3: REFLECTIVE RESPONSE 1 ■ 103National Conference of State Legislation reports more than 350 SOP laws enacted in 48
states since January 2011.
As SOP is determined at the state level for professionals, they work at countering
these intrusions state by state. NPs have full autonomy in 20 states and the District of
Columbia; optometrists have gained simple surgical privileges in three or more states;
and psychologists have won prescribing rights in two or more states. This paper also
documents physicians’ worries over the recent proliferation of doctorates in many of the
10 nonphysician professions. The worry is that a doctorate may strengthen the individu-
als in their advocacy for full practice authority, and they will engage consumer organi-
zations and other nonmedical colleagues to increase their credibility and political clout
with each state’s legislators. In fact, they even worry about the additional fund- raising
for advocacy that these non professionals are able to accomplish, and lack of funding of
the professional medical organizations by salaried physicians.
In one case it was the Colorado Medical Society versus Hickenlooper 2015 CO 41
(Colo. 2015), where CRNAs had a win but it was a very unfavorable decision for phy-
sicians. This case had to go all the way to the Colorado Supreme Court because of the
medical societies appeals but on June 1, 2015, the Colorado Supreme Court affirmed
that the Colorado Nurse Practice Act allows CRNAs to provide health care services
without physician supervision. In addition, the Colorado Supreme Court affirmed the
finding that the governor of Colorado had acted within his discretion regarding the
Medicare opt- out requirement!
Therefore, all Doctor of Nursing Practice (DNP) graduates will need to follow leg-
islation that may influence their practice, positively as well as negatively, such as the
new APRN Compact (NCSBN, 2015). The APRN Compact, approved on May 4, 2015,
allows APRNs to practice in the other compact states with a single multistate license.
Maintaining membership in one’s professional nursing organization is essential in order
to follow the dialogue on a particular issue, regardless of whether it will negatively or
positively influence one’s practice. The following are some examples of ongoing issues
and organizations that can potentially affect DNP- APRN- CNP practice.
DNPs have every right to be called doctor and are very proud to be nurses and
not physicians. They should have no problem being included in appropriate legisla-
tion, and like the dental hygienists, their education and training will not be confusing
to patients.
Each year, state legislators are bombarded with bills related to SOP. The publica-
tion Advance for Nurse Practitioners ( nurse- practitioners.advanceweb.com ) is one source
of such professional SOP information. For example, a July 29, 2009, posting shared the
successful end to an NP Restraint- of- Trade Case from Butte, Montana. This case involved
two NPs who owned and operated a clinic, whose referrals for imaging beyond routine
x- rays were refused by a physician director of radiology and pathology at a nearby
hospital, because they did not have physician supervision (which was not required in
Montana). After an 8- month delay by the defendants (physician and hospital), the par-
ties settled four days into the trial. Advice from these APRNs was, “Don’t back down,
don’t allow it, stand up for our rights” (Ford, 2009, p. 1).
DNPs should also follow the calls for quick action from professional organiza-
tions regarding proposed federal legislation. The Nurse Practitioner Roundtable (NPR),
a coalition of seven national NP organizations, works very hard to influence federal
legislation (Nurse Practitioner Roundtable, 2008).
One hurdle in 2014 that the NPR took a stance on was documented in its paper
Nurse Practitioner Perspective on Education and Post- Graduate Training. They made five
evidence- based recommendations in their joint organizational paper. In addition, they