Running Head: The Nurse Practitioner Full Practice Authority Act

The Nurse Practitioner Full Practice Authority Act

Cheryse Jackson
Health Systems Policy, Organizations and Financing (NURS. 505)
Dr. N. Philipsen

Running Head: The Nurse Practitioner Full Practice Authority Act

The Nurse Practitioner Full Practice Authority Act

The Nurse Practitioner (NP) Full Practice Authority Act (SB 723/HB 999) aims to repeal
redundant paperwork previously mandated for advanced practice nurses to fill out attestation
forms, stating that they must collaborate with physicians to maintain high level of patient care
and to ensure patient safety. For the last five years, nurse practitioners have had to work under
these stipulations, with no evidence of a decline in patient care nor issue as far as patient safety
was concerned (Institute of Medicine [IOM], 2010; National Governors Association (NGA),
2012; Koslov, 2014; Gilman & Koslov, 2014; Nurse Practitioner Association of Maryland
[NPAM], 2015). All health care professionals collaborate with other members of their multidisciplinary team, so why do Nurse Practitioners need a formal agreement and no one else
does? Nurse practitioners even get paid 15% less than physicians do to function on the same
level (Robert Wood Johnson Foundation [RWJF], 2012). This should not be the case, and creates
injustice among professions. It is also reported that nurse practitioners and doctors both provide
quality care with similar outcomes but patients are more satisfied with nurse practitioners in
general (RWJF, 2012).
The barriers that result from the attestation, majorly outweigh the supposed benefits of
having the attestation agreement in the first place. The cumbersome barriers detected with the
utilization of the attestation agreement include: 1) NPs trying to find a practicing physician in
their desired practicing area thats willing to vouch for them; 2) paying excessive amounts of
money covering the cost to obtain the attestation for a collaboration that probably wont even
take place; 3) staying in practice if the physician decides to stop or simply cant work anymore;
4) costly fees occur if the NP cant get the collaborating physicians signature in a timely manner
(usually 24 hours); 5) delaying the NPs start date due to paperwork processing down at the

Running Head: The Nurse Practitioner Full Practice Authority Act

Board of Nursing; 6) having the insurance companies not cover the NPs patients if the
collaborating physician is not listed with the company; and 7) delaying timely health care for
those that need it and can now afford to see health care providers because of the Affordable
Health Care Act, which is probably most important (NPAM, 2015; Robert Wood Johnson
Foundation [RWJF], 2015; RWJF, 2012; Buonato, 2014; Department of legislative Services
[DLS], 2015). This bill is supported because anything that is a hindrance to the performance of
qualified nurse practitioners, their duties, and those in need of health care, such as the outdated
attestation agreement, should not be mandated as law, especially when it does more harm than
good (Gilman & Koslov, 2014).
Stakeholders in full support of the Nurse Practitioner Full Practice Authority Act because
they believe that Nurse Practitioners are very capable to provide effective, quality care are:
American Nurses Association (ANA); Nurse Practitioners; Nurse Practitioner Association of
Maryland (NPAM); Maryland Academy of Advanced Practice Clinicians (MAAPC); Maryland
Board of Nurses (MBON); Institute of Medicine(IOM); National Governors Association (NGA);
Robert Wood Johnson Foundation (RWJF); and the Federal Trade Commission (FTC) to name a
few (IOM, 2010; NGA, 2012; Koslov, 2014; Gilman & Koslov, 2014; NPAM, 2015; RWJF,
2015). These entities are also in full support of this bill because Nurse Practitioners bring a
plethora of valuable qualities to the table, while providing prudent care, such as providing
comprehensive physical examinations for accurate assessments, lab studies and diagnostic
testing for precise diagnosis, prescribing medication for treatment, referrals, etc(NPAM, 2015;
RWJF, 2012). In 2010, the IOM reported in The Future of Nursing: Leading change, Advancing
Health that nurses should be able to practice according to their highest level of education and
training and not be limited solely by laws that govern their scope of practice. They made

