Resistance to the Advanced Nurse Practitioner by Organized Medicine

Overview

Although physicians and Advanced Nurse Practitioners (ANPs) collaborated at the local level, organized medicine began to express its resistance to the ANP role. One of the most contentious areas of interprofessional conflict involved prescriptive authority for nursing.

Nurse Practitioners and Prescriptive Privileges

The fight for prescriptive authority for Advanced Nurse Practitioners (ANPs) spanned the latter decades of the 20th century.

Historical Context

• 1983: Only Oregon and Washington granted ANPs statutory, independent prescriptive authority.
• Other States: Required direct supervision by a licensed physician.

Prescription Handling

• Physician Availability: Depended on the negotiated boundaries of the physician–ANP team and locality.
• Remote Clinics: Physicians might countersign prescriptions weekly or pre-sign prescription pads for ANPs.
• State Variations: Practices varied, with some states requiring physicians to write and sign prescriptions at the ANP’s request.

Legal and Regulatory Developments

• 1971: Idaho recognized diagnosis and treatment as part of the specialty nurse’s scope of practice.
• Drug Enforcement Act: Required practitioners to obtain DEA registration numbers to prescribe controlled substances.

Progress and Challenges

Throughout the 1980s, ANPs worked tirelessly to convince state legislatures to pass laws and establish reimbursement policies that would support their practice. Interprofessional conflicts with organized medicine and, to a lesser extent, with pharmacists, centered on control issues and the degree of independence the ANP was allowed. These conflicts intensified as ANPs moved towards a more autonomous model.

Seminal Legal Case

Sermchief v. Gonzales (1983)

• Initial Ruling: Missouri medical board charged two women’s healthcare ANPs with practicing medicine without a license.
• Appeal: Missouri Supreme Court overturned the decision, allowing the scope of ANP practice to evolve without statutory constraints.

Policy and Perception

In 1986, a government report concluded that ANPs and Certified Nurse-Midwives provided care equivalent in quality to that provided by physicians. However, the American Medical Association House of Delegates opposed empowering nonphysicians to become unsupervised primary care providers.

Access to Cost-Effective, Quality Health Care for All Americans

Key Findings

• 1986 Government Report: Concluded that ANPs provided care equivalent in quality to physicians within their areas of competence.

Opposition

• American Medical Association: Passed a resolution to oppose any attempt at empowering nonphysicians to become unsupervised primary care providers and be directly reimbursed.

Summary

The evolution of prescriptive authority and practice autonomy for Advanced Nurse Practitioners has been marked by significant legislative and legal challenges. Despite resistance from organized medicine, ANPs have achieved recognition and expanded roles, contributing to accessible and high-quality healthcare.