Allowing Michigan nurse practitioners to have full practice authority could improve access to care in rural areas, MNA says


Shane Ersland


Supporters of legislation that would allow Michigan nurse practitioners to practice without physician supervision say it would improve access to care, particularly in rural areas.


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In April, Sen. Jeff Irwin (D – Ann Arbor) introduced Senate Bill 279, which would remove the state mandate for nurse practitioners to contract with a supervising physician in