The Consultation and Referral Plan: Removing the Barrier to Nurse Practitioner Full Practice Authority in Utah

Full practice authority for nurse practitioners (NPs) includes the evaluation of patients, diagnosis, ordering and interpreting diagnostic tests, initiation and management of therapeutic treatments and prescribing medications. Licensure in the state of Utah is overseen by the state board of nursing. Utah NPs are limited from practicing to the full extent of their education and training by mandated consultation and referral plans (CRPs), which must be jointly developed with a physician in order to prescribe schedule II and III controlled substances. This is a barrier to practice as some physicians have been unwilling to develop a CRP with NPs that are outside their geographic area, denied CRPs to limit competition from a shared patient population, or required a fee for collaboration. States with full NP practice have similar or better health care outcomes, improved patient satisfaction and more cost effective care. Additionally, there are more NPs per capita than states with limited or restricted practice. Utah will benefit from the removal of the CRP mandate in many ways. Removing mandated CRPs will allow NPs to practice to the full extent of their training and education, and will help address the shortage of primary health care providers in the state. Independent NP practice is recommended by the Institute of Medicine (IOM), the National Governors Association (NGA) and the Federal Trade Commission (FTC). Full NP practice can increase health care access and quality of care, allow for similar or better health outcomes and similar or improved patient satisfaction compared to physician care. Mandated CRPs limit competition in the health care marketplace, decrease growth of NPs per capita, increase cost and decrease access to health care providers. To date, full NP practice has been incorporated in 21 states, including every state that surrounds Utah. Furthermore, no state that has implemented NP full practice has reversed their decision. The objectives of this project were: evaluation of the transition to NP full practice authority in other states, using Kotter's theoretical framework; development of educational materials for use in the legislative process; and dissemination of information to support the removal of the CRP mandate from the Utah Nurse Practice Act. Implementation and evaluation included: Use of Kotter's theoretical framework for change to evaluate the transition to full NP practice in other states. An educational video and legislative talking points were developed, which included FTC, NGA and IOM recommendations for NP full practice authority and comparison between NP and physician outcomes. The video and legislative talking points were distributed to UNP, NPs, NP students and legislative decision makers in Utah. Many NPs and NP students participated in the legislative process, viewed and shared the video and contacted their legislators. The dissemination of information about NP full practice and educational material about full NP practice supported a successful legislative effort in Utah, which resulted in the removal of the CRP mandate for most NPs. The CRP mandate remained for NPs in their first two years or 2000 hours of practice and NPs operating pain clinics. This important step toward full NP practice in Utah will better allow NPs to regulate their own profession, promote free trade in Utah's health care marketplace, attract health care providers to Utah. Additionally, it will increase the quality of care provided and promote cost effective health care.