Nursing Groups Denounce AMA's Effort to Regulate Advanced Practice RNs

'The AMA is again adopting policies encouraging laws and regulations that impede competition and help their bottom line.'

Nursing groups are denouncing the American Medical Association's recent policy amendment calling for advanced practice RNs (APRNs) to be licensed and regulated jointly by the state medical and nursing boards.

The policy amendment was passed by the AMA's House of Delegates (HOD), the policy-making body of the organization, during its annual meeting last week in Chicago.

The National Council of State Boards of Nursing (NCSBN) "strongly opposes" the recommendation, given that U.S. nursing regulatory bodies (NRBs) have regulated the practice of nursing for more than 100 years, the NCSBN noted in a statement.

"They have the unique experience and expertise to license, regulate, and discipline nurses at all levels of practice from licensed practical/vocational nurses, to registered nurses to APRNs," according to the NCSBN. "The Consensus Model for APRN Regulation, the nationally recognized and longstanding model for APRN regulation, calls for regulation of APRNs by NRBs."

The American Association of Nurse Anesthesiology (AANA) also called out the AMA's action.

"At a time when the healthcare industry is facing a critical workforce shortage and patients' access to care is in jeopardy, the AMA has chosen to focus on ‘fixing' a problem that does not exist," Angela Mund, DNP, CRMA, president of AANA, said.

The American Association of Nurse Practitioners (AANP) also weighed in: "The AMA has once again dusted off its old protectionist playbook and demonstrated its commitment to put profit and powerplays ahead of patients and their access to high-quality healthcare," the organization said.

Adding state medical boards into the mix could negatively affect care, said Maryann Alexander, PhD, RN, FAAN, chief officer of nursing regulation for the NCSBN.

"In the interest of public safety and protection, best practice dictates that regulation of APRNs should be within the purview of NRBs," Alexander said. "Adding the needless oversight of state medical boards does nothing to enhance patient protection but has the potential to add unnecessary bureaucracy that may actually slow down the regulatory process and impede access to care."

Additionally, research has identified that in those states with the most restrictive laws and regulations—such as this new AMA policy—access to care is adversely affected, according to the NCSBN.

Agreed, said Jon Fanning, MS, CAE, CNED, CEO of AANP.

"The only appropriate regulatory entities to oversee nursing licensure and practice are state boards of nursing," Fanning said. "Not only is the model proposed by the AMA flawed, but it has also been soundly rejected by 46 states and the District of Columbia. In the handful of states where NP practice is regulated outside the exclusive oversight of the board of nursing, the restrictive involvement of the board of medicine directly contributes to healthcare access challenges, resulting in continued low health care rankings, geographic disparities in care, and unnecessary regulatory cost in these states."

'Stuck in the past'

The AMA and other physician groups have long argued that collaborations are needed for patient safety, though some question their motives.

"The AMA has historically supported policies which restrict APRNs practicing to the top of their education and certification despite decades of evidence demonstrating APRNs provide safe, high-quality care," according to the NCSBN.

"The Federal Trade Commission has repeatedly cautioned against state legislative proposals that recommend regulation of APRNs by physician-controlled boards, urging lawmakers to ‘consider whether to allow independent regulatory boards dominated by medical doctors and doctors of osteopathy to regulate APRN prescribing, given the risk of bias due to professional and financial self-interest,'" the NCSBN continued.

Mund was a bit more direct.

"The AMA is again adopting policies encouraging laws and regulations that impede competition and help their bottom line," she said. "As a CRNA and a member of America's most trusted profession, I feel it's incumbent upon us as healthcare professionals to be honest and transparent about healthcare policy."

Mund charged that the AMA's proposed policies put physicians, rather than consumers, in control of patients' healthcare decisions.

"The AMA is simply stuck in the past," she said. "As frontline providers during the pandemic, CRNAs, as well as all APRNs, proved once and for all they have the training and clinical competence to provide safe, high-quality care without restrictive physician involvement."

"We urge our medical colleagues to join us in our movement to put patients first by supporting a modernized healthcare system that looks to the future, not the past."

AANP also called for the AMA to "put patients first."

"Unfortunately, the AMA's tactics are not new. AANP will continue to fight for patients," according to AANP. "AANP calls on the AMA to stop the rhetoric and resolutions that undermine patient choice, access and truly coordinated care. The AMA’s ongoing fearmongering and physician-protectionist resolutions are negatively impacting the health of our nation. It’s time the AMA retires its dated tactics and put patients first."

Editor's note: This story has been updated to include AANP comments.