Maryland passes new law giving NPs practice autonomy from physicians

Maryland nursing leaders believe patients will benefit from new state legislation that allows nurse practitioners to work independently of physicians. The law also gives independent NPs the ability to open their own practices. Gov. Larry Hogan signed the Nurse Practitioner Full Practice Authority Act into law in May, making Maryland the 21st state to have passed such legislation. American Association of Nurse Practitioners President Ken Miller, PhD, RN, CFNP, FAAN, FAANP, called the passage of the Maryland law "very rewarding." Fifty years of data prove "that NPs provide high-quality, cost-effective and safe care that can improve access and make healthcare delivery more efficient when NPs are authorized to practice at the top of their education and national certification," said Miller, a Maryland resident. The measure allows nurse practitioners, who usually have two years of post-graduate education and advanced training, to prescribe certain drugs and diagnose and treat routine and complex medical conditions without physician oversight. Prior to the law, nurse practitioners were required to maintain attestation or collaborative agreements with physicians as a pre-condition of licensure and practice. "I'm thrilled. We worked awfully hard for this," said Veronica Gutchell, DNP, RN, CNS, CRNP, an assistant professor at the University of Maryland School of Nursing in Baltimore, who testified about the need to remove impediments for NPs. "It removes another barrier to nurse practitioner practice and I think it will improve access to care for patients." The push to allow nurse practitioners to practice with full autonomy has gained momentum across the nation in recent years. Local and national advocates say nurse practitioners -- given their education and experience and the shortage of primary care providers -- can deliver the same quality of care as licensed physicians. But state medical societies often disagree. MedChi, the Maryland State Medical Society, successfully lobbied for amendments to the legislation including a requirement that new NPs maintain a mentoring relationship with a physician or experienced NP for at least 18 months. The law eliminates some of the barriers to care for patients, especially those in rural environments and medically underserved areas, said Dale Jafari, MSN, CRNP, and president of the Nurse Practitioner Association of Maryland. The move will improve the healthcare in the state by increasing the number of available providers without limitations, she said. The role of the nurse practitioner is critical to the healthcare team, she said. "We work hand in glove with the physician providers, and we take on a different role in terms of the fact that our focus is often more on prevention, education and management of the chronic problems our patients present with," Jafari said. The law will not only increase flexibility, choice and access to healthcare for millions of patients, but it also will enhance Maryland's ability to recruit nurse practitioners from neighboring states, Miller said. "We'll be able to retain more Maryland-prepared NP graduates, more NPs will open practices, and patients will gain additional choices for their healthcare services."