Post-Conference Session Summaries

Scope of Nursing Practice Under Attack: Beware AMA Efforts in Your State

Special Session, presented Thursday, April 26

Ilisa Halpern Paul, MPP, began by commenting on an interesting shift in policy; nurses increasingly are affected by legislative policy at the state level. As a result, advocacy is becoming more important. Recently, the scope of nursing practice has been attacked by organized medicine, and Paul called ONS members to action to defend nursing by developing relationships with policy makers to expand the base of supporters and champions.

Amy Hanley, BA, discussed the historical background of the American Chiropractic Association's experience with the American Medical Association (AMA), which is leading the current attack on scope of practice. In 1963, the AMA authorized the formation of the Committee on Quackery under the AMA's Department of Investigation. The committee's primary goal was to contain and eliminate chiropractic medicine. As a result, the chiropractic profession filed a lawsuit (Wilk v. AMA), and in 1987, a district court found that AMA and its officials were guilty of engaging in a nationwide illegal boycott and imposed a permanent nationwide injunction.

Pam Hagan, MSN, RN, said that in 2005, the AMA overwhelmingly accepted Texas Resolution 814, which indicated that the association and a Scope of Practice Partnership (SOPP) would collaborate to interpret and work within scopes of practice for nonphysician healthcare providers. The resolution allowed for the study of the role, benefit, training, and education of nonphysician healthcare providers in rural and underserved areas.

The SOPP, comprised of six medical associations, is staffed and receives basic support from the AMA. The partnership provides financial or in-kind support to federation members facing significant issues related to scope of practice. It funds studies that determine whether allied healthcare professionals fill healthcare voids in rural and underserved areas and that examine the education and training of allied healthcare professionals, with a goal of sharing that information with legislators.

Scope-of-practice issues are being evaluated in individual states. Legislation has been introduced in the past year in 31 states and the District of Colombia regarding the scope of practice of more than 20 healthcare professions (e.g., licensure, general prescriptive authority, opposition to expanding scope of practice, inclusion in health insurance panels). The SOPP has been reviewing and affecting these legislative efforts.

In 2006, the American Association of Anesthesiologists introduced Resolution 902 that indicated that the AMA and SOPP identify physicians and seek to have them elected or appointed to state medical boards. The selected physicians would be committed to regulating the practice of medicine regardless of the activities of boards of nursing or other groups that work to redefine scope of practice. In addition, the resolution noted that AMA and SOPP would work with state medical boards to assist law enforcement in the prosecution of unlicensed medical practice by limited or midlevel practitioners.

As a result of AMA's activities, the Coalition for Patients' Rights (CPR) was established by the American Nurses Association. Comprised of more than 30 organizations representing more than 3 million licensed healthcare professionals, CPR works to ensure that patients have access to quality care provided by a full range of licensed healthcare professionals of their choice and to support coalition members in responding to scope-of-practice attacks. The coalition has been active in a number of legislative campaigns, informing representatives of the full intention of proposed bills.

Paul suggested that nurses become involved in advocacy in their individual states. She offered a number of suggestions for making contacts and advocating locally, such as testifying at hearings and being interviewed by the media. She encouraged nurses to visit the Legislative Action Center (www.onslac.org), which provides tips for advocacy, hot button issues, and more.