pharmacology, boards and paramedic / emergency medical technicians (in that order).

Scope of Practice in the News

  • *NEW* Are there enough doctors for the newly insured? - Signing up for health insurance on the new state and federal exchanges was supposed to be the easy part of the Affordable Care Act. The really dicey part, lots of health policy experts have always feared, will come after the new law takes effect. Stateline, Dec. 30, 2013

  • California: State bill to boost use of nurse practitioners goes nowhere.  The effort to ease shortage of primary-care doctors would have let nurse practitioners work without direct MD supervision. Powerful doctors group had opposed it. Sept. 2, 2013

  •  CSPAN l Washington Journal: March 28, 2013/Nurse Practitioners - "Susan Apold talked about legislation in several states that would give nurse practitioners the ability to practice without physician supervision. Topics included nurse practitioner training, licensure, and regulation; similarities and differences between nurse practitioners, physician assistants, nurses, and doctors; and ways nurses might ease the shortage of doctors that will occur when the health care law is fully enacted in 2014, She also responded to telephone calls and electronic communications."
  • Becky Yeh, of Instant Analysis, wrote Danger's of Expanding 'Scope of Practice' on March 19, 2013.  ""Lots of people will have 'coverage,' I'll put that in quotation marks," Smith [Dr. G. Keith Smith, a board-certified anesthesiologist based in Oklahoma]
    Dr. G. Keith Smith, a board-certified anesthesiologist based in Oklahoma - See more at: http://www.onenewsnow.com/latest-headlines-from-american-family-news/2013/03/19/dangers-of-expanding-scope-of-practice#sthash.6NmVd1Sk.dpuf 
    comments. "It's going to be a card in their wallet that's going to give them a right to hope for care, and then they're going to find out this card won't even get them in to see a physician; it will only get them in to see someone who is a non-physician. So, one of the real downsides of what's going on in the country and what's going on in California is that the whole definition of medical care is going to change and be blurred.""
    "Lots of people will have 'coverage,' I'll put that in quotation marks," Smith comments. "It's going to be a card in their wallet that's going to give them a right to hope for care, and then they're going to find out this card won't even get them in to see a physician; it will only get them in to see someone who is a non-physician. So, one of the real downsides of what's going on in the country and what's going on in California is that the whole definition of medical care is going to change and be blurred." - See more at: http://www.onenewsnow.com/latest-headlines-from-american-family-news/2013/03/19/dangers-of-expanding-scope-of-practice#sthash.6NmVd1Sk.dpuf
    "Lots of people will have 'coverage,' I'll put that in quotation marks," Smith comments. "It's going to be a card in their wallet that's going to give them a right to hope for care, and then they're going to find out this card won't even get them in to see a physician; it will only get them in to see someone who is a non-physician. So, one of the real downsides of what's going on in the country and what's going on in California is that the whole definition of medical care is going to change and be blurred." - See more at: http://www.onenewsnow.com/latest-headlines-from-american-family-news/2013/03/19/dangers-of-expanding-scope-of-practice#sthash.6NmVd1Sk.dpuf
    "Lots of people will have 'coverage,' I'll put that in quotation marks," Smith comments. "It's going to be a card in their wallet that's going to give them a right to hope for care, and then they're going to find out this card won't even get them in to see a physician; it will only get them in to see someone who is a non-physician. So, one of the real downsides of what's going on in the country and what's going on in California is that the whole definition of medical care is going to change and be blurred." - See more at: http://www.onenewsnow.com/latest-headlines-from-american-family-news/2013/03/19/dangers-of-expanding-scope-of-practice#sthash.6NmVd1Sk.dpuf"

    Dangers of expanding 'scope of practice'

    Posted by Becky Yeh (American Family News) - March 19, 2013
    - See more at: http://www.onenewsnow.com/latest-headlines-from-american-family-news/2013/03/19/dangers-of-expanding-scope-of-practice#sthash.6NmVd1Sk.dpuf

    Dangers of expanding 'scope of practice'

