The Impact Scope-of-practice Laws Have on Urologic Care Outcomes

Raychael Noland, BSN, RN; Peggy Ward-Smith, PhD, RN


Urol Nurs. 2020;40(5):251-255. 

In This Article

Future Directions

The Urologic Diseases in America project (Litwin & Saigal, 2012) provides a compendium of data specific to incidences, treatments, encounters with the health care system and health care providers, and costs for many urologic conditions. These data provide a blueprint for where NPs can interact and provide care in a timely and cost-effective manner. We have documented evidence that 1) research data demonstrate NPs as capable of treating many urology health conditions; 2) state laws continue to hamper the ability to provide appropriate, valued care; and 3) there is a present and anticipated shortage of urology care providers. Addressing the first two challenges will positively impact the third.

In 2010, a report from the Institute of Medicine identified eight recommendations aimed at improving health care in the United States. One of these recommendations focused on increasing access to care by allowing NPs to practice to the full extent of their education and training. Research has demonstrated that NPs in general, as well as NPs in urology, can provide care, achieving similar health outcomes. Would the AUA report include a statistically significant increase in the number of NPs within their practice if care were compromised? The experience described by Krieg (2020) represents cultural barriers that state law changes would alleviate. While the National Institute of Medicine perceives NPs as appropriate care providers, perceptions of our health care colleagues need to be changed. Changing scope-of-practice laws will accelerate that change.

Since the initial Institute of Medicine (2010) report, 10 states have removed practice restrictions (Stringer, 2019). At present, 22 states grant NPs full practice authority. The present public health crisis, a result of COVID-19, has stressed our health care system. In response, 22 states have temporarily relaxed practice restrictions so NPs could provide care without physician supervision (Zolot, 2020). Returning to pre-COVID-19 practice guidelines will be a decision made by each of these states. This represents an opportunity for NPs to advocate for permanently removing the practice guidelines.

The continuation of the present practice restrictions, in light of the evidence, seem hard to comprehend. One has to wonder about the economic interest of other care professionals and the perception that full practice may decrease income. While continuing to require NPs to be supervised limits marketplace competition, it also limits access to care and increases the cost of care. Survey results obtained by Donelan and associates (2013) concluded that 57% of primary care physicians believed increasing the number of NPs would decrease their income; 75% reported that increasing the number of NPs would increase their fear of being replaced. In their conclusion, Perloff and colleagues (2017) posit that "in states where physicians and their associates have felt threatened by the potential for increased competition between primary care NPs and physicians, the medical profession appears to have used its political capital to resist expansion of the legal scope of practice governing NPs. McMichael and associates (2017) stated that these activities occur regardless of the strength of the research evidence.

Continued scope of practice limitations, together with the inability to independently diagnosis and treat a variety of urology health conditions has implications for health policy and health advocacy, and the care provided in the United States is at risk. Providing evidence-based care requires that we utilize the evidence. Certainly, more research data are needed. These data should be NP-specific, longitudinal, and obtained from a variety of stakeholders. Describing the ability of NPs to provide care is one part of the equation – documenting the quality and satisfaction with that care will provide a complete evidence-based perspective. Affording the opportunity to specialize within NP academic programs should include a research project. Guided by academicians, rigor would be included in these activities. We are at a pivotal point in health care, one that NPs may use to alter their practice and enhance the care they provide. These changes would benefit us professionally, while enhancing the quality of life for patients needing urology care.