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Nursing Practitioner Scope of Practice

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Nursing Practitioners Scope of Practice

Nursing is considered the most versatile occupation in healthcare. In the United States, Nurse practitioners (NP) continue to be essential care providers in multiple clinical settings, including hospitals, clinics, schools, nursing homes, and public health departments, among many others. Their scope of practice differs from state to state. However, their rapid growth in healthcare has been necessitated by the increasing emphasis on primary care in rural and urban areas where there have been shortages of primary care providers. Some causes of the shortage include retirements, resignations, workforce misdistribution, and the urge for physicians to practice outside primary care (Barnes et al., 2018). Policy experts in the United States have developed and supported changes in the restrictive state-based scope of practice to respond to this issue. 

The standard operating procedure (SOP) authority for nurse practitioners has continually attracted heated debate from several health organizations over the years. For instance, AANP advocates for a full practice authority for NPs, while the American Medical Association maintains that only physicians can lead a patient care team (Mileski et al. 2020). In Massachusetts, NPs cannot include physician oversight in diagnosing and treating patients. Therefore, a physician must be involved in prescribing and a consequent collaborative agreement specifying the scope of practice to have the prescriptive authority. However, the physician must belong to the same expertise area as the NP (Cuccovia et al., 2020). Also, the physician must not present on-site but must be available for NP's consultation by all means. The collaborative agreement must incorporate eleven items addressing the scope of the NP's prescribing practice and the different medications to be prescribed to patients. On the other hand, for an NP in Massachusetts to gain practice authority, the state law requires a mutual written collaborative agreement agreed upon by the physician and the nurse practitioner.

Massachusetts state law recognizes NPs as primary care providers. This means that they can practice independently. Massachusetts appears to be one of the 23 states that have allowed this. Its care delivery model recognizes NPs as part of the solution to achieving quality patient-centered care. However, if a healthcare carrier needs to be designed as a primary care provider, it should allow its insurer to select the participating NP as the primary care provider.

Considering the Massachusetts state laws, they are consistent with the policies governing the scope of practice for Nurse practitioners at my healthcare facility. The scope of practice for NPs here allows us to practice optimal care delivery to the patients autonomously. The primary duties range from assessing, diagnosing, and treating patients. However, treating patients at our facility occurs in two ways; independently and through coordination and supervision from healthcare providers this aligns with the Massachusetts state laws that allow NPs to prescribe medications through a collaborative process with the physician. Besides, NPs at the facility are considered primary caregivers and mainly focus on health promotion, including training families and communities on the most effective ways of preventing diseases. Additionally, nurses conduct follow-ups to establish the patient's health progress after administering medications and other treatment interventions. Essentially the facility is less restrictive to the scope of Nurse practitioners.


There are several similarities and differences between what our health facility and Massachusetts state laws allow. Some of the similarities include both recognize nurses as primary care providers. Providing care in this context is both a science and an art. As a science, it means that NPs should have the relevant skills, knowledge, and compassion that make them competent enough to attend to patients exhibiting different conditions. As an art, NPs should endeavor to create a rapport with the patients that allows them to trust them to open up more about their health conditions for their greater good and the community at large (Park et al., 2020). Thus, our facility and state laws allow NPs to attend to patients independently but with consultations from physicians in case of complex medical conditions. This means they can assess, conduct laboratory tests and diagnose patients depending on their area of expertise.

Conversely, some of the differences between what our facility permits in terms of Nursing Practice versus Massachusetts NP scope of practice include the following. At the facility, NP can prescribe any medicine to the patients without necessarily collaborating with a physician. On the contrary, according to Massachusetts state policies, for prescriptive authority, NP's charts must be rechecked every three months, although no specific quantities of chart reviews are needed. The prescriptive authority limitation ranges from schedule II to IV drugs. Nevertheless, the charts must be reviewed within the next ninety-six hours to prescribe schedule ii medications. Also, there is a prohibition on self-prescribing schedule II, III, and IV drugs (Cuccovia et al. 2020. On the other hand, nurse practitioners are prohibited from certain practices at my healthcare facility, such as signing the death certificate; it is only limited to physicians. At the same time, Massachusetts scope of practice laws allows NPs to sign death certificates after attempting to consult a medical examiner.

Generally, the scope of practice for Nursing Practitioners varies from state to state. Some are extensive, while others are restrictive. However, some NP's scopes of practice are constant in all states. For instance, NPs will remain primary care providers who work alongside medical doctors to ensure optimal care delivery. Also, it is worth noting that Massachusetts is among the few states in the United States that have extended the scope of practice for NPs for better delivery of health care services.


Barnes, H., Richards, M. R., McHugh, M. D., & Martsolf, G. (2018). Rural and nonrural primary care physician practices increasingly rely on nurse practitioners. Health Affairs37(6), 908-914.

Cuccovia, B. A., Heelan-Fancher, L., & Aronowitz, T. (2022). A policy analysis of nurse practitioner scope of practice in Massachusetts. Journal of the American Association of Nurse Practitioners34(2), 410-417.

Mileski, M., Pannu, U., Payne, B., Sterling, E., & McClay, R. (2020, June). The impact of nurse practitioners on hospitalizations and discharges from long-term nursing facilities: a systematic review. In Healthcare (Vol. 8, No. 2, p. 114). Multidisciplinary Digital Publishing Institute.

Park, J., Han, X., & Pittman, P. (2020). Does expanded state scope of practice for nurse practitioners and physician assistants increase primary care utilization in community health centers? Journal of the American Association of Nurse Practitioners32(6), 447-458.