The Trouble with Nurse Practitioners

Chelsea Rice, for HealthLeaders Media , March 18, 2013

There are certain geographic areas where more advanced nurse practitioners have multi-state licenses, but compared to the RN world, where compact licensures exist for as many as 25 states at a time, on the advanced practice side that doesn't exist, and according to Knybel this is a challenge to recruiting and placing nurse practitioners in positions that require a move across state lines.

"Our pools of nursing candidates are traditionally more mobile. So we can take people from Massachusetts and provide them with a temporary home in the state of California and give them an assignment for three months. This same process can verify them to secure licenses in other states, but for advanced practitioners that's not as easy—the regulations that oversee their practices vary so much more."

When you line up the ratio of nurse practitioners to state population and the state's scope of practice laws, a picture emerges of the impact restrictive and heavily regulated state policies have on the APRN population.

Alabama scores an 'F' from the The American Journal of Nurse Practitioner's 2011 Pearson Report for the scope of patient access to nurse practitioners, and it also has the fifth lowest ratio of nurse practitioners to state population (40 per 100,000 people). Meanwhile, New Hampshire scored an 'A+' with no restrictions on nurse practitioners' scope of practice and has the second highest ratio of nurse practitioners to patient population (114 per 100,000 people).

"Are the patients different in different states? What's the big deal?" says Smolenski.

Isn't the common goal to treat the sick and heal those who are suffering? This hierarchical culture of medicine needs to shift—it's not about who is in charge, it's about treating the overflowing waiting rooms.

Chelsea Rice is an associate editor for HealthLeaders Media.
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2 comments on "The Trouble with Nurse Practitioners"

MBRose (3/27/2013 at 3:50 PM)
Perhaps it is time for physicians to finally accept that nursing is not only a valuable profession, but one that can provide high quality health care in all settings, and become our colleagues and not our overseers. Nurses have been socialized to revere MDs; however, MDs have not educated or socialized to value what nurses bring to the health care table. Time for things to change if this country is ever going to get health care back to top quality for a reasonable cost. Time for nurses to step up and speak up regarding the care provided and advocating for clients we serve in all aspects of healthcare.

Bob Lowry, PA-C (3/27/2013 at 9:26 AM)
Perhaps Ms. Rice should have included Physician Assistants in this article to give it a broader view. PAs can help fill this provider shortage. PAs work under the supervision of physicians and stress the team concept of complete patient care. More info about PAs can be found at




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