In 2020, New York State Nurse Practitioners (NPs) have once again petitioned lawmakers to loosen the restrictions that currently exist on their ability to practice independently from physicians in NY.
In New York, NP licenses are treated differently depending upon where the NP is employed and seeing patients. NPs in a hospital or other Article 28 facility are regularly employed by physician practices to round on their patients, and may diagnose, refer, prescribe, and write orders.
NPs seeing patients in an outpatient office or clinic setting are not granted as much independence. For example, in the first 3600 hours of hands on work and 36 months of their careers, they must be directly supervised by a physician. Thereafter, New York NPs can be employed by physicians in their practices, where the physicians remain ultimately responsible for the overall care of the patient; or they may open their own offices and see their own patients, but they still must collaborate with one or more physicians. Collaboration is envisioned as including, for example, an agreement to communicate, albeit from a distance, to answer questions, discuss problems, and address care issues that arise in their population of patients.
Full practice independence has long eluded NPs in New York. The requirements on NPs in New York formerly required that an NP opening their own practice had to enter into a written practice agreement with a physician, which was viewed by many NPs as just a continuation of a supervisory arrangement. But in 2014, the Nurse Practitioners Modernization Act of NY was passed. Although scheduled to sunset in June, 2021, it ushered in the new compromise of the less restrictive collaboration relationship between an experienced NP and one or more physicians noted above.
In March, 2020, NY once again moved toward greater NP independence, when it temporarily relaxed some of its requirements on NPs practicing during the COVID-19 healthcare crisis, particularly for home care patients. The relaxed requirements are also set to expire, however, in November, 2020.
The issue must therefore be taken up again within the next few months. The new proposal would, for example, retain the current initial supervisory period of 3600 hours and 36 months, but would allow the replacement of a supervisory physician with a supervisory nurse practitioner.
Physicians groups have consistently objected to NPs practicing completely independently from any physician guidance or input, arguing that NPs have not been to medical school and are not physicians. Under New York law, only physician licenses are defined as permitting, "the practice of medicine." NPs have consistently pointed to the valuable contributions they supply to a highly stressed health care marketplace. Both sides seek data to support their positions.
Currently, New York requires a mandatory collaboration relationship between a NP and a MD.