Which procedures would you consider to be outside the scope of practice for a primary care nurse practitioner (NP)? State practice acts are vague in terms of specific procedures or acts. Do they include performing procedures such as a colonoscopy or skin biopsies?
Response From the Expert
Carolyn Buppert, CRNP, JD
Nurse practitioner and attorney who specializes in the legal issues affecting medical practices and nurse practitioners. She is the author of 5 books. Ms. Buppert counsels clients, and lectures extensively on reimbursement issues, how to avoid malpractice, and contract negotiation. She is also president of Better Life Health Care Systems, which contracts with businesses and educational institutions for nurse practitioner services. Through that company she serves as Director of Student Health at St. John's College in Annapolis, Maryland. Her Web site is www.buppert.com
You are correct. The state nurse practice acts can be vague, and in no state is there direct legal authority for NPs to perform a colonoscopy. Note that state laws on physician scope of practice do not name specific procedures either, but authorize physicians to do anything related to medicine and surgery. For example, California law states that "The physician's and surgeon's certificate authorizes the holder to use drugs or devices in or upon human beings and to sever or penetrate the tissues of human beings and to use any and all other methods in the treatment of diseases, injuries, deformities, and other physical and mental conditions." In California, the NP scope of practice is "within the scope of practice as specified in the Nurse Practice Act and as it applies to all registered nurses." California NPs might perform colonoscopies under a standardized procedure, developed collaboratively with a physician.
New Hampshire law provides NPs with more direct authority to perform medical acts than does California law, but still does not give direct authority to perform specific procedures. New Hampshire law says:
The ARNP shall have the ability to:
However, there is evidence that NPs are performing colonoscopies.
In every state, there is a process for determining whether the Board of Nursing would approve an NP to perform colonoscopy.
To determine whether a specific procedure is within the scope of practice, follow this process:
Medscape Nurses. 2004;6(1) © 2004 Medscape
Cite this: Carolyn Buppert. How Can I Determine Which Procedures a Primary Nurse Practitioner May Perform? - Medscape - Jun 03, 2004.