'Turf wars' heat up: Nurses fire back at American Medical Association's stand on independent practice

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The divide continues between doctors and nurses over whether nonphysician practitioners should be able to practice independently.

A resolution adopted by the American Medical Association is perpetuating “long-standing turf wars” between some physicians and nurses, one leading nurses' organization claims.

Both the American Nurses Association (ANA) and the American Association of Nurse Practitioners (AANP) blasted the action by the AMA’s House of Delegates at its interim meeting last week that calls for a national strategy to oppose legislative efforts that grant independent practice to nonphysician practitioners.

In an emailed statement, Pamela F. Cipriano, Ph.D., R.N., president of the ANA, which represents the interests of the country’s 3.6 million registered nurses, said the action perpetuates the turf war that divides doctors and nurses. “This divisive tactic will directly impact the nation’s advanced practice registered nurses, and perpetuate the dangerous and erroneous narrative that APRNs are trying to 'act' as physicians and are unqualified to provide timely, effective and efficient care,” said Cipriano.

The AMA adopted an amendment to its resolution 214 that urges the organization to create a strategy to oppose model legislation, and national and state level campaigns, that would allow nonphysician practitioners to practice independent of doctor supervision.

Over the weekend, the AANP, which represents the country’s 234,000 nurse practitioners, also responded to the AMA’s action, saying it is designed to protect physicians and not patients.

“The American Medical Association has asserted, once again, its commitment to put the profit of its physician membership ahead of patients and their access to high-quality healthcare,” said the group’s president, Joyce Knestrick, Ph.D., in a statement.

“We call on the AMA to stop hampering access to care. Stop the rhetoric and resolutions that undermine patient choice, access and true coordinated care. The AMA’s ongoing fear mongering and physician protectionist resolutions are hurting patients and negatively impacting the health of our nation. It’s time the AMA lay their dated tactics aside,” she said.

An AMA spokesman said the organization would have no reaction to the criticism from the nurses' organizations.

The issue has divided doctors and nurses in the past, including the debate last year over the Department of Veterans Affairs' plans to expand the scope of practice for APRNs who work for the agency. Last December, the VA published a final rule that permits full practice authority for most APRNs, namely certified nurse practitioners, clinical nurse specialists and certified nurse-midwives. That sparked heated debate about the role of APRNs and doctors.

APRNs practice advanced nursing, not medicine, and regularly consult, collaborate and refer patients to ensure they receive appropriate diagnosis and treatment, Cipriano said. “For AMA to imply that APRNs are incapable of providing excellent care or that their care puts the patient at risk is blatantly dishonest,” she said, adding that the future of healthcare calls on healthcare professionals to work as a team to meet patient demand for healthcare services.

She called the AMA’s stance a “dated way of thinking” that conflicts with recommendations made by the Institute of Medicine in a 2010 report on nursing that called for APRNs to practice at the full extent of their education and training. She said the ANA will continue to advocate for strategies, legislation and regulations, such as the Veterans Affairs’ rule, that support APRNs.

The Centers for Medicare & Medicaid Services has dedicated money to hospitals to train APRNs with a goal of bolstering the primary care workforce. A recent study said nurse practitioners could offer relief for primary care offices struggling with the physician shortage and rising burnout rates.