The profession of Nurse Practitioner originally came about as a result of a shortage of MDs in the 1960s. Since that time, many things have changed, but one thing has not—the ability for a NP to move to another state and expect to be able to work in the same manner as before. Federalism is a wonderful aspect of the government, but one that ultimately falls short when it comes to regulating health care.
This issue may be a divisive one, but the truth of the matter is that NPs all over the United States are subject to completely different sets of rules and regulations from one state to the next. Whereas in one state a NP has full autonomy and can even practice independently, in others they must work in collaboration with an MD, while in others still they work beneath the doctor and must answer to that individual.
As for funding, the stipulations and regulations regarding this aspect of the NP system are something only the initiated can understand fully. Educational requirements also vary from state to state, with some requiring master, while others ask for a few months worth of post RN coursework.
This conundrum brings up various ethical and philosophical points which aren’t answered as easily as at first they seem. Obviously, the NP who moves from one state to another doesn’t change physically or mentally, yet their credentials fall under scrutiny because of discrepancies in the method of certification.
Naturally we don’t want unqualified or under qualified people practicing, which is why there needs to be some sort of baseline mandate in place that each state can adhere to. If health care, money, and insurance can all be so tangled that they are good enough to work for treatment by an NP in one state, they should certainly work in any other state in the same way.
Health care and all of the labyrinthine issues related to our health care system are being drowned out by other concerns for the time being. Let’s hope someone decides to address it eventually. Perhaps then the need for a comprehensive and cohesive nurse practitioner licensing system will finally be addressed.
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