Nurse practitioners (NPs) licensed in New York are now fully able to practice independently, joining those in 24 other states who have already been granted this authority.
As part of the state budget signed by Gov. Kathy Hochul (D) on April 9, NPs with more than 3,600 hours of experience no longer need a formal relationship with a medical doctor to practice, and can “evaluate patients; diagnose, order and interpret diagnostic tests; initiate and manage treatments; and prescribe medications,” according to the American Association of Nurse Practitioners (AANP).
Before this change, New York was one of 15 states with “reduced” practice authority for NPs (rather than “restricted” or “full”), meaning that they were required to have a “written practice agreement” with a physician in their specialty area, with provisions for the physician to review patient records periodically, make referrals, be available for consultation, and have the final word in disagreements over patient care, among others.
NPs with more than 3,600 hours of experience could have a less restrictive “collaborative relationship” with a physician or even a healthcare facility, meaning that they didn’t need a signed agreement with a physician or supervision. This relationship had to be proven by an attestation form and documentation showing communication between the two parties.
Both the written practice agreement and the collaborative relationship were subject to approval or inspection by the New York State Education Department.
Now, New York NPs will require no oversight. According to the AANP, authorizing NPs to practice independently can increase access to healthcare in areas where physicians are scarce and can remove delays in care that can arise when physicians are unavailable.
Stephen Ferrara, DNP, FNP-BC, president-elect of the AANP and associate professor at the Columbia University School of Nursing, also cited the costs associated with MD-NP contracts. “What happened oftentimes was nurse practitioners needed to pay physicians in order to have this contract agreement, and that didn’t serve the healthcare system very well,” he explained. “Because, again, without the agreement or the relationship in place, there was no practice.”
“Nurse practitioners and all healthcare practitioners collaborate as part of what we do. We refer, we get expert opinions, we get consults,” he told MedPage Today. “The difference now is, no longer is that required as a condition of a nurse practitioner’s practice.”
Ferrara said that giving NPs full practice authority would also remove barriers to NPs practicing in the first place, by eliminating the need for a physician relationship and the paperwork proving it.
NPs can now begin to see patients with “less of a regulatory hoop that [they] would have to jump through,” he noted, pointing out that this will increase access to healthcare in the state, especially in rural areas where there might be a shortage of MDs, or in environments with a lack of mental health care professionals.
According to the Primary Care Coalition, NPs generally need 5.5 to 7 years of education to earn their master’s (or doctoral) degree, compared with 11 years for MDs.