Although nurse practitioners are very capable of prescribing medication, ordering and interpreting diagnostic tests, and administering treatments, many states do not allow nurse practitioners to perform these functions without the oversight of a doctor.
With the advent of the Affordable Care Act, millions of Americans who now have health insurance face a critical shortage of primary care doctors. In theory, nurse practitioners should be able to fill this void. Studies have shown that nurse practitioners provide high quality medical care. In addition, it is much cheaper to educate a nurse practitioner than a doctor. According to a report by the National Institute of Medicine, the cost to educate one physician would cover the cost of educating between 3 and 4 nurse practitioners.
The shortage of doctors is particularly acute in rural areas where isolation can take a toll on those who are mentally ill. Access to psychiatrists in particular is highly limited in rural areas such as western Nebraska and much of Montana. Allowing nurse practitioners training in the subspecialty of mental health to practice autonomously could help to ameliorate this growing problem.
The national trend is to give nurse practitioners full practice authority. Nebraska and Maryland just granted NPs this authority, and eight additional states are considering such legislation.
The New York Times featured psychiatric nurse Murlene Osburn in a recent article. She had hoped to set up a psychiatric practice in a highly rural area of western Nebraska. However, state law required her to get a psychiatrist to sign off on her practice, and the nearest one willing to do it was seven-hours away.
Osburn abandoned her goal and returned to ranching full-time. However with changes to the law governing nurse practitioners in Nebraska, she plans on practicing in her town – where the nearest psychiatrist is hundreds of miles away. Nebraska’s new state law does require some supervision at first, but this can done by another psychiatric nurse.
Granting full practice authority to nurses in rural areas should greatly improve access to mental health services for those that wouldn’t otherwise get the help they need.