This article discusses limitations on Nurse Practitioner's scope of practice. Unfortunately, Nurse Practitioners in some states are unable to practice completely what they went to school for. Some examples and explanations are provided in this article.
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I decided to become an ARNP because I knew it would be an empowering career. Although the work of an ARNP and Physician is similar, there are many differences. Physicians tend to use a scientific approach when addressing their patients, due to their rigorous science-based education. ARNPs approach the patient holistically. When I diagnose a patient with Diabetes Mellitus Type 2, I explain what this disorder is and the causes; I explain the treatment plan; I discuss nutrition and physical activity changes; I assess the patients comfort level with their treatment; I encourage the patient to discuss their feelings upon finding out they have this new chronic disorder; and I reassess the patient within a 2-4 week timeline. I am interested in making sure the patient understands their disorder and how they can manage it.
Unfortunately, in Florida there are some limitations on the ARNP that allows physicians to have more power. For example, Physicians can order home health treatment,controlled substances, and open their own practices without having a supervisory protocol. It is frustrating that Florida is one of the few states that has such strong limitations on ARNP scope of practice. For example, ARNPs cannot order durable medical equipment for Medicare patients in Florida. This means I cannot order a low back brace for my patient with chronic low back pain; I cannot order diabetic shoes for my patient with DM Type 2; I cannot order a cane for my patient with Parkinson's.
Moreover, ARNPs cannot prescribe controlled substances, including benzodiazepines that so many of my patients take for their anxiety or insomnia. Currently, I write out the prescription and my supervisory physician will sign the prescription. The only people suffering are my patients because this delays access to their medications. Recently,Tramadol was added to the controlled substance list. I had previously prescribed this medication frequently for my patients with chronic low backpain and severe osteoarthritis. I was not thrilled the day I received a phone call from the pharmacist telling me that tramadol was effectively now a controlled substance.
In addition, ARNPs cannot order home health treatment. This does not make sense to me since I am the primary care provider for many patients and oversee their medical care. So if I have a patient with history of a stroke and hemiparesis, I believe I should be able to order home health physical therapy for them. If I have a patient with dementia and uncontrolled hypertension, I believe I should be able to order home health blood pressuremonitoring for them.
Lastly, I do not like that ARNPs have to have a protocol with a supervising physician. It's as if the physician defines our scope of practice and not the state board of nursing. If I wanted to open up my own practice, I would need a physician to be the medical director. This means I would have to waste a few thousand dollars a month just to pay the physician for having their name on the wall of my clinic. I would be seeing the patients, overseeing the clinic, and reviewing charts, but would still have to pay my supervising physician to do nothing except 'supervise me'.
I am hoping with the Affordable Care Act and the abundance of new people seeking primary health care, that Florida will increase the scope of ARNPs. Working with the ANA, FNA, and other nursing organizations, I plan to fight for these rights. I see myself having my own practice where I see a variety of illnesses and ages. I hope that the care provided will not be based as much on cost as it is today. We already know ARNPs will be a forefront to help with the primary care shortage.
