Nurse scope of practice expansion may help ease rural healthcare woes

As more states move to expand nurses' scope of practice, these measures may be especially vital in rural America, where healthcare access gaps are often the most glaring, according to the New York Times.

In Nebraska, Republican Gov. Pete Ricketts signed legislation in March that allows nurse practitioners to perform duties they're nationally certified to perform without a physician's presence or approval. It was the 20th state to enact such a law, and eight more are considering similar legislation, according to the Times.

However, groups like the Nebraska Medical Association and the American Medical Association oppose the practice-expansion laws, as they believe physicians should lead all collaborative care teams and note that nurses do not receive the same degree of training that doctors do.

Still, the new law was a victory for Murlene Osburn, a cattle rancher and psychiatric nurse who previously was unable to open a practice in remote Wood Lake, Nebraska, because she couldn't afford or coordinate physician supervision, the Times reported. In remote towns like hers, patients who need psychiatric help often have to drive hours to see a doctor, a situation that exacerbates the already steep cultural barriers to mental healthcare in rural areas.

Indeed, expanding nurses' scope of practice can help lessen the blow from what one leading association has predicted will be a shortage of 90,000 physicians by 2025, a crisis that is likely to continue to hit rural areas particularly hard. Rural hospitals also have found themselves in crisis in recent years, troubled by declining patient bases and rising costs.

Furthermore, providers of all types can benefit from more autonomous advanced-practice nurses, as their existence helps smooth the transition to value-based care and can even boost patient outcomes, FierceHealthcare has reported.

All of these factors mean that doctors groups aren't likely to win the fight against the expansion of nurses' scope of practice, Uwe E. Reinhardt, a health economist at Princeton University, told the Times. "The nurses are like insurgents," he said. "They are occasionally beaten back, but they'll win in the long run. They have economics and common sense on their side."

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