The Impact of Scope of Practice
Currently, regulation and licensure of health professionals—nurses, physicians, pharmacists, and others—falls to the states. State laws and regulations define legal scopes of practice for health professions. The existing regulatory structures cannot easily accommodate workforce innovations needed for health reform. Existing state-based laws and regulations limit both the effective and efficient use of the health workforce by creating mismatches between professional competence (ie, what a health professional is trained and competent to do) and legal scope of practice (ie, what a health professional is legally allowed to do in a given state). Further, most state-based health professions regulatory approaches lack the flexibility to support overlap in scopes of practice among professions working collaboratively in team-based models of care. Research has found that such shared responsibility among health care team members can improve the efficiency and accessibility of health care services. While protection of the public through mindful regulations is a critically important objective, state regulatory processes and policies may result in overly restrictive or proscriptive practice standards that can impede delivery of care, increase the cost of services, and fail to fully use the abilities of the available health workforce.
Many states are considering modifications to scope of practice for a variety of health workers to safely expand roles and functions. Examples of scope of practice modifications include allowing pharmacists to provide immunizations, or permitting dental hygienists to provide prophylactic oral health services in public health settings without direct supervision by a dentist. These changes improve access to health services by enabling health care delivery in a broad array of community settings by a variety of health professionals, some of whom have overlapping competencies, while still preserving the safety of the patient.