Opinion: All ‘independent practice’ for APRNs is not created equal

As Connecticut legislators and Gov. Dannel P. Malloy seem intent on passing a bill to allow advanced practice registered nurses (APRNs) to “practice independently,” I would urge some caution.

The lobby pushing for this change in state statute has repeatedly made it appear that Connecticut is “behind the times” since 19 other states already allow independent practice for APRNs. And the sky is not falling in those states with any epidemics of sub-standard care being provided by APRNs, so how can there be any problem with allowing the same in Connecticut?

Has anybody done some legislative homework and examined exactly how “independence” is defined in the laws of those 19 states? As usual, the devil is in the details. There are three specific areas that vary greatly among these states: regulatory oversight, education requirements, and prescriptive authority definition.

According to the National Council of State Boards of Nursing, there are 22 states allowing independent practice for nurse practitioners, meaning “no requirement for a written collaborative agreement, no supervision, no conditions for practice.” And 17 states allow prescriptive authority, defined as authority “to prescribe pharmacologic and non-pharmacologic therapies beyond the peri-operative and peri-procedural periods.” Several of these states such as West Virginia, Massachusetts, and Rhode Island established that prescribing may only occur within limits set up by formularies.

Robert M. McLean, M.D. practices internal medicine and rheumatology in New Haven. He is immediate past-Governor of the Connecticut Chapter of the American College of Physicians (ACP) and currently serves on the ACP’s Board of Regents and its Medical Practice & Quality Committee.

See the complete story at CT News Junkie.



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