Overlap of Registered Nurse and Physician Practice

Implications for US Health Care Reform

Registered nurses (RNs) who received specialized, on-the-job training and used standardized care protocols were able to administer a number of treatments, traditionally performed by physicians, without compromising patient safety or clinical outcomes.

Substituting advanced practice registered nurses (APRNs) for physicians has reduced health care costs while maintaining the quality of care. Newly designed health care delivery systems could further reduce costs by shifting activities from physicians to non-advanced RNs.

This article considers expanding the role of the RN. The authors examine potential areas of overlap in the legal framework that defines the work of physicians and RNs; review licensure requirements for physicians and RNs; cite examples, from the U.S. and abroad, of tasks traditionally performed by physicians that are now routinely performed by RNs; and, discuss how standardized procedures and regulatory changes have already expanded the traditional scope of practice for RNs.

Key Findings:

  • Categories of activities common to nursing and medical practice include physical examination, health assessments and treatments.
  • New York State changed its law so that RNs could deliver numerous services without a physician ordering a standardized protocol for a specific patient.
  • Health organizations that permit expanded RN roles, as allowed by state practice acts, may risk being out of compliance with Medicare and Medicaid.

Training RNs to perform activities traditionally within the physician’s scope of practice could potentially increase access and reduce costs, without compromising the quality of care. However, because of current RN workloads, shifting tasks from physicians to RNs will require careful planning and examination.


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