Dear Stakeholder

Dear Stakeholder:

The Nurse Practitioner Association of Maryland (NPAM) and the Maryland Academy of Advanced Practice Clinicians would like your support of our efforts to remove barriers and increase patient access to high-quality, cost-effective healthcare. The statutory requirement for nurse practitioners to submit an attestation for approval before practice was a compromise implemented in 2010 due to concerns about patient safety when repealing the burdensome written collaborative agreement. The attestation, in effect for the past 5 years, has still proven to create barriers, but no patient safety issues or complaints against NPs have arisen whatsoever.

We have introduced the Nurse Practitioner: Full Practice Authority Act of 2015 SB 723/ HB 999 that will remove the attestation requirement.

Nurse practitioners will continue to be licensed and certified by the Board of Nursing according to the current high standards. By removing the attestation requirement, nurse practitioners will be able to practice according to their education and established scope of practice without undue barriers imposed by insurance companies, other healthcare providers, and facilities. Examples of these barriers include

• insurance companies delaying or prohibiting the nurse practitioner to be a credentialed provider because the attestation-named physician is not credentialed with the company
• nurse practitioners having difficulty finding physicians in his or her area willing to be named on the attestation
• undue cost for the nurse practitioner to secure an attestation arrangement with a physician
• practice suddenly being suspended when an attestation-named physician leaves a job

Overwhelming evidence shows that nurse practitioners improve patient health in every state that allows them to practice at the full extent of their training. Patient safety is exactly the reason health experts at the Institute of Medicine[1], the National Governors Association[2], the Federal Trade Commission[3]and many others support full practice authority for nurse practitioners.

In Maryland, part of the 2010 legislation codified the scope of practice for nurse practitioners defining the practice of a nurse practitioner as “independently performing the duties of a registered nurse; conducting comprehensive physical assessments; establishing a medical diagnosis for common chronic, stable, or short-term health problems; ordering, performing, and interpreting laboratory tests; prescribing drugs; performing diagnostic, therapeutic, or corrective measures; making referrals; and providing emergency care.”[4] This effort ensures that all nurse practitioners and the State Board of Nursing are aware of the standards for licensure and certification and are applied consistently across the state.

At the time of that legislation, there were approximately 3,200 certified nurse practitioners in the State which has grown by about 1000 nurse practitioners over the past 5 years, allowing more qualified practitioners to move to Maryland to treat patients and serve the needs of the patient population in one of the fastest growing professions.

Please consider supporting SB 723/ HB 999 The Nurse Practitioner Full Practice Authority Act of 2015. If you would like to discuss this issue further, please feel free to contact me directly. Thank you for your consideration.

Sincerely,

[1] The Future of Nursing – Focus on Scope of Practice, The Institute of Medicine (October 2010),

[2]Nurse Practitioners Have Potential to Improve Access to Primary Care, National Governors Association (Dec. 20, 2012),

[3] Koslov, Tara Isa, The doctor (or nurse practitioner) will see you now: Competition and the regulation of advance practice nurses, Federal Trade Association (Mar. 7, 2014),

[4] Md. Code. Health Occs. §8-101(e)-(f) (LexisNexis 2013).