Scope of Practice

How the APRN Compact would undermine physician-led care

Tanya Albert Henry , Contributing News Writer

AMA News Wire

How the APRN Compact would undermine physician-led care

Jun 27, 2024

Nearly a decade after its initial inception, the latest version of the Advanced Practice Registered Nurse (APRN) Compact continues to threaten patient care and safety.

The compact would allow all four types of advanced practice registered nurses—including nurse anesthetists, nurse midwives, nurse practitioners and clinical nurse specialists—to practice without any physician involvement, even in states with laws requiring that they practice with physician supervision or collaboration. That includes:

  • 44 states and Washington, D.C., that require physician supervision, direction, collaboration or another level of physician involvement for nurse anesthetists who provide anesthesia care.
  • 30 states that require physician supervision, collaboration or another level of physician involvement for nurse practitioners to diagnose, treat or prescribe.

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Among the state practice and prescribing laws that would be preempted are laws that state and national organizations representing nurses previously supported and helped advance. Moreover, proponents of the APRN Compact inaccurately claim that the APRN Compact does not expand scope of practice. Such claims are an attempt to confuse legislators.

Patients deserve care led by physicians—the most highly educated, trained and skilled health professionals. The AMA vigorously defends the practice of medicine against scope of practice expansions that threaten patient safety.

Allowing advanced practice nurses to practice without physician supervision is not good for patients. Studies have shown that advanced practice registered nurses practicing outside physician-led care teams raise health care costs because they order more diagnostic imaging tests and prescribe more antibiotics and opioids than physicians.

Other research conducted using the AMA Health Workforce Mapper has shown that advanced practice nurses do not practice in underserved rural areas, but instead tend to practice in the same areas that physicians do—even if they are in a state that already allows for independent practice.

The National Council of State Boards of Nursing created the APRN Compact as a way for advanced practice nurses to have one multistate license that lets them practice in all of the states that are part of the Compact. Yet, unlike similar compacts for every other type of health professional, the APRN Compact would preempt state scope of practice laws. Notably, existing health licensure compacts for physicians, psychologists, physical therapists and nurses retain individual state scope of practice laws.

The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety.

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To join the 2020 APRN Compact, a state’s legislature must enact the compact as legislation. Seven states must adopt the compact for it to become effective. Through the advocacy of the AMA and state medical associations, the compact has stalled as only four states—Delaware, North Dakota, South Dakota and Utah—have enacted legislation. Meanwhile, seven states defeated the APRN Compact in 2023 and three states have defeated it so far this year.

“The AMA strongly objects to the use of interstate compacts as a mechanism though which to grant independent practice to APRNs or grant prescriptive authority where such authority does not currently exist,” the AMA says in an issue brief. “Not only is this deceptive, it is the AMA’s position that this use of a licensure compact has the potential to threaten patient care and safety.”

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