Monday, April 22, 2013

Nurse Practitioner Scope of Practice Grades by State

NP's scope of practice varies widely from state to state. I know where I live and many states have current bills trying to improve NP scope of practice. Primarily because of the new Affordable Care Act, the shortage of primary care doctors and an aging population.

The state ranking below are from the Pearson Report. The most interesting thing I found was that only 24 states restrict Doctorate and PhD NP's from calling themselves Doctors. This is a pet peeve of mine, because as an NP you should never imply to a patient that you are a doctor without clarifying you are a NP. (more on that another time)

Hopefully change happens sooner rather than later in more of these states.

2011 Pearson Report
NP scope of practice laws

Alabama:  F                       Alaska:  A                      Arizona:  A                     Arkansas:   D
California:   C                    Colorado:  A-                 Connecticut:  B               Delaware:  C  
Florida:   F                        Georgia: F                       Hawaii:  B                      Idaho:  B
Illinois:   D                         Indiana:  D                       Iowa:  B                        Kansas:  C
Kentucky:  B                     Louisiana:  D                    Maine: A-                     Maryland: A-
Massachusetts: D              Michigan: F                     Minnesota: C                 Mississippi: C
Missouri:  F+                    Montana: A                     Nebraska: D+                 Nevada: C
New Hampshire: A+         New Jersey:  B                New Mexico:  A             New York:  B
North Carolina: F             North Dakota:  A             Ohio:  C                       Oklahoma:  C
Oregon:  A+                     Pennsylvania:  C               Rhode Island:  A          South Carolina:  F
South Dakota:  D              Tennessee:  C                   Texas:  D                         Utah:  B
Vermont:  C                      Virginia:  D                       Washington: A+           West Virginia:  C
Washington DC:   A          Wisconsin:  C                   Wyoming:  A


Candi said...

I would never live in a state where I wasn't allowed to call myself "Dr." if I had my PhD or my DNP. Ridiculous that that's even an issue!!

NP Odyssey said...

It is a touchy issue. Technically the guy at 7-11 with a PhD, or a botanist with a PhD can call themselves a doctor, but they are not MD's. You can call yourself a doctor in most states, but you need to clarify that you are a NP not MD

PediNP said...

I clarify to my patients multiple times/day that I am an NP yet they still call me doctor. I just move on. I have bigger issues than my title. I live in a "D" state, and want my collaborative agreement to go away! Even worse, while my awesome physician partners view me as an equal, the medical group I work for still requires me to bill under the physician I am working with, which means he/she has to sign my notes. I can't order therapies at the hospital system I work for. Stupid, stupid, stupid. A title is the least of my worries.

NP Odyssey said...

PediNP, I'm in a C state and I was surprised at some of the rankings.
I understand about being called doctor. As a male nurse it happens regularly the first time I meet a patient, but it could be the anesthesia too. NP's are often called doc, but like you I clarify I am an NP

Kathryn Cooper said...

ND is now an independent practice state. It changed in 2011.

Sophia said...

Thanks for posting this graphic. I'd love to move back to Texas one day and hopefully things will improve by then.

NP Odyssey said...

Kathryn, good for ND hopefully more states will change soon. They are trying to here. I just posted the Pearson Report grades, but looking at the 2012 scope of practice ND should probably be an "A" now

Sophia, thanks I like the scope of practice link. I'm surprised at some of the states I thought were progressive like MA

Anonymous said...

You want to talk hot button issue results?

We had a nurse fired on the spot for referring to herself as "Doctor" on the day after she received her credential/graduation letter from her online DNP program (twice, once written on the note/chart and once with a patient that was witnessed by someone else).

She was asked about it by one of the other docs, and she dished back an attitude, saying she had "earned" it. This particular doctor is one of three directors of our practice group, which services two large-to-mega-hospitals (soon to be three, or four if the merger goes through) in my city, the fifth largest metro in the country. Not a man to be trifled with, and, since he does the HR/policy/discipline for us docs, not a pleasant guy anyway.

The nursing staff office and security are literally just outside our doors, so she was being walked to her car inside 90 seconds.

That's not the best part. Of course we got to read the flaming email that came out to the RNs, but a few weeks later (!), but there was an immediate and permanent halt on NP hiring at those three hospitals which has so far stuck. Since we are expanding, we are talking several dozen jobs. Our RN jobline website now has a line that reads "Advanced Practice / Degreed Nurses need not apply" or it did six months ago. Luckily, we have two large (now three) PA schools nearby so we are good for midlevels at least for now.

So, don't do it. I have asked Dr. Director since then and he agrees: If you are referred to as "doctor" and you ignore it, fine. But outside academia or your resume, don't even think about it.

He did get off our asses about chart review for a couple of months though.

NP Odyssey said...

Funny and a good point

CAM2013 said...

No way Jose! They can dish out that SH_T all day long because they believe in the ego tripierarchy. Doesn't mean you need to. I have the same credentials as Dr. Margaret Mead, Dr. Henry Kissinger and Dr. Jill Biden
Some hospital systems develop a culture of shame and exclusion.

TREY said...

It's crazy that with a DNP you aren't called Dr. Some of the "doctors" working in many facilities are DO which is not an MD but they are covered. I think Drs are a bit intimidated by the fact that NPs with a DNP ARE doctors.

My state is liberal and do allow DNPs to be called Dr. But you have to continue to function as a NP and not an MD. Though I do the same as they do ......