New Era Begins for Nurse Practitioners in New York
By Dean Bobbie Berkowitz, PhD, RN, FAAN
The Nurse Practitioners Modernization Act took effect in New York State on January 1, opening a positive new chapter in the history of the profession. Under the law, nurse practitioners with more than 3,600 hours of practice (approximately two years of full-time experience) no longer require a signed written practice agreement with a physician to care for patients-- though they still must maintain a collaborative relationship with a medical doctor. Additionally, practice protocols no longer need to be identified and quarterly chart reviews no longer need to be performed.
The Act, while not perfect, is a milestone for New York and culminates a 10-year campaign to eliminate the restrictions on nurse practitioners practicing at their full scope.
The Affordable Care Act, which to date has resulted in approximately one million new consumers obtaining health insurance in New York state, was a main impetus for broadening the previous legislation. Moreover only 44 percent of new New York-trained physicians say they plan to practice in our state, with more than 40 percent intending to enter a specialty and not provide primary care. Clearly this convergence of trends and developments would have made it more difficult for large numbers of New York residents to obtain primary care.
In recognition of their advanced level of education many professional organizations have called for greater flexibility in allowing nurse practitioners to care for patients. For example, in 2010 the Institute of Medicine’s The Future of Nursing: Leading Change, Advancing Health report emphasized the importance of enabling nurse practitioners to “fulfill their potential as primary care providers to the full extent of their education and training” and said that “restrictions on scope of practice…undermine the nursing profession’s ability to provide and improve both general and advanced care.”
Similarly the Federal Trade Commission has recommended that states eliminate collaborative agreement requirements with physicians. In fact before the Nurse Practitioners Modernization Act took effect, 21 jurisdictions nationwide already allowed nurse practitioners to practice without a written practice agreement.
These policies and professional recommendations are based on an ample body of respected evidence showing that nurse practitioners provide safe and effective care, as good as or in some cases superior to that of physicians.
The new law “sunsets” in June 2021, meaning it will be up for review. This will present a new opportunity to increase the benefits that nurse practitioners bring to patient care, particularly primary care.
I look forward to the day when the achievements of New York nurse practitioners serve as a model for progressive, continued reform throughout our nation even as we take additional steps in ensuring that our own legal scope of practice reflects the significant skills, training, and ongoing education that nurse practitioners bring to the table.