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The Pearson Report (Pearson, 2009), as published by The American Journal for Nurse Practitioners, outlines the general practice guidelines and regulations by each individual state and the District of Columbia for Advance Practice Nurses.  This annual report reviews the type of physician involvement, regulatory board, prescriptive authority, diagnostic authority, and certification requirements, among other elements, of each region.  The following summarizes some issues the report reviews.
    
In regard to diagnosing and treating by Advance Practice Nurses:
•    23 states and DC do not require any Physician collaboration or oversight
•    4 states require Physician involvement, but no documentation of this relationship
•    24 states require documentation of Physician involvement

In regard to prescriptive authority of Advance Practice Nurses:
•    13 states and DC have no requirements for Physician involvement
•    38 states require documentation of Physician involvement

In regard to regulatory board oversight for Advance Practice Nurses:
•    31 states and DC establish oversight by only the state Board of Nursing
•    10 states establish joint oversight by the state Board of Nursing and state Board of Medicine for some aspect of practice
•    8 states establish the state Board of Nursing as the overseeing organization, but the state Board of Medicine regulates specific aspects of practice
•    2 states establish an independent oversight board, aside from the state Board of Nursing and the State board of Medicine, to regulate practice


In regard to NPDB (National Practitioner Data Bank) filings from September, 1990 until September 2008:
•    Total filings against Nurse Practitioners were 851, with a ratio of 1 filing per 173 practitioners during that time period.
•    Total filings against Doctors of Osteopathy were 15,297, with a ratio of 1 filing per 4 practitioners during that time period.
•    Total filings against Medical Doctors were 234,887, with a ratio of 1 filing per 4 practitioners during that time period.

In regard to HIPDB (Healthcare Integrity and Provider Data Bank) filings from January, 1999 until September, 2008:
•    Total filings against Nurse Practitioners were 652, with a ratio of 1 filing per 226 practitioners during that time period.
•    Total filings against Doctors of Osteopathy were 4,478, with a ratio of 1 filing per 13 practitioners during that time period.
•    Total filings against Medical Doctors were 41,923, with a ratio of 1 filing per 23 practitioners during that time period.

From this data, Linda Pearson encourages all Advance Practice Nurses to first, advocate for a decrease or removal of physician supervision in their states.  The figures corresponding to malpractice and malfeasance demonstrate that physician oversight is not necessary or prudent to provide safe practice for APNs.  Many states with independent practice for NPs have recorded very low ratios for malpractice and malfeasance claims against APNs.  “NPs throughout the country must strive to increase our legislatively sanctioned autonomy.” (Pearson, 2009 p. 11)
Second, she charges NPs to become more outspoken about their practice and healthcare influence to policymakers and legal representatives.  APNs are regularly forgotten when discussions surround healthcare policy and reform.  NPs have a key role to play in policy formation, patient advocacy, cost effectiveness, and health promotion.  Pearson encourages APNs to form personal relationships with their state representatives and senators to show them the safety in practice and value of care they provide.
Finally, Pearson admonishes states who have allowed doctorate prepared NPs to be addressed as “doctor.”  She speaks out against states that have placed legislation preventing doctorate prepared APNs from being referred to or for referring to themselves as “Doctor NP.”




Pearson, L. (2009).  The pearson report – 2009. The American Journal for Nurse Practitioners, 13(2).