Should nurses' scope of practice be expanded?

The way nurses work in America needs to change to meet the rising demand for care, according to a report released today by the Institute of Medicine.

Perhaps the most striking recommendation to come out of the report is the IOM's call for government and healthcare organizations to remove scope of practice limits that prevent nurses from practicing "to the full extent of their education and training." The rationale is that millions more patients are expected to gain access to healthcare through the healthcare reform.

The report notes that of the roughly 3 million nurses in the U.S., more than 250,000 are advanced practice registered nurses, who have master's or doctoral degrees and have passed national certification exams. Yet what they are allowed to do at work varies, depending on state regulations, which may limit their scope of practice. Already about 28 states are considering expanding the role of nurse practitioners to fill the void created by the primary-care physician shortage.

Because the healthcare system today does not offer enough incentives for nurses to pursue higher degrees and more training, the U.S. faces a shortage of nursing professors and advanced practice nurses. The report calls on public and private organization to offer resources to help nurses with associate's degrees and diplomas to go on to get their bachelor's degrees in nursing.

With the doctor shortage projected to hit 63,000 by 2015, it's not surprising that the report calls for nurses to play a bigger role in healthcare. In a potentially controversial recommendation, it suggests that nurses become "full partners" with physicians and other healthcare professionals in redesigning healthcare in America. In the past, the American Medical Association has warned that broadening nurses' authority could pose a danger to patients.

To learn more:
- read the Institute of Medicine report
- see the press release
- read the Medical News Today article
- see the MSNBC article

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