Sunday December 17th 2017

White House report on occupational licensing

Lisa Summers

Nursing, as a health profession that poses a risk of harm to the public if practiced by someone unprepared or incompetent, has long been regulated. It is widely accepted that nurses, along with physicians, attorneys and pilots, should hold a license to practice and that licensing boards should enforce minimal qualifications and standards.

There has, however, been an explosion in the number of professions being regulated. It is estimated that as many as 1,100 professions are regulated in at least one state (although fewer than 60 are regulated in all 50 states), and today, one-quarter of workers in the United States must have a state license to do their jobs — a fivefold increase since the 1950s.

These are among the key points in the recent White House report, “Occupational Licensing: A Framework for Policymakers,” which explores the rise in occupational licensing, describes its consequences and proposes best practices for policymakers.

The American Nurses Association has prepared a summary of the report to inform our members — particularly APRNs — of its resources for policymakers, research appendix (which includes some studies of nursing) and best practices proposed as licensing reforms.

While acknowledging that the regulation of workers can benefit consumers, the report suggests that too often policymakers do not carefully weigh the costs and benefits of licensing, and the resulting patchwork of different decisions and requirements is problematic. APRNs, who have been working to standardize licensing through the Consensus Model for APRN Regulation, are all too familiar with the implications of that patchwork. While the report does not reference the Consensus Model, it does cite the National Council of State Boards of Nursing and the Nurse Licensure Compact as early examples of a profession responding to concerns about accountability across state lines.

The report addresses restrictions on scope of practice, acknowledging that they can have effects similar to the overall impact of licensing — limiting the supply of labor, restricting competition and increasing the cost of services. Scope of practice laws “are a particular source of tension among groups of professions that provide complementary and sometimes overlapping or competing services, such as dentists and dental hygienists, doctors and advanced practice nurses.” Also, the Institute of Medicine’s report on the Future of Nursing and a number of studies are cited as evidence that easing restrictions on APRNs “represents a viable means of increasing access to certain primary care services.”

Perhaps the most important section is the one on licensing reforms, which enumerates issues policymakers “should take into consideration in order to ensure that occupational regulation serves the public interest” and “outlines some promising efforts to improve our system of licensing, and describes several federal initiatives to promote licensing reform.” The report repeatedly notes that licensing falls under the purview of states, but notes that “the federal government can help to facilitate state reforms by providing information and resources to states.”

There are several best practices and potential reforms within the report that APRNs should note:

• “Ensure that Licensing Restrictions are closely targeted to protecting public health and safety, and are not overly broad or burdensome.”

• “Allow licensed professionals to provide services to the full extent of their current competency.”

• States facing sunset and sunrise reviews will want to review the pros and cons presented regarding those processes.

A conservative think tank has called occupational licensing reform “one of a few key issues with the potential to unite Americans across the political spectrum — whether progressive, conservative, or libertarian.” And in preparing the report, the White House sought input from experts covering the political spectrum. ANA is working with its constituent and state nurses associations to monitor the response to the report and consider how we might leverage policy discussions to achieve our goal of lifting regulatory barriers to APRN practice.

— Lisa Summers is the senior policy fellow in Health Policy at ANA.

Resources

Read ANA’s White House report summary and a listing of organizations that have issued reports or policy papers addressing full utilization of APRNs, on the APRN section of www.nursingworld.org.

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