"Particularly since 2009, there have been concerted efforts to limit authority for advanced practice registered nurses to participate in the healthcare system to their full extent...because scope of practice rules vary state by state because of states rights issues," she says.
For example, there are limits to practice in Arkansas, California, Colorado, Indiana and Louisiana for such functions as the ability to prescribe medications or practice independently. In Iowa, she says, the Iowa Society of Anesthesiologists and the Iowa Medical Society are in court seeking to prohibit APRNs from using fluoroscopy.
Fluoroscopy is an X-ray like strategy to help visualize procedures so the practitioner knows lines are being placed in the appropriate location for pain mediation or cancer care.
"That's important because in Iowa, there are a lot of rural areas where folks who don't have access to fluoroscopic services provided by APRNS won't get the care they need," she said.
In its conclusion, the Johns Hopkins authors wrote that "APRNs, in partnership with physicians and other providers, have a significant role in the promotion of health. American healthcare professionals will have to move forward with evidence-based and more collaborative models of are delivery to promote national unified health goals."