Expanding Scope of Practice: Inter-professional Collaboration or Conflict?

Deborah Gardner, PhD, RN


Nurs Econ. 2010;28(4):264-266. 

In This Article

Turf Battles

Too often scope of practice changes are seen as politically charged "turf battles" between two or more health professions, each seeking financial or political gain. In the meantime, millions of people in this country are unable to get the care they need. Some health professional leaders argue wisely that SOPs do not have to engender turf battles. They offer that decisions about the extent of permissible scope of practice can be reframed and resolved through fact-based discussions that provide evidence-based data regarding a health care profession's training, skills, quality of care provided, and the public's need for access to quality affordable care. Once presented to medical groups and state legislatures, rational thinking will prevail. Hmmm. The assumption that consensus-generating processes can be made value-free may be taking too much for granted. While many conflicts involve disputes over facts, the SOP dispute involves not just the facts but values, professional identity, as well as interest-based conflicts.

The SOP issue has created an intractable battle line for some time, but leveraging the content and context of health reform to challenge SOP issues is a timely strategy. The idea of an expanded role for APNs figures prominently in many models of a less costly and more accessible health care delivery system. For nurses this is a window of opportunity to influence the redesign of state practice acts that will support all nurses to provide the same services across states. Recent white papers by the National Health Policy Forum (Cunningham, 2010) and the Citizen Advocacy Center provide an excellent overview of the issues (LeBuhn & Swankin, 2010). These are must-read materials for all nurses.

The Affordable Care Act (ACA) (the official name for health reform legislation) also provides an opportunity to focus on improving inter-professional collaboration as team-based models of care will be the primary mode of health care delivery. Funding includes the exploration of team-based models including patient-centered medical homes (MCHs), accountable care organizations (ACOs), and nursemanaged clinics. Increased funding for community health centers, teaching health centers, and nursemanaged clinics will provide more opportunities for medical residents, nurse practitioners, and physician assistants to have community-based experiences, and also increase support for inter-professional education. Although collaborative, team-based approaches are the goal of the ACA, not enough has been done to develop this design at the decision-making, front-end of the process. Underlying this promising context/intent is the ongoing tensions between nursing and medicine.


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