While scope of practice discussions and efforts are occurring in many states and involving varied professions, California is one of 11 states requiring collaborative agreements between NPs and physicians. According to the CaliforniaHealthline article, the state currently has four scope of practice bills under consideration, one (SB 491) regarding NPs. Not surprisingly, the AAFP president-elect was quoted as having pointed out that "The independent NP has not solved" the issue of access to care, pointing to a "team-based approach" as the answer to the problem. This is curious as "independent physicians" have also not solved the access to care problem. The point is that there is an existing access to care gap that will be significantly widened as more Americans have health insurance in the near future. The population of primary care providers is not adequate to meet the demand. While NPs are the group of providers most likely to be prepared for and practice in primary care, more are needed-yet hindrances such as regulatory handicaps only exacerbate the problem.

A day following the Healthline article, Kaiser Health News published a story originating with the Pew Charitable Trusts. This article described advances among states where practice restrictions were adjusted to allow NPs to more readily practice to their full scope, with Nevada being the most recent to enact change after six years of debate. The National Conference of State Legislators (NCSL) reported that 178 proposals related to NP scope of practice had been considered in 2013, alone.  Many of these were related to loosening restrictions on specific tasks (e.g. signing death certificates). The author cited HRSA's statistics regarding the looming primary care provider shortage, with up to 15,000 additional providers needed. However, the Association of American Medical Colleges (AAMC) was cited as projecting a shortage of approximately 45,000 primary care providers in the near future.

Regardless which statistics are accurate, the fact remains that Americans are unable to access high quality primary care-the kind of services for which NPs are known. In fact, almost 50 years of research has consistently supported the quality and cost-effectivenes of NP care and no differences have been demonstrated specific to the presence of regulatory restrictions.  NPs are the only category of primary care providers growing at a significant rate, according to a GAO report to Congress (2008). Another recent publication (Kuo, Loresta, Rounds, & Goodwin, 2013) report findings that as states eliminate restrictions, NPs increasingly were responsible for a greater number of visits. The time for turf-battles has long passed.

There is a real and existing need for all hands on deck from the primary care community, regardless of profession or discipline. The American healthcare consumer deserves no less. Why is this an issue for INPE?  INPE's mission is to promote excellence in NP practice and outcomes by providing superior, evidence-based education, research, and resources--provide content designed to help NPs make a difference in their patients' health and which goes beyond basics. Advocacy skills, knowledge, and efforts are critical to support those efforts and we are committed to provide relevant educational material in the near future.