    Posted by Becky Yeh (American Family News) - March 19, 2013
    - See more at: http://www.onenewsnow.com/latest-headlines-from-american-family-news/2013/03/19/dangers-of-expanding-scope-of-practice#sthash.6NmVd1Sk.dpuf
  • N.C. Aizenman from The Washingon Post wrote a March 2013 article titled Nurses Can Practice Without Supervision in Many States which notes that "nurse practitioners say that they are eager to work in teams with physicians but that this is impractical where doctors are in short supply, such as rural and low-income communities. And they contend their training, which emphasizes a holistic approach, makes them just as capable as doctors in catching problems."
  • According to The Texas Tribune, Senate Panel Backs CPRIT, "Scope-of-Practice" Bills by Becca Aaronson, "Nelson, who authored Senate Bill 406, which would eliminate on-site physician supervision requirements to allow doctors to delegate prescription authority to advanced practitioner nurses, joked that the negotiation process “was like going through labor,” and commended physician and nursing groups for reaching an agreement addressed in the bill. SB 406 would also increase the number of advanced practice nurses a physician can supervise from four to seven, and it would also address coordination between the Texas Medical Board and the Board of Nursing and Physician Assistants. It would also allow physicians to delegate authority to advanced practice nurses to prescribe Schedule II controlled substances, which are classified as having a higher potential for abuse, in hospitals and hospice settings. “Although we didn’t obtain everything we wanted to with this bill, it [does] a great deal in improving the current complicated site-based restriction law that we followed for many years,” said Gene Geisler, a nurse practitioner representing the Texas Nurses Association and other nursing groups. Dr. Gary Floyd, representing the Texas Medical Association and other physician groups, told senators that the bill "represents a significant step forward in supporting a lot better access for all parts of Texas," and would help foster a team environment for health care providers."
  • Doctor shortage? What doctor shortage? By Sarah Kliff, January 15, 2013, The Washington Post. "“All of these things, the growth in the supply of non-doctors, the team approach, they all add up to having physicians cover twice as many patients as they have in the past,” Green says."
  • Proposal: Abolish Medical Practice Statutes. By , December 19, 2012. "At first glance, certification might appear to be a much weaker regulatory approach. But in some respects it raises the bar much higher. Under current law, once a doctor has a license to practice medicine she can legally perform brain surgery ― even if she never received a minute of training in that field. Licensing doesn’t protect the patient from practitioners who claim to have skills they really don’t have. Certification, however, would do so."
  • New York Times - Editorial, When the Doctor is Not Needed. "There is plenty of evidence that well-trained health workers can provide routine service that is every bit as good or even better than what patients would receive from a doctor. And because they are paid less than the doctors, they can save the patient and the health care system money."
  • Star Tribune - Maura Lerner, More independence sought for 5,000 nurse practitioners. "For years, nurse practitioners in Minnesota have been able to see patients only in association with a licensed doctor. But a governor's task force says it's time to let those nurses work independently -- in part, because of a coming shortage of primary care physicians." December 13, 2012.
  • The American Medical Association (AMA) released the Scope of Practice Data Series: Nurse Practitioners in 2009. "Each year in nearly every state, and sometimes at the federal level, limited licensure health care providers lobby state legislatures, their own state regulatory boards and federal regulators for expansions of their scopes of practice. While some scope expansions may be appropriate, others de"nitely are not. It is important, therefore, to be able to explain to legislators and regulators the limitations in the education and training of non-physician health care providers that may result in substandard or harmful patient care."   

Health Professionals - Legislative Snapshots and other Reports

Pharmacists

A report to the U.S. Sugeon General 2011, Office of the Chief Pharmacist. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. "Physicians, administrators and patients that have worked within this paradigm of collaborative patient care delivered by pharmacists have supported and continue to support this model. What has occurred over time within this paradigm is somewhat analogous to “common law.” In common law, decisions are based on past precedent in lieu of specific policy or statute. Federal pharmacy systems have developed a “common pharmacy practice” across decades of implementation where it has become common and accepted for pharmacists to function as health care providers and deliver direct patient care services in collaboration with physicians based on positive outcomes. Although this collaborative practice is implemented as a pragmatic solution to meet some of the health care demands and improve delivery of care, it is not clearly discussed at the highest levels of health leadership or correctly articulated in current pharmacy legislation or compensation structures. This Report includes objectives that would acknowledge and advance this “common pharmacy practice” in the form of advocacy, policy, and legislation" (pg. 46).

