Dental hygienists scored a major judicial win in late February that could have positive implications for another group of health professionals: advanced practice registered nurses (APRNs).
The U.S. Supreme Court ruled that a North Carolina dental board violated federal law when it barred dental hygienists and other non-dentists from performing teeth-whitening procedures. The ruling could strengthen the position of APRNs in their efforts to practice to the full extent of their education and training, national nursing organizations say. That, they add, could increase consumer access to high-quality, affordable health care.
The ruling will help limit “unnecessary, anticompetitive restrictions that impede access to care, increase costs, and exacerbate delays” as well as improve transparency, the American Association of Nurse Practitioners (AANP) wrote in a statement in response to the ruling.
The case was a challenge to an order from the North Carolina Board of Dental Examiners—a group comprised of dentists—that said non-dentists in the state must stop offering teeth-whitening services. The Federal Trade Commission (FTC) argued that the board’s actions violated federal trade law by restricting competition from non-dentists, who offer the services at lower rates than dentists. But the dental board argued that it was immune from federal trade laws because it was acting as a state agency.
The Fourth Circuit Court of Appeals, in Richmond, Va., heard the case and sided with the FTC in 2013. On Wednesday, Feb. 25, the U.S. Supreme Court upheld the appellate court’s ruling, with Justice Anthony Kennedy writing the majority (6-3) opinion.
Case Divides Health Care Professionals
The case—North Carolina State Board of Dental Examiners v. Federal Trade Commission—divided the health care community, with groups like the American Dental Association and the American Medical Association (AMA) backing the dental board, and nursing and other groups siding with the FTC.
In August, 2014, the American Association of Nurse Anesthetists (AANA) filed a friend of the court brief in support of the FTC position and the AANP, American Nurses Association, American College of Nurse Midwives, National Association of Clinical Nurse Specialists, and other nursing groups signed on. The organizations “had a strong interest in this case because unnecessary restrictions on the practice of any qualified health care provider limit patient access to quality care, may increase cost, and can compromise the quality of health care delivery,” AANA President Sharon Pearce, CRNA, MSN, said in a statement after the ruling came down.
The Institute of Medicine (IOM) reached a similar conclusion in its landmark 2010 report on the future of nursing when it called for an overhaul of the nursing profession, including the removal of scope-of-practice barriers on APRNs in order to improve health and health care. “To ensure that all Americans have access to needed health care services and that nurses’ unique contributions to the health care team are maximized, federal and state actions are required to update and standardize scope-of-practice regulations to take advantage of the full capacity and education of APRNs,” the report states.
The AMA disagreed with the Supreme Court ruling. The “decision will ‘spawn confusion’ by creating far-reaching effects on the jurisdiction of states to regulate medicine and protect patient safety,” AMA President Robert Wah, MD, said.
Nursing organizations are considering how the new ruling may affect state regulations pertaining to the scope-of-practice of nurse practitioners and other APRNs.
But the benefits to consumers are clear, according to Winifred Quinn, PhD, MA, director of advocacy and consumer affairs at the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation (RWJF) that is coordinating a national Campaign to transform nursing to improve health and health care. The ruling is “a win for consumers” because it may help remove obstacles that prevent highly qualified providers, including APRNs, from providing the high-quality care they need, she said.