In recent testimony before the Nebraska Advanced Practice Registered Nurse (APRN) Technical Review Committee (Committee), AMA President Susan R. Bailey, MD, shared the AMA's perspective on scope of practice, including the impact of scope expansions on the cost and quality of care. The Committee is tasked with reviewing a proposed scope expansion of health care professionals and is currently considering a proposal submitted by the Nebraska Board of Nursing to expand the scope of practice of nurse practitioners, clinical nurse specialists and certified nurse midwives. Dr. Bailey provided a national perspective, sharing fact-based resources including data on the impact of scope expansions on utilization of services, health care costs and patient safety. She noted that "expanding the scope of practice of APRNs to allow independent practice and prescribing privileges will increase utilization of diagnostic services, antibiotic prescribing and opioid prescribing–all of which can take a real toll on health care costs as well as threaten the health and safety of patients." Dr. Bailey described the vast differences in education and training of APRNs compared to physicians and the need for health care professionals to practice in physician-led teams. Finally, Dr. Bailey pushed back on the notion that scope expansion is the answer to improving access to care in rural and underserved communities, highlighting the AMA's data from the Health Workforce Mapper and geomaps which show "state by state and year after year...APRNs tend to practice in the same areas of the state as physicians. This is true even in states that have allowed scope expansion." Nebraska Medical Association has been leading the opposition against the proposed scope expansion and will continue to engage as the Committee is expected to vote on the proposal in the coming months.
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