Las Vegas – Regulatory practices requiring unnecessary physician oversight for services that nurse practitioners (NPs) are educated, credentialed and competent to provide unfairly limit NP scope of practice and may jeopardize patient safety and health outcomes, according to a researcher at the American Association of Nurse Practitioners 2013 National Conference.

“NP practice regulation has evolved in an arbitrary manner with wide variations and has resulted in a unique situation in which another profession governs another proven professional group,” Bobby Lowery, PhD, MN, FNP-BC, of East Carolina University School of Nursing in Greenville, N.C., said during a poster session.

NP regulation is deeply embedded in the economics and political processes of healthcare, and although NP regulation is well documented in the literature, no studies have examined the impact of physician oversight on patient care and NP perceptions of job satisfaction, autonomy and mobility.

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To address these questions Lowery surveyed a randomly selected sample of NPs from 24 states to determine how NPs felt about these issues, and whether NP perceptions differed on the impact of physician oversight based on rankings of state regulatory environment (SRE), type of regulation, NP experience and type of physician oversight required.

The 34-question, mixed-mode survey consisted of multiple choice, Likert scales and open-ended questions and was sent to 24,000 NPs enrolled in the Fitzgerald Health Associates Database. A total of 12,000 respondents were included in the final analysis.

In regard to patient care, the majority of NPs indicated physician oversight reduces consumer access to NP care (76%), does not improve patient or public safety (71% and 74.2%, respectively) or safe medication management (71.6%).

In terms of NP practice, the majority of NPs indicated physician oversight constrains direct reimbursement for NP care (89.8%), reduces NP autonomy (86.4%), discourages NPs from owning their own practice (85.6%) and lowers NP job satisfaction (74.5%). When it comes to promoting safety, 60.9% of NPs said physician oversight has no effect on their practice.

Furthermore, a substantial majority believe physician oversight hinders provider-patient communications (81%), creates provider-patient confusion (74.5%), increases the overall cost of healthcare (70.7%) and specifically the cost for patients who seek care from NPs (69.7%).

“Understanding the impact of regulatory requirements for physician oversight on NP practice has implications for nurse educators, policy leaders, regulators and legislators,” Lowery concluded. “Nursing leadership is required in this important policy discussion.”


  1. Lowery B. Poster #209. “Nurse Practitioner Perceptions Regarding the Impact of Regulatory Requirements for Physician Oversight on Nurse Practitioner Practice.” Presented at: American Association of Nurse Practitioners 2013 National Conference. June 19-23, 2013; Las Vegas.