Are Nursing Boards Equipped to Regulate Independent Nurse Practitioners?

In the midst of all the breaking news updates in the last several months it would have been quite easy to overlook the following headline out of California: “Nursing Board Faked Docs on Investigation.” In short, the nursing board falsified documents to make it appear as if the board was investigating complaints against nurses — when in actuality they were doing nothing of the sort.  Nursing boards are state licensing and regulatory boards which exist for the sole purpose of protecting the public from potentially dangerous nurses, just as state medical boards exist to regulate physicians and physician assistants.

Let’s take a look at the numbers:

• As of 2019, there were more than 270,000 nurse practitioners licensed in the United States.  This figure represents an increase of over 20,000 in just the last year alone!
• There are also more than 3.8 million registered nurses in the country.
• In addition to regulating all of these registered nurses (RNs) and nurse practitioners (NPs), state nursing boards also regulate other nursing professionals such as licensed practical nurses (LPNs).

The sheer number of licensed nurses renders appropriate regulation of these professionals exceedingly difficult, if not impossible.  In comparison, state medical boards are only responsible for regulating 1.1 million physicians and 123,000 physician assistants.

In perhaps one of the most egregious examples, the Tennessee Board of Nursing allowed Christina Collins, a nurse practitioner, to keep her license and continue to treat patients despite the irrefutable evidence that she had been prescribing massive opioid dosages to patients — patients she had never even examined. The prescriptions were ‘so colossal’ the Tennessee Department of Health actually argued that their only conceivable use would have been drug trafficking or suicide. Despite this obvious malpractice and undeniable threat posed to patients, state attorneys had to take the case to court in order to challenge this clearly dangerous nursing board decision.

Despite the fact that both nursing and medical boards exist for the exact same purpose, their actions indicate significant fundamental differences.

A recent example of this can be seen with the South Carolina Nursing Board decision to allow unlicensed newly graduated nurses to practice nursing without a license. Previously, if someone did not pass the nurse licensing exam (NCLEX), they would not be issued a license and therefore could not work in a health care facility as a nurse. 

This was done under the guise of supposedly increasing nurse availability to hard-hit COVID-19 hospitals. However, couldn’t this exact same goal have been achieved while still adhering to basic standards of care?  Couldn’t a more expedited licensing process have been undertaken?

It can and has been done.

The boards of medicine in multiple states, for example Alabama, allowed for emergency licensing procedures for physicians in order to accommodate the growing need for physicians in an expedited process.  Successful completion of medical school, passage of licensing examinations (USMLE) and other longstanding basic requirements put in place to assess competence and assure patient safety however remained unchanged.

This post has primarily focused on nurse practitioners and the board of nursing.  Physician assistants (PAs) often erroneously get lumped together with NPs as other non-physician practitioners. Thus far, physician assistants have been regulated by the exact same board of medicine as physicians.  It should however be noted that PAs have begun to request their own separate board to further distinguish themselves from physicians. This would be a mistake.

Anyone who is practicing medicine (defined by some states as diagnosing and treating illness i.e. prescribing medication, and/or performing surgery) should be regulated by the state’s board of medicine.  Nurse practitioners consistently argue that they are practicing ‘advanced nursing.’  However when radical legislation such as AB 890 defines the practice of advanced nursing as “conducting an advanced assessment, ordering, performing, and interpreting diagnostic procedures, prescribing medications, establishing diagnoses and planning and initiating a therapeutic regimen,”  the definition is eerily similar (if not identical!) to that of the practice of medicine.