The pandemic has sent a clear message that artificial barriers to mobility and professional practice by nurses, doctors and other healthcare professionals are dangerous to our nation’s ability to treat and heal as many people as possible who are infected by Covid-19 — and in the next global infectious disease.
To combat the pandemic, most states issued executive emergency orders temporarily lifting restrictions on practicing across state lines, telehealth, nurse practitioner authority, and other strictures.
But if removing barriers to practice makes sense during a pandemic, it makes sense all the time. Shortages of nurses and other healthcare professionals were a crisis before the pandemic, a fact that the public is becoming aware of due to increased media coverage of the current dire situation in our hospitals. Our national population is aging rapidly, causing severe shortages of practitioners because older people require more health services and greater complexity of care, while the wave of retirements among baby boomer clinicians worsens the supply and demand imbalance. The pandemic is making shortages worse; early evidence suggests it may hasten the retirement wave, burnout, PTSD rates, and physician health issues. Reducing barriers to practice is necessary to ease the worsening healthcare challenges caused by clinician shortages.
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Removing barriers begins with removing boundaries. The Covid-19 crisis has been the most poignant demonstration that diseases don’t recognize state lines or even international boundaries. Since disease isn’t restricted by state, then people who treat diseases shouldn’t be either. The first step is for every state to join the existing licensure compacts for nursing, therapist, physicians and as others are created. Secondly, in a time of crisis the establishment of a single national license for each healthcare profession makes sense, rather than state-by-state licensure. This uniformity must be accompanied by a common set of requirements, credentials, and technology for clinical practice that can support mobility, transparency, scalability, and interoperability, while engendering trust among patients and practitioners alike.
Other regulatory barriers to practice reduce the use of telehealth, which is limited by state licensing along with various federal and state requirements and reimbursement policies that differ from in-person visits. State-by-state policies further limit the effectiveness of nurse practitioners and other advanced practice professionals by denying them the authority to practice at the full extent of their education and competency.
Some of these barriers also have been reduced on an emergency basis during the pandemic. If we have learned anything, it is that restricting practice by licensure restricts access to care and does not optimize care delivery, putting our citizens at risk.
When the current public health crisis subsides, we can’t go back to old rules that will derail the advances in patient-centered care gained during the pandemic. Now is the time to secure these advancements in professional practice by making emergency rules permanent so healthcare practitioners can help more patients and maintain high-quality care.
There’s no evidence that state-by-state licensing and other healthcare policies and practices are better for patient care than a more national approach to licensing, while there is significant evidence that unfettered utilization of telemedicine and full-practice authority for nurse practitioners could improve patient access and care quality. Barriers to practice needlessly obstruct the healing work of nurses, doctors, and other practitioners, and they also prevent optimizing the talents and expertise of an already stressed and strained clinical staff when they are needed most.
Already, some states are rolling back the pandemic emergency measures that give greater patient access to care. But there are signs of growing support for dismantling barriers to professional healthcare practice, such as the federal legislation to expand the use of telehealth, practice expansion for Advance Practice Providers, and the establishment of advocacy group Nurses Everywhere to champion issues such as nurse practitioner scope and expanded access to nursing care for patients.
Healthcare leaders need to join together to protect the gains made during the pandemic. We need a progressive remaking of healthcare practice in America, and that means we must turn the emergency measures that removed barriers to practice into permanent measures, so that patients will have the greatest possible access to quality care and create more equitable models – throughout the pandemic and into the future.
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