Take the chains off nurse practitioners

Give them ability to practice to their full potential

HISTORICALLY, MASSACHUSETTS HAS BEEN a leader in healthcare reform. However, antiquated, restrictive laws and licensing requirements leave Massachusetts among only 13 states in the country – and the only state in New England – that does not currently allow nurse practitioners to practice to the full extent of their education and training. Limitations to nurse practitioners’ practice authority has led to limitations in healthcare delivery.

Legislation pending on Beacon Hill would modernize Massachusetts licensure laws and provide nurse practitioners with full practice authority, maximizing their education, certification, and training. Nurse practitioners are already providing comprehensive health services to patients and working closely with members of the healthcare team, but are required to practice under the supervision of physicians. They are registered nurses with advanced master’s or doctoral-level education, nationally certified in advanced-practice nursing specialties, and have the knowledge and experience needed to deliver high-quality, cost-effective healthcare to patients – yet, despite a burgeoning healthcare need across the state, they remain underutilized.

Providing nurse practitioners with full practice authority would provide millions of dollars in crucial healthcare cost savings for the Commonwealth; increase access for patients, particularly in underserved areas of the state; and deliver additional resources to combat the ongoing opioid epidemic plaguing Massachusetts.

The cost of healthcare is on the rise for both the Commonwealth and its patients. It is essential that we identify cost savings for the system and improve utilization of nurse practitioner-delivered care that will translate into large cost savings for Massachusetts and for patients. When treated by nurse practitioners, the cost of a patient’s office visit can be 20 to 35 percent lower than a visit with a physician – and without compromising quality of care.

Nurse practitioners are already performing physical examinations; prescribing medications; ordering and interpreting diagnostic tests; and treating and managing acute, episodic, and chronic conditions. And they are often treating some of the most vulnerable members of society, including the elderly, people living in poverty, patients with complex chronic illnesses, and patients with opioid addictions. According to a recent Gallup poll, nurses are the most trusted professionals in the United States and nurse practitioners are well recognized for delivering high quality, cost effective healthcare.

Boston prides itself as a hub for healthcare and is home to some of the highest-rated hospitals in the nation. However, outside of the city, there are areas of the state where patients lack basic access to primary and specialty care, primarily in areas of western Massachusetts and Cape Cod. Due to supervision requirements in the current law, nurse practitioners cannot practice to the full extent of their education and training and, as a result, patients suffer.

In 2013, a group of nurse practitioners based out of Quincy were providing mental health treatment and support services to over 1,000 patients when, unexpectedly, they were forced to turn their patients away after the supervising physician abruptly left the practice. Because of restrictions outlined in the current law, these highly competent Nurse Practitioners could no longer provide their patients with the same level of continued care, primarily prescribing medications. As a result, these men and women were suddenly left searching for mental health services, and for many of them it meant an inability to receive and renew their prescriptions. This is just one example of many like it. Passing the legislation pending on Beacon Hill and providing nurse practitioners with full practice authority would help close these gaps and increase access for patients in need.

As Massachusetts continues to face a rising number of opioid-related deaths, with 2,016 deaths reported in 2016, nurse practitioners stand ready to do their part and offer treatment services for those suffering from opioid dependence. Passing this bill would remove an additional barrier that currently exists for patients seeking medication-assisted treatment for their drug dependence.  Many patients looking for help are met with long wait times and limited access to providers trained and able to provide the treatment they need. There are 28,000 actively licensed physicians in Massachusetts and less than 10 percent of them have received medication assisted treatment waivers to provide treatment to patients suffering from opioid dependence. While many nurse practitioners have attained the waiver for medication-assisted treatment, they are prohibited from providing treatment without a physician who is willing to provide supervision. This requirement impairs the ability of nurse practitioners to respond to the escalating opioid crisis.

Meet the Author

Stephanie Ahmed

Chair, Massachusetts Coalition of Nurse Practitioners' Legislative Committee
For many patients, the nurse practitioner is already the face they are used to seeing in the office, the person answering their calls and overseeing their care and treatment. Granting full practice authority to nurse practitioners means more patients can have access to the high-quality care that they deliver, and at a lower cost for everyone.

Stephanie Ahmed, chair of the Massachusetts Coalition of Nurse Practitioners’ Legislative Committee and former president of the coalition.