According to analysis conducted by NCSL's Health Program staff, there have been 234 pharmacology-related bills proposed in 34 states, territories or D.C. since 2011.  Of these 234, 74 bills have been enacted.  For more specific detail, please refer to the Scope of Practice Legislative Tracking Database.

Recent Studies:
Comparison of Pharmacists and Primary Care Providers as Immunizers, John Fontanesi, PhD, Jan D. Hirsch, RPh, PhD, Sarah M. Lorentz, PharmD, Debra Bowers and Jason Shafrin. This study looked compared the administration of immunizations by primary care providers and pharmacists. Results of this study indicate that pharmacies consistently follow patient safety protocols, have low unit costs, and are oftentimes equally or more effecient with greater productivity. 

 


Nursing
NCSL has seen a great deal of interest in the area of advanced pratice nurses/autonomy and scope of practice in 2013.

Currently there are 22 states which require collaborative agreements, 17 states + D.C. allow autonomous practice, 10 states require general supervision by a physician and the Commonwealth of Virginia requires a ‘patient care team’ practice model (per 2012 legislation).

Current bills of active nterest for 2013 included:

GA SB 94 “A BILL to be entitled an Act to amend Code Section 43-34-25 of the Official Code of Georgia Annotated, relating to delegation of certain medical acts to advanced practice registered nurses, so as to revise provisions relating to the delegation of authority to order radiographic imaging tests; to provide for related matters; to repeal conflicting laws; and for other purposes.”
IL HB 1052 “Removes references to a written collaborative agreement throughout the Act. Provides that an advanced practice nurse's scope of practice includes collaboration and consultation with or referral to a physician or other appropriate health-care professional for patient care needs that exceed the APN's scope of practice, education, or experience. Provides that as part of the professional scope of advanced practice nursing, an advanced practice nurse possesses prescriptive authority appropriate to his or her specialty, scope of practice, education, and experience. Such prescriptive authority shall include the authority to prescribe, select, order, administer, store, accept samples of, and dispense over-the-counter medications, legend drugs, medical gases, certain controlled substances, and other preparations, including botanical and herbal remedies. Amends various other Acts to make related changes.”
KY SB 43 (specific to PAs) “Amend KRS 311.860 to give the supervising physician or the credentialing facility oversight of physician assistant nonseparate location practice; allow a newly graduated physician assistant to practice in either a separate on nonseparate location as delegated by the supervising physician or the credentialing facility; eliminate the 18 month waiting period before a physician assistant may practice in a separate location; remove the board's authority to modify or waive the separate location practice privileges.”
MD HB 630 (signature authority) “FOR the purpose of requiring that, under certain circumstances, the term “physician” be interpreted to include an “advanced practice nurse” and a “physician assistant.””
CT HB 6391 “and [shall] may collaborate with [a physician licensed to practice medicine in this state] other licensed health care providers. In all settings, the advanced practice registered nurse may [, in collaboration with a physician licensed to practice medicine in this state,] prescribe, dispense and administer medical therapeutics and corrective measures and may request, sign for, receive and dispense drugs….”
NV SB 69 & AB 170 “AN ACT relating to nursing; removing the requirement that an advanced practitioner of nursing practice pursuant to a protocol approved by and under the supervision of a licensed physician; and providing other matters properly relating thereto.”
WV SB 379 “A BILL to amend and reenact §30-7-15a, §30-7-15b and §30-7-15c of the Code of West Virginia, 1931, as amended; and to amend and reenact §30-15-7, §30-15-7a, §30-15-7b and §30-15-7c of said code, all relating to expanding prescriptive authority of advanced nurse practitioners and certified nurse-midwives; and removing the requirement for collaborative relationships with physicians.”
IN S 268 would allow certified nurse anesthetists to administer anesthesia under the direction of and in the immediate presence of a podiatrist or a dentist if the podiatrist or dentist is certified to administer anesthesia.
MI S 2 would establish a license for nurse midwives, nurse practitioners, and clinical nurse specials and provide other general amendments for advanced practice registered nurses.
NM S 342 would amend sections of the Medical Imaging and Radiation Therapy Health and Safety Act to provide limited authorization for registered nurses and certified nurse-midwives to perform certain ultrasound procedures.
OR S 8 would remove certain restrictions on authority of certified nurse practitioner or certified clinical nurse specialist to dispense prescription drugs.
ENACTED 2012 Legislation from VA:
VA H 266 defined surgery and provides that no person other than a licensed doctor of medicine, osteopathy, or dentistry, a licensed nurse practitioner, or a person who is acting pursuant to the orders and under the appropriate supervision of a licensed doctor of medicine, osteopathy, or dentistry shall perform surgery.
VA H 346 provided that nurse practitioners shall only practice as part of a patient care team, which shall include at least one patient care team physician licensed to practice medicine in the Commonwealth who provides management of and leadership in the care of a patient or patients.
 

