Expanding Roles of Health Workers to Meet Patient Needs

The Impact of Scope of Practice

In the US, states are primarily responsible for regulating health professions, with the goal of patient safety. State laws and regulations define legal scopes of practice—or allowable activities—for specific professions. State-specific health professions regulation has significant impacts on the delivery of health care services. Existing state-based laws and regulations can, at times, 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). Overly restrictive scopes of practice can limit access to needed services, increase the cost of services, or fail to fully deploy the available health workforce. Further, in many states, health professions regulation often lacks the flexibility to support overlap in scopes of practice among multiple professions working collaboratively in team-based models of care.

Strategies to strengthen scope of practice decision-making include:

  • Assuring that legal scope of practice closely aligns with professional competence
  • Supporting regulatory flexibility to accommodate new and emerging health workforce roles and scope overlap
  • Using the best available evidence to authorize new professions or expand scope of practice for existing professions that are proven to be safe and effective

Examples of progressive scope of practice modifications include giving nurse practitioners prescriptive authority and permitting dental hygienists to provide prophylactic oral health services in public health settings without direct supervision by a dentist.