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  • Health equity

Leader of nurse practitioners’ group aims to lift restrictions on authority


More states are giving nurse practitioners the ability to practice without the supervision of doctors. As the new president of the American Association of Nurse Practitioners, Stephen Ferrara wants to continue that momentum.

Stephen Ferrara, the new president of the American Association of Nurse Practitioners, says he has a lot on his plate.

Stephen Ferrara just took over as president of the American Association of Nurse Practitioners, which has more than 350,000 members. (Photo: AANP)

Stephen Ferrara just took over as president of the American Association of Nurse Practitioners, which has more than 350,000 members. (Photo: AANP)

But Ferrara, who took over as president of the association on July 1, says his main priority is to push for full practice authority for nurse practitioners across the nation. The organization represents more than 350,000 nurse practitioners.

“We want to continue working to remove all arbitrary barriers to nurse practitioner practice,” Ferrara says.

To date, 27 states allow nurse practitioners full practice authority, meaning they can diagnose, treat patients and prescribe medications without a doctor’s supervision. In other states, nurse practitioners must work in collaborative agreements with physicians.

Utah is the most recent state to lift restrictions on nurse practitioners. New York gave nurse practitioners full practice authority last year.

Ferrara, who is also the associate dean of clinical affairs at Columbia University, says he sees growing momentum at the state level to allow nurse practitioners to work without the supervision of doctors.

“It's a conversation that has to take place in each and every state because it's a state issue,” Ferrara says.

“But you know, I am from New York and New York became one of those states that did transition to full practice authority last year,” he continues. “I think when a state like New York transitions, it makes some of the other states look and say, ‘Okay, how is this model working in a large state such as New York?’ So there are a number of states that I think are taking notice, and learning from each other.”

Resistance from doctors

While advocates for expanding the practice authority of nurse practitioners contend that it will enable more people to get care, groups representing physicians have pushed back against those legislative efforts.

The American Medical Association, and groups of physicians at the state level, have opposed measures that would give nurse practitioners the ability to treat patients without the supervision of physicians. The AMA says that physicians should be leading decisions on patient care. The AMA has cast efforts to expand the authority of nurse practitioners as part of the growing problem of “scope creep,” or giving more medical decisions to those not trained as doctors.

Ferrara says he understands that some physicians are opposed to giving more authority to nurse practitioners.

“The idea that anything that changes what's always been, is uncomfortable,” Ferrara says. “So I think, you know, we are certainly open to conversation and discussion. We want to provide the best accessible health care to our patients.”

Ferrara says that expanding the practice authority of nurse practitioners would be particularly beneficial for communities with a shortage of doctors, including rural areas.

While hospital and health system leaders have bemoaned shortages of doctors and nurses, Ferrara says there are nurse practitioners who have left the profession in recent years due to burnout, particularly during the COVID-19 pandemic.

“We need students to fill that absence of nurse practitioners,” Ferrara says. “We have seen an uptick (in students), but as we are now it's kind of flattened out a little bit.”

He also says he’s hoping to see more diversity among nursing practitioners. “We need more Hispanic nurse practitioners. That's a low number. We need more African American nurse practitioners,” he says.

Connecting with stakeholders

Ferrara also hopes to educate the public on the capabilities of nurse practitioners.

He says many Americans don’t understand the scope of services they provide.

“Nurse practitioners are found in all settings,” Ferrara says. “I think we focus a lot on primary care because that's where the biggest need is, but there's also nurse practitioners in mental health, which is also a crisis in this country, having access to psychiatric mental health. Nurse practitioners are in acute care, women's health, pediatrics, so we really span the gamut of specialties.”

At a time when health systems are increasingly focused on improving health equity, Ferrara says nurse practitioners can play an important role in closing disparities in underserved groups.

“We look at the social determinants of health, and I'm not saying other professions don't. I'm not saying we do this and nobody else does. But it's just integrated within our practice, and it's how we're educated. It's how we're prepared. So I think it's very much a health equity issue,” Ferrara says.

Ferrara is relishing his new role, including the distinction of being the rare male to serve as president of the organization. (Another man served as co-president several years ago, he notes).

“Our profession of nursing, it's predominantly female,” he says. “But I speak to a lot of men who are nurses or nurse practitioners, and I'm inspired by their support. They reach out to me. They have told me that they appreciate having someone like me in the role.”

“I'm most excited about the role, just to see how I could represent the profession and try and serve as a conduit from nurse practitioners, to stakeholders to lawmakers, to other healthcare profession counterparts,” he adds. “How can we get the dialogue going? How can we have discussions again, with the bottom line of increasing access to healthcare, to making sure that we're serving the populations that need us the most?”

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