Nursing continued...

As of February 11, 2013, there have been 42 nurse-related scope-of-practice bills proposed across 17 states; including Alabama, Florida, Hawaii, Iowa, Illinois, Indiana, Michigan, Missouri, Mississippi, Montana, North Dakota, New Mexico, Nevada, New York, Oklahoma, Oregon, and Virginia. 

Nurses have varrying degrees of education and experience, resulting in the numerous titles you may run into today. 

The following terms may be useful and are from the National Council of State Boards of Nursing:

Registered nurse (RN): An individual who has graduated from a state-approved school of nursing, passed the NCLEX-RN Examination and is licensed by a state board of nursing to provide patient care.

Licensed practical/vocational nurse (LPN/VN): An individual who has completed a state-approved practical or vocational nursing program, passed the NCLEX-PN Examination, and is licensed by a state board of nursing to provide patient care. Normally works under the supervision of a registered nurse, advanced practice registered nurse or physician.

Advanced practice registered nurse (APRN): An RN who has a graduate degree and advanced knowledge. There are four categories of APRNs: certified nurse-midwife (CNM), clinical nurse specialist (CNS), certified nurse practitioner (CNP) or certified registered nurse anesthetist (CRNA). These nurses, depending on state regulations, often diagnose and prescribe treatments and medications.  In some states, this is under the supervision of, or in collaboration with, a physician, while in other states, APRNs practice independently. 

Certified medication aide/assistant (MA-C): A person who is certified to administer medication under the supervision of a nurse.

Certified nursing aides/assistant (CNA): A person who is certified to assist with the delivery of direct nursing care to patients. Works under the supervision of a nurse.

Unlicensed administrative personnel (UAP): Any unlicensed person, regardless of title, who performs tasks delegated by a nurse. This includes certified nursing aides/assistants (CNAs), patient care assistants (PCAs), patient care technicians (PCTs), state tested nursing assistants (STNA), nursing assistants-registered (NA/Rs) or certified medication aides/assistants (MA-Cs). Certification of UAPs varies between jurisdictions.


Physician Assistants
According to the US Deparment of Labor  Bureau of Labor Statistics, Physician assistants, also known as PAs, "practice medicine under the direction of physicians and surgeons. They are formally trained to examine patients, diagnose injuries and illnesses, and provide treatment." In 2010 there were 83,600 PAs practicing, most of whom have master's degrees.


 


Research conducted and posted by Kara Nett Hinkley, former Policy Associate, NCSL Health Program (2012-13)

Please note that the legislative issue of scope of practice can be a contentious one; wrought with both political and policy challenges. The research and  links cited above may have a natural or contrived bias in the scope of practice debate. Please take note that NCSL is a non-partisan research organization and does not support or oppose any state legislation.

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