102 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
Clearly, the authors of this chapter present data to dispute such claims of threat-
ened patient safety, as do representatives from each profession in their letters of response
to AMA’s Data Series. On the other hand, if we keep in mind the 2006 collaborative
document on Changes in Healthcare Professions’ Scope of Practice: Legislative Considerations
(revised in 2009)^3 developed by: the Federation of State Medical Board (FSMB), National
Council of State Boards of Nursing, Inc. (NCSBN), Federation of State Board of Physical
Therapy (FSBPT), National Board of Certification on Occupational Therapy (NBCOT),
Association of Social Work Boards (ASWB), and National Association of Boards of
Pharmacy (NABP), we can be hopeful with their statement, “overlapping scopes of
practice are a reality in a rapidly changing healthcare environment. The criteria related
to who is qualified to perform functions safely without risk of harm to the public are
the only justifiable conditions for defining scopes of practice” (National Council of State
Boards of Nursing, 2009, p. 15).
However, the AMA never gives up on an issue! In 2012, through their Advocacy
Resource Center, they published a five- page white paper on the need for Physician led
health care teams— Advocacy on behalf of physicians and patients at the state level (AMA 2012).
They approached this topic with their values and opinions in seven areas, including:
- Education and training makes physicians most qualified to lead the health
care team—not advanced practice registered nurses. - Patients want physician leadership and one patient survey documented that
patients care most about doctor’s (of medicine) education, training and exper-
tise not factors relating to convenience. - Top integrated health care institutions are physician lead.
- Physician assistants (PAs) support the physician- led team model of care (be-
cause PAs cannot practice independently). - Increased utilization of APRNs does not lead to cost savings.
- Increased use of APRNs is not the solution to access problems (because only
52% go into practicing primary care in the United States based on their geo-
graphic mapping). - Workforce shortages include both physicians and nurses.
In addition, in 2014, the AMA developed what it calls “Health Workforce Mapper,”
which is an interactive tool that illustrates the geographic locations of the health care
workforce in each state, as well as other related trends including where to locate or
expand your practice to reach patients without current access to care, and where not to
locate due to an excess of providers for each patient currently (AMA, 2014).
Luckily, the ANA (2009) is an official observer at the AMA Annual Meeting, where
the AMA proposes many resolutions and reports that could affect nursing practice.
The ANA publishes its observations in Capital Update after each annual meeting—
so we are able to follow its assaults on our ability to practice to our full SOP.
We know the AMA tries constantly to stop any changes in SOP that it thinks will
lessen its power and control of health care delivery in states. It continues to oppose the
IOM’s The Future of Nursing (2011) key message: “Nurses should practice to the full
extent of their education and training” (p. 29).
In 2012, the AMA, feeling very threatened, worked with the Physicians Foundation-
Empowering Physicians, Improving Healthcare on two documents regarding SOP:
(a) A Decision- Maker’s Guide to Scope of Practice (Issacs and Jellinek, October 2012) which
covers nurse anesthetics, NPs, murse- midwives, and ten other professionals like audi-
ologist, pharmacists, and psychologist; and (b) Accept No Substitute: A report on Scope of
Practice (Issacs and Jellinek, November 2012) because in 2012 it had found through the