By Angela Thompson, DNP, FNP-C, BC-ADM, CDCES, FAANP
As a nurse practitioner (NP) in Indiana, I have seen firsthand the effects of our state’s outdated health care workforce laws ― patients suffering from preventable and chronic disease, conditions worsened by inadequate access to care. Many people in Indiana must wait weeks or months for appointments, travel a significant distance to see a provider and endure costly inefficiencies and inequities within the health care system.
As the National Conference of State Legislatures brings together policymakers from around the nation to learn from each other in Indianapolis during its annual 2023 Summit, I know our host legislators will represent Indiana well. But what I really hope for is our lawmakers will speak with their colleagues from the 27 states who have already modernized their state laws to ensure patients have full and direct access to NP care and more choice in their health care.
Hoosiers are in desperate need of increased health care access. Indiana was a shocking 35th overall in the latest United Health Foundation’s America’s Health Rankings, which cites a high prevalence of multiple chronic conditions among state residents.
Appointment wait times are a very real obstacle to accessing care in Indiana. The American Association of Nurse Practitioners recently released the results of a new national survey of U.S. adults that found more than 40% of respondents experienced a “longer than reasonable” wait for a health care appointment. According to the survey, nearly half of those who experienced unreasonable wait times gave up trying to get an appointment and did not receive care, which includes patients seeking mental health services.
Tied to appointment wait times are significant shortages in health care providers. According to the U.S. Department of Health and Human Services, there are now 100 million people living in Health Professional Shortage Areas (HPSAs). We have 138 primary care HPSAs in our state, affecting more than 2.4 million people and leaving more than 31% of the state’s health care access needs unmet.
This must change. NPs are well-positioned to help meet our growing health care challenges and improve access to timely care for patients. However, Indiana law requires NPs contract with a physician—essentially obtain a permission slip—before we can legally provide care that we are educated and board certified to provide. This outdated requirement costs the state in reduced health outcomes, diminished access to care, impaired health workforce recruitment and efficiency ― and real dollars. And it has no beneficial impact on the actual delivery of care.
More than half of U.S. states have retired this outdated requirement and taken steps to ensure patients have full and direct access to NPs. In March 2023, Utah became the 27th state to adopt this policy, called Full Practice Authority (FPA). FPA authorizes NPs to provide the care they currently delivering patients—evaluating, diagnosing, ordering and interpreting tests, initiating and managing treatments and prescribing medications—under the exclusive licensure authority of the state board of nursing and without a state-mandated contract with a physician.
It is time to follow the lead of these other states as well as the evidence — including 50 years of research— confirming the high-quality care NPs deliver to patients.
Modernization of licensure laws is a no-cost, no-delay solution for states to help solve their growing health care challenges. Research has shown states with FPA are better positioned to offer access to care, grow their health care workforce and address health care disparities while also delivering high-quality care and better outcomes for their residents.
Indiana’s legislators have much to be proud of and share with their colleagues at the NCSL Summit. My hope is that by next year, Indiana will have joined the majority of states and acted to improve health care access and efficiency by providing patients with full and direct access to NP care.
Angela Thompson, DNP, FNP-C, BC-ADM, CDCES, FAANP, is a practicing NP from Pittsboro, Indiana. She’s a board member of the American Association of Nurse Practitioners and the past president of the Coalition of Advanced Practice Nurses of Indiana.
