To Do or Not to Do

Abstract

Thanks to the efforts of our federal, state, and local policy advocates, nurse practitioners (NP) enjoy full practice authority in 22 states and the District of Columbia. However, with this authority comes legal accountability, based on rules, regulations, and state statutes. This authority is regulated by scope of practice for each role and population focus. In essence, the scope determines the role. This special issue of JNP focuses on the legal implications of scope of practice issues from a variety of perspectives. My article provides an in-depth look at whether setting or patient care needs define scope of practice for NPs. Specifically, the article focuses on differentiating the various roles between the adult-gerontology acute care NPs (AG/ACNP) and the family NP (FNP). From an anecdotal perspective, it appears that there is some confusion, as evidenced by a slow uptick in malpractice suits against FNPs who believe they can simply step into a hospitalist role, despite their lack of education/certification as an AG/ACNP, because of their prior work as registered nurses in critical care units. A follow up is provided by Palomino Flordelin on the acute care NP in the Critical Care setting. A companion article by Melanie Balestra takes an in-depth look at the scope of practice of FNPs who treat patients with mental health issues. Primary care clinics are increasingly seeing patients with anxiety, depression, and attention deficit/hyperactivity disorders. Although FNPs may screen for mental health disorders, they do not have the same depth of education to treat more complex mental health disorders as psychiatric mental health NPs (PMHNPs) do. So it is important for FNPs to recognize when they might be straying outside their educational preparation and breaching their scope of practice. Balestra provides a cornucopia of risk control recommendations that have the potential to prevent civil liability or disciplinary actions from the board of nursing. The other articles in this issue provide sound advice on how to avoid litigation based on a violation of one’s scope of practice. Andrew Frados provides insight into airline medicine and the role of the NP. Omobola Oyeleye delineates the need for reasonable accommodations for patients with disabilities. Kylee Funk and colleagues discusses the legal implications of collaborative agreements between NPs and pharmacists. On a broader level, Lee Ann Eissler and Tammy Young review the practice of NPs worldwide, while Andrew Scanlon discusses the international transferability of NP credentials in 5 different countries. And finally, Shelly Smith and co-authors provide an insider’s view of how to achieve legislative success. All of these articles provide a link to the legal implication of NPs working within their scope of practice. Scope of practice matters!