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Former Nurse Practitioner Association President Reflects on Pandemic and Scope of Practice Regresses

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Nurse practitioners, like other healthcare workers, have been on the front lines of the COVID-19 pandemic. They helped fight a virus they initially knew little about and saw its disparate impact on communities of color, all while grappling with mental health issues and burnout among their own ranks.

At the same time, some NPs were given greater authority to practice amid setbacks aimed at freeing up the national supply of healthcare workers, such as those exempting from the requirements that NPs must sign a contract agreement with a supervising doctor before they can practice. But those rules will soon be reinstated, or have already been, when public health emergency declarations expire.

No practice agreement is needed in approximately half of the states. A.The states that pushed them back had greater access to desperately needed staff when traveling nurses, respiratory therapists and others were in short supply as COVID-19 swept the country, advocates say giving NPs full practice authority.

One such advocate is Sophia Thomas, whose two-year term as president of the American Association of Nurse Practitioners just ended. In this interview, he reflects on the state of the profession in the wake of a historic public health crisis and discusses how removing the barriers faced by NPs can give patients greater access to the care they need.

Editor’s Note: This interview has been edited for clarity and brevity.

Sanitary diving: What exactly do nurse practitioners do?

SOPHIA THOMAS: Nurse Practitioners are advanced practice registered nurses who complete a prerequisite as a bachelor’s registered nurse, return for their education at the master’s or doctoral level, and then receive national certification in specific specialty areas of the population. That’s why nurse practitioners evaluate, diagnose, treat, and prescribe patients of all ages across the spectrum of healthcare.

Right now there are around 325,000 RN in this country, so RN really do offer healthcare options and access to patients. We are meeting the needs of more than 80 million people who live in areas without access to care, what we call health professional shortage areas. Many of these areas are rural, and the interesting thing is that nurse practitioners practice in these areas because they often live in these areas while receiving their education, so they go back and practice in the areas where they live and are treating their own communities.

What are the most important changes or changes that you have witnessed in the profession in the last two years in your position?

TOMAS: Nurse Practitioners have truly stepped up to treating patients during COVID and have been on the front line testing and treating COVID patients in primary care, hospitals, long-term care settings, and even home visits. We have also intensified and embraced telehealth services and we know that this will truly be the way of the future, to be able to provide access to care only to more people.

I believe that in the last few years and in light of COVID, the role of nurse practitioners in healthcare was not just to improve access, but to take a leadership role and make sure we speak up and let communities and the public understand that there are disparities and social determinants of health, and all of this must be recognized and recognized. And it really is time we overhauled and reinvented our nation’s health care system to improve the outcome for people who die of COVID, the people who have the most disparate care. We really need to do something and the nurse practitioners just acknowledge it.

What are some of the biggest challenges facing the profession?

TOMAS: Nurse Practitioners are licensed in all 50 states, the District of Columbia, and the US Territories, and we practice under the rules and regulations of each individual state in which we are licensed.

We are nationally certified and have specific specialty areas. On certain states, Nurse Practitioners cannot practice at the peak of their education and training. They are outdated practice laws, and in those states, we do not have what is called full practice authority, which is the ability of an NP to practice at the peak of their education and training without regulatory constraints.

Outdated practice models and outdated regulatory bureaucracy require that nurse practitioners have a written agreement with a specific division called a collaboration agreement, and if we don’t have that role, we can’t practice.

So I would say the biggest challenge is removing those outdated regulatory barriers that are unnecessary. They restrict access to patient care in the sense that they do not allow nurse practitioners to practice at the peak of their education and training. More recently, Louisiana had a bill that would allow NPs to practice fully and actually give them the ability to move to more rural areas.

Eighty percent of Louisiana is a health professional shortage areaand it is difficult to find doctors to go to rural areas. And we know that the US faces a shortage up to 90,000 doctors by 2025, and doctors just don’t go to primary care. So that’s where Nurse Practitioners really excel, a vast majority of NPs are front-line primary care providers who really provide access to care for patients.

Who is the new president of the AANP?

TOMAS: His name is April bell. She is phenomenal, leaving Vanderbilt, served on the AANP board for several years and will continue to work with the AANP, obviously highlighting the role of nurse practitioners in health care and access to care, but actually also is working to highlight and speak out against disparities in healthcare and populations that so desperately need access to care.

We feel like these populations – those most affected by COVID-19 they deserve care, they deserve preventive care and screenings, so we will continue our work to help improve access to health care for all Americans.

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