Navigating Scope of Practice Tensions

D. Matthew Sherrer, MD, MBA, FASA, FAACD; Brooke R. Vining, CRNA, MNA; Andrew H. Morris, CRNA, MSN


South Med J. 2023;116(5):419 

To the Editor: The notion of scope of practice (SOP) has become a topic of contention between physicians and advanced practice providers across many medical specialties. From a 2017 Department of Health and Human Services report, the following recommendations underscore the current highly charged SOP tensions:

  • Advanced practice registered nurses' scope of practice varies widely for reasons that are not related to their ability, education or training, or safety concerns.

  • States should consider changes to their scope of practice statutes to allow all healthcare providers to practice to the top of their license, using their full skill set.[1]

A recent Anesthesia Patient Safety Foundation article described how, in the perioperative space, SOP conflicts can spill over into the operating room at the point of patient care in the form of microaggressions, stereotyping, and role ambiguity, all of which can threaten patient safety and promote provider unwellness.[2]

Bearing those themes in mind, the experience of the Anesthesia Care Team Optimization Committee (ACTOC), a joint venture between anesthesiologists from the University of Alabama at Birmingham (UAB) Marnix E. Heersink School of Medicine Department of Anesthesiology and Perioperative Medicine and UAB Medicine nurse anesthetists, serves as an example of civil discourse. Beginning in late 2019, ACTOC members came together with a consulting psychologist to acknowledge SOP tensions and to collectively redefine the state of anesthesia care at UAB. The team first sought to acknowledge its differences and discuss the "undiscussable." Early sessions allowed each "side" to speak freely to the other "side," with the only retort initially being a summation of what was heard. With grievances aired, the group then began to acknowledge differences while gradually building momentum toward common values. It became increasingly clear that both sides felt devalued by the other.

Acknowledging that professional politics threatened the quality of care delivered in the operating room, that both sides valued patient care as paramount, that both groups brought unique and complementary skills and perspectives to the table, and that a fulfilling and respectful working environment was critical to wellness and job satisfaction, the team began to craft shared mission, vision, and core values. Over the subsequent meetings, the collective mindset of the group shifted palpably away from "me" to a transcendent sense of pride in "we." ACTOC has since established task forces to capitalize on the progress made by committee members and to take the shared and codrafted mission, vision, and values to the larger group via interprofessional teamwork, education, clinical, and scholarship committees. These individuals have been able to see beyond the ideology of each group to the greater good that can be achieved in working together.

We hope that this example can help others across the healthcare landscape to similarly build back mutual respect and trust with one another through civility, inquiry, openness, and the ability to visualize a world in which both groups succeed so that we can collectively achieve our common goal of providing outstanding patient care every day, every time.