Running Head: The Nurse Practitioner Full Practice Authority Act

recommendations at that time for state and federal laws to be changed to reflect this notion
(IOM, 2015). The RWJF (2015) speaks out about how they put together a campaign called the
Future of Nursing: Campaign for Action (inspired by the IOM 2010 report), to allow Americans
the opportunity to live better, healthier lives and having easier access to healthcare through the
initiative of bringing more nurse practitioners on board to practice. The RWJF shares the belief
that as the population ages and because more individuals have become privy to receiving
healthcare through the Affordable Care Act, nurse practitioners are key components in delivering
timely care and promoting good health as they practice at the top of their licenses as soon as
possible (RWJF, 2015).
Opposing the Nurse Practitioner Full Practice Authority Act are many organizations and
physicians that simply dont and wont support SB723, even though many of the physicians are
over-qualified for basic primary care (Buonato, 2014). Perry Pugno, former vice-president of
medical education at the American Academy of Family Physicians and one of the nonsupporters, believes about nurse practitioners that, they are members of the medical home
team, but should work under the supervision of a physician to be maximally effective and
efficient (Buonato, 2014). According to RWFJ (2015), the American Medical Association have
put out disheartening statements that nurse practitioners should know there places and just do the
job they were trained to do, letting the doctors be doctors, as they were trained. Also putting
distaste in the air, attempting to avert a nurse practitioner take-over by saying that, increasing
the responsibilities of nurses is not the answer to the physician shortage (RWFJ, 2015). Hearing
such testimonies, could easily make one postulate that there is plenty ego and/or insecurity
involved in the physicians reasoning for trying to keep NPs in their place.

Running Head: The Nurse Practitioner Full Practice Authority Act

This Nurse Practitioner Full Practice Authority Act bill is on the legislative agenda
because it is an important issue. There are approximately 30 states left to adopt the new
licensing laws granting nurse practitioners the ability to fully operate at the top of their license
(American Association of Nurse Practitioners [AANP], 2015). For the last few decades, the
IOM and the National Council of State Boards of Nursing (NCSBN) has held a licensing model,
as a guideline, which supports these new licensing laws that are being rejected (AANP, 2015). If
this bill can be enacted in all states, Nurse Practitioners will not be limited in the number of
duties that they are qualified to perform (Advanced directives, handicap tags, physical
assessments for employment, etc) but are not allowed to do.
Policy goals urge that legislature readdress the negative impact that the attestation have
on Nurse Practitioners and let them practice freely, under their own credentials (AANP, 2015).
Gilman and Koslov (2014), who are the Attorney Advisor and Deputy Director of the FTC, also
believe that it is ultimately unsafe and unhealthy for the community to senselessly restrict
competition and ignore competitive health policy with an attestation agreement that is not
justified. To ignore competitive concerns in health policy can impede quality competition, raise
prices, or diminish access to health care- all of which carry their own health and safety risks
(Gilman & Koslov, 2014). The goals are to simply get the bill to pass legislature. A
According to the Maryland Academy of Advanced Practice Clinicians (MAAPC, 2015),
there is plenty money to be saved in Maryland by enacting the Nurse Practitioner Full Practice
Authority Act bill. The insurance companies will not allow nurse practitioners to accept
Medicaid MCO patients without a credentialed physician, so patients are continuing to be seen in
the emergency rooms (Maryland Academy of Advanced Practice Clinicians [MAACP], 2015).
There are 86.5% of all nurse practitioners that are prepared and credentialed in primary health

