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Milestone New York legislation eases practice restrictions on NPs

Monday May 5, 2014
Stephen Ferrara, NP
Stephen Ferrara, NP
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Experienced nurse practitioners in New York will be able to practice more independently of physicians beginning Jan. 1, 2015.

The Nurse Practitioners Modernization Act, included in the state budget passed in March, will allow NPs with more than 3,600 hours of experience to treat patients without a mandatory written practice agreement signed by a supervising physician.
The new law will empower NPs, allow them to better serve patients and improve access to quality healthcare, said Stephen Ferrara, RN, DNP, NP, FAANP, executive director of The Nurse Practitioner Association New York State.

“NPs will have a bit more comfort in knowing that their practice is not tied to this written collaborative agreement anymore, should their collaborating physician decide to stop collaborating with them,” said Ferrara, an NP and senior clinical associate at Montefiore Medical Center, Brooklyn. “The long-term benefits will reduce wait times in healthcare settings because there will be increased access to care.”

The Affordable Care Act will provide access to an estimated 1.1 million New Yorkers who were previously uninsured.

“This is one way to address those people coming into the healthcare system,” Ferrara said.


Bruce Zitkus, APRN
The law will impact many of the state’s 16,000 NPs and may increase the number of NPs opening their own practices, said Bruce Zitkus, APRN, EdD, ANP-BC, FNP-BC, CDE, president of the Nurse Practitioner Association of Long Island, Inc.
Work to make changes to the current regulations started around 2000, Zitkus said, with efforts to lobby and explain what NPs do in the healthcare setting.

“Even today there are a lot of people who don’t understand,” Zitkus said. What NPs do can differ from state to state. In New York, the act says NPs diagnose and treat illnesses and prescribe medications. Across the nation in recent years, NPs have played a greater role in primary care.

Physicians’ groups have argued removing the requirement would weaken patient safety and quality of care.

New York joins 17 other states and Washington, D.C., in no longer requiring NPs to enter into written practice service agreements with physicians. Still, barriers to care remain so the work continues, said Bobbie Berkowitz, RN, PhD, FAAN, who serves as dean of Columbia University’s School of Nursing.


Bobbie Berkowitz, RN
Organizational barriers exist in some health systems “where nurse practitioners are not given admitting privileges and some insurance companies do not pay parity to nurse practitioners for the same care that physicians are providing,” she said.

Before the new law goes into effect, Berkowitz said attention must focus on the rule-making process that will occur this year to get the law ready for implementation. The state’s Board of Nursing will develop the proposed rules and invite public comment.

“This is a critical time to make sure that implementation of the new regulation is consistent with the intent of the changes in the regulation of NP practice,” Berkowitz said.

NPs will need to develop an effective communication strategy to educate physician colleagues about the changes as well as the public, health systems, insurance industry and the federal government, according to Berkowitz.

Plenty of communication is needed “so the word gets out about these very important changes,” she said.

The new law eliminates the written practice agreement, but collaborative relationships remain unaltered.

“Doctors ask me questions because of my experiences in the various practices I’ve been in over the years and I ask them,” Zitkus said. “Nobody knows everything, so it’s a team.”

Robin Farmer is a freelance writer.


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