Ask a Professor: Georgia’s NPs and the Fight for Full Practice Authority
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“It’s one thing to talk about advocacy, and it’s another thing to actually put on that white coat and hit the capital and shake hands with these individuals in the legislature. It’s pretty eye-opening.”
Dr. Humberto Reinoso, Assistant Professor and Nurse Practitioner Coordinator at Mercer University
As the Baby Boomers enter retirement, the nation is experiencing a worsening primary care crunch: more and more Americans need primary care services, but medical schools aren’t supplying enough primary care physicians to meet that need. The problem is particularly acute in Georgia, which ranks 41st in the nation for overall health.
There are 127 counties in Georgia that are designated as Health Professional Shortage Areas (HPSAs), and lacking in consistent primary care access. Nine counties are without physicians entirely. Exacerbating the problem is the fact that over 20 percent of the state’s working physicians intend to retire in the next year. To meet the growing needs of its population, Georgia needs to add an estimated 2,100 primary care physicians at a minimum in the next ten years, the equivalent of a 38 percent increase.
“The fact that there are not enough primary care providers available in the rural parts of the state makes it more difficult to maintain preventative services and keep patients outside of hospitals,” says Humberto Reinoso, PhD, RN, FNP-BC, ENP-BC, an assistant professor and the nurse practitioner coordinator at Georgia Baptist College of Nursing at Mercer University. “Nurse practitioners (NPs) could help bridge the gap of primary care providers in Georgia, especially in rural areas.”
According to 2019 Bureau of Labor Statistics data, Georgia is home to 7,690 nurse practitioners. NPs and physicians share some of the same responsibilities, and nurse practitioners are more likely to work in underserved and rural areas. As highly trained clinicians, NPs could act as an immediate force multiplier in the fight against Georgia’s primary care crunch.
Meet the Expert: Humberto Reinoso, PhD, RN, FNP-BC, ENP-BC
Dr. Humberto Reinoso is an assistant professor and the nurse practitioner coordinator at Georgia Baptist College of Nursing of Mercer University. He received his MSN and his PhD in nursing from Barry University in Miami, Florida.
Prior to joining the faculty at Mercer University, Dr. Reinoso served as an adjunct faculty member at the University of Miami and at Barry University, where he taught undergraduate and graduate nursing students. He holds dual certification from the American Nurses Credentialing Center (ANCC) as a Family Nurse Practitioner (FNP) and Emergency Nurse Practitioner (ENP).
The State of Play for NPs in Georgia
A majority of states in the US grant full practice authority to their NPs, which means that those states’ NPs are allowed to provide care to the full extent of their education and training. Those states with full practice authority are also among the best-ranked states in terms of overall health; Georgia is not one of them. Instead, Georgia’s NP practice laws are some of the most prohibitive in the nation.
Under Georgia’s Nurse Protocol Act of 1989, Georgia’s NPs must have a protocol agreement with a supervising physician, and they’re also prohibited from prescribing Schedule II medications or ordering certain diagnostic tests. Those requirements act as barriers to otherwise routine care. They place a burden on the NP’s time, the supervising physician’s time, and the patient’s time—they do not improve the quality of care. Georgia’s 31-year-old law governing the increasingly advanced work of nurse practitioners needs an update.
“If I feel a patient needs a certain test or a certain medication, at times that gets pushed back because I’m an NP and I need to contact my supervising physician, and the physician has to be the one that orders that particular test or medication,” Dr. Reinoso says. “Not being recognized as a primary provider for a patient also delays care for that patient. The patient ends up in limbo, and it’s also a burden to the NP who is trying to see the other patients who are in the waiting room.”
Removing the requirement for NPs to have a supervising physician doesn’t mean NPs will stop collaborating with their physician colleagues. The medical profession is intrinsically collaborative and interconnected, and it’s a part of an NP’s education and training to seek out specialty advice and expert opinions through the course of delivering holistic care. A majority of states trust NPs to collaborate with physicians when necessary, but Georgia requires them to collaborate even when it isn’t necessary. By stipulating that each NP must have a supervising physician, the state massively undercuts its ability to meet its primary care needs.
“What these restrictions are doing is imposing regulations into the otherwise natural process of collaboration,” Dr. Reinoso says. “And we know that in other parts of the country, where you don’t have those regulations—and where NPs are practicing to the full extent that they’re educated—you don’t have a decrease in care quality. The care is equivalent to what our physician colleagues are providing, and in some cases better, because NPs are able to follow up and do what they can do for that patient.”
The Road to Full Practice Authority in Georgia
Georgia is one of the fastest-growing states in the nation, but its laws regarding NPs haven’t followed suit. Until recently, Georgia was the only state in the union that still restricted NPs from ordering radiological imaging tests. Organizations like Georgia’s Coalition of Advanced Practice Nurses (CAPN) at the state level, and the American Association of Nurse Practitioners (AANP) at the federal level, are taking a grassroots approach to modernize NP practice in Georgia.
For Dr. Reinoso, getting involved in those efforts is part of being a nurse practitioner, and another way of advocating for patients. In his nurse practitioner program at Georgia Baptist School of Nursing, students take a policy course that highlights health disparities in the state and explore how they could be improved. Dr. Reinoso emphasizes to his students the importance of getting to know their state representatives and taking a seat at the table to make their voice heard.
“It’s one thing to talk about advocacy, and it’s another thing to actually put on that white coat and hit the capital and shake hands with these individuals in the legislature,” Dr. Reinoso says. “It’s pretty eye-opening. Just being able to put a face with a name, and also a cause, is important.”
In other states, the road to full practice authority has been paved with small legislative victories: allowing NPs to order a wide range of diagnostic tests; allowing NPs to prescribe the medications that their patients need; or allowing NPs to earn the right to operate autonomously after a certain number of years of supervised experience. Along the way, more evidence accrues that patients benefit when NPs are able to practice to the full extent of their education and training. And more states are learning that the solution to their primary care problems might be right in front of them.
“I think ultimately we will get to full practice authority,” Dr. Reinoso says. “It’s a slow process, especially in Georgia, but with ongoing education regarding NP education and practice it is very achievable.”
Matt Zbrog is a writer and researcher from Southern California, and he believes a strong society demands a stronger healthcare system. Since early 2018, he’s written extensively about emerging topics in healthcare administration, healthcare research, and healthcare education. Drawing upon interviews with hospital CEOs, nurse practitioners, nursing professors, and advocacy groups, his writing and research are focused on learning from those who know the subject best.