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Advanced Practice Nursing Policy: A Necessary Change

Keston Trammell
Auburn University/Auburn University Montgomery

Advanced Practice Nursing Policy: A Necessary Change
The current legislation regarding collaboration of Certified Registered Nurse
Practitioners and physicians from the Alabama Board of Nursing (2003) states that a full time
CRNP must collaborate no less than 10% of hours with the collaborating physician. Included in
the collaboration law is a 10% quality assurance protocol that states the collaborative physician
must review 10% of medical records of patients seen by the CRNP (Alabama Board of Nursing,
2003). This legislation severely limits the autonomy of the CRNP. The Alabama legislation
should remove the requirement of 10% direct physician oversight for nurse practitioners to
provide more affordable healthcare access, to enhance the state legislated scope of practice of the
nurse practitioner to the full ability of the profession, and to encourage true collaboration
between medical professionals.
Alabama legislation should make changes necessary to provide more affordable
healthcare access. A report by The Institute of Medicine (2010) states that while the physician
and Advanced Practice Registered Nurses (APRN) have differences in the level of expertise,
with the growing need for healthcare providers, the APRN can provide care that focuses on
treatment and prevention of disease, and promotion of health. With the current national
healthcare law, healthcare access will be a paramount issue. With the current changes of the
Affordable Care Act, Nurse Practitioners will need to be able to provide services in primary care
to keep up with the current demand (Poghosyan et al., 2013). The 10% required physician
oversight decreases the amount of patients seen by both the Nurse Practitioner and the
collaborating position.
Alabama legislation should also enhance state scope of practice of the nurse practitioner
to full ability by making legislative change. Lowery and Varnum (2011) state that the laws

regarding physician supervision of NPs limit the ability of the NP to provide care to their full
educated potential. They also cite no increase or benefit in safety or decrease in adverse events
by utilizing a physician supervision law (Lowery & Varnum, 2011). Physicians often cite a lack
of an ability of nurse practitioners to provide primary care. The Institute of Medicine (2010) has
declared that in states allowing full autonomous care of Advanced Practice Registered Nurses
there has been no degradation in the quality of care delivered by the APRN.
A change in Alabama legislation would also encourage true collaboration between
various medical professionals. With physician supervision of nurse practitioners, an unbalanced
view of the collaborative network is established. Current collaboration within the supervision
law can lack the fundamental aspects of collaboration specifically trust, mutual respect, and
recognition of the need of diversity in practice (Hamric, Hanson, Tracy, & OGrady, 2014). This
creates a barrier in providing collaborative care that can limit the benefits of a healthcare team
with different focuses of practice such as physicians and nurses (Hamric. Hanson, Tracy, &
OGrady, 2014.)
Primary Care Nurse Practitioners are a great solution to the current healthcare need.
There are however many barriers and hindrances to the full potential of Nurse Practitioners in the
state. A 10% direct oversight and medical record review has not be discovered to improve safety
or quality of the care delivered and hinders the relationship development of CRNPs with other
healthcare professionals. State policy must make the necessary change in physician oversight of
nurse practitioners to provide more healthcare access, allow nurse practitioners scope of practice
to display their full potential, and to ensure a balanced collaboration between nurse practitioners
and other health care professionals.

Alabama Board of Nursing. (2003). Advanced practice nursing: Collaborative practice.
Retrieved from Alabama Board of Nursing website:
https://www.abn.alabama.gov/UltimateEditorInclude/ UserFiles/docs/admincode/Chapter%20610-X-5.pdf
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2014). Advanced practice
nursing: an integrative approach (5th ed.). St. Louis, MO: Elsevier/Saunders.
Lowery, B., & Varnam, D. (2011). Physician supervision and insurance reimbursement: policy
implications for nurse practitioner practice in North Carolina. North Carolina Medical
Journal, 72, 310-313. Retrieved from: http://www.ncmedicaljournal.com/archives/?
Poghosyan, L., Nannini, A., Smaldone, A., Clarke, S., ORourke, N. C., Rosato, B. G., &
Berkowitz, B. (2013). Revisiting scope of practice facilitators and barriers for primary
care nurse practitioners: A qualitative investigation. Policy, Politics & Nursing
Practice, 14(1), 6-15. doi:10.1177/152715441348088
The future of nursing: Focus on scope of practice. (2010, October 1). . Retrieved June 6, 2014,
from http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-ofNursing/Nursing%20Scope%20of%20Practice%202010%20Brief.pdf