FTC Calls for APRN Independent Practice

In a new report, the Federal Trade Commission (FTC) encourages states to allow a wider scope of practice for nurses with postgraduate education and urges state lawmakers to loosen regulations on advanced practice registered nurses (APRNs), allowing them to deliver care independently of physicians. The FTC claims more independent APRNs will increase competition in the primary health care marketplace.

TMA policy acknowledges the importance of APRNs to the current health care system. TMA strongly supports current Texas law that requires APRNs to maintain clinical linkages to physicians through integrated practice.

TMA opposes independent delivery of health care by nurses. Nurses should, however, be encouraged to obtain advanced education and training. The policy states the nurse with such training: 

  • Engages in decisionmaking about the nursing care of patients under the supervision of a physician; 
  • Collaborates with social workers, nutritionists, and others in making decisions about nursing needs; 
  • Plans and institutes nursing programs as a member of the health care team; and 
  • Is directly accountable and responsible to the patient for the quality of nursing care rendered under the Nurse Practice Act of Texas. 

In the report, the FTC states physician supervision requirements for APRNs may deny consumers the benefit of greater competition by giving one group of health care professionals the ability to restrict access to a competing group of health care professionals. APRNs play a vital role in compensating for primary care physician shortages and expanding access to care for underserved populations, the FTC says.

The FTC argues additional supervision requirements could hinder APRNs' collaborative, consulting, or referral-based relationships with primary care doctors, specialty physicians, and other health care professionals and impair the development of new models of health care.

"Effective collaboration between APRNs and physicians does not necessarily require any physician supervision, much less any particular model of physician supervision," the FTC says.

The FTC's move stems from an October 2010 Institute of Medicine (IOM) report that asserts access to care can be expanded by increasing the use of APRNs in primary, chronic, and transitional care. The report also contends scope-of-practice restrictions undermine the nursing profession's ability to provide and improve general and advanced care. 

In the report, IOM calls upon the FTC and the Antitrust Division of the U.S. Department of Justice to pay continued attention to the competition issues raised by scope-of-practice regulations. 

Action, April 15, 2014