Running Head: The Nurse Practitioner Full Practice Authority Act

care alone (American Association of Nurse Practitioners [AANP], 2014). If the attestation was
repealed and nurse practitioners were allowed to see MCO patients, this would not be the case
because $8 million could be saved annually by decreasing the cost of well-visits through
Medicaid (MAACP, 2015). Of the almost 600,000 children enrolled in Medicaid, their cost
totaled almost $6 million (of the eight) due to the many well-visit they require over their young
life span (Mannheim, 2013). Additionally, $33 million annually for hospital stays through
Medicaid (MAACP, 2015).
The amended criteria that was set for SB 723 to pass legislature is for the new Nurse
Practitioners to have a mentor for the first 18 months, which could be another nurse practitioner
of 3 years or a physician; both of which the nurse practitioner will collaborate with along with
other members of the health care team (Conway, 2015; DLS, 2015). With overwhelming
amounts of advantages to having the bill, public demand, and public support, the amended bill
went under careful review for consideration. A second and third reading was needed in both the
House and the Senate before SB 723 could go to the Governor (NPAM, 2015; General Assembly
of Maryland, 2015). There were many factors to be weighed out for the passing of the bill,
including all of the aforementioned barriers that would no longer exist, the money that would be
saved if the bill was enacted as law, and thousands of people that would benefit from a patient
and provider stand point. The opposing reasons did not outweigh the benefits. The Nurse
Practitioner Full Practice Authority Act has been passed as of 4-13-15 (NPAM).
In supporting and helping to pass bill SB723, the barriers that once stood as major
obstacles to Nurse Practitioners practicing effective health care can now be a thing of the past.
Nurse Practitioners are capable of providing great care to those in need. Although some oppose,
with the new bill, money will be saved and a quicker health service can be provided to the

Running Head: The Nurse Practitioner Full Practice Authority Act

public. Nurse practitioners will now be able to continue their well-earned, educated right to
practice what they do best without many burdensome stipulations.

Running Head: The Nurse Practitioner Full Practice Authority Act

References
American Association of Nurse Practitioners. (2014). NP Fact Sheet. [Online]. Retrieved from
http://www.aanp.org/all-about-nps/np-fact-sheet
American Association of Nurse Practitioners. (2015). AANPs 2015 State policy priorities full
and direct access. [Online]. Retrieved from http://www.aanp.org/images/documents/stateleg-reg/2015%20State%20Policy%20Priorities.pdf
Buonato, M. (2014). Are physicians affecting your attestation? [Online]. Nurse Practitioner
Association of Maryland. Retrieved from http://www.npamonline.org/news/185051/ArePhysicians-Affecting-Your-Attestation.htm
Conway, J. (2015). Senate bill 723. [Online]. Retrieved at
http://mgaleg.maryland.gov/2015rs/bills_noln/sb/tsb0723.pdf
Department of Legislative Services. (2015). Fiscal and policy note revised. [Online]. Retrieved at
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Gilman, D. Koslov, T. (2014). Policy perspectives: Competition and the regulation of advanced
practice nurses. Retrieved from http://www.nacns.org/docs/FTC140307aprnpolicy.pdf
Institute of Medicine. (2010).The future of nursing: Leading change, advancing health. [Online].
Retrieved from http://www.iom.edu/Reports/2010/The-Future-of-Nursing-LeadingChange-Advancing-Health.aspx

Running Head: The Nurse Practitioner Full Practice Authority Act

Koslov, T. (2014). The doctor (or nurse practitioner) will see you now: Competition and the
regulation of advanced practice nurses. [Online]. Retrieved from
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http://www.nlm.nih.gov/medlineplus/ency/article/001928.htm
Maryland Academy of Advanced Practice Clinicians. (2015). Fact sheet SB723 & HB999: The
nurse practitioner full practice authority act. [Online]. Retrieved at http://enpnetwork.s3.amazonaws.com/Maryland_Independent_Practice_Alliance/file/March_2015
_Updates/APRN%20Practice.org%20Fact%20Sheet.pdf
National Governors Association. (2012). Nurse practitioners have the potential to improve access
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Nurse Practitioner Association of Maryland. (2015). Nurse Practitioner Full Practice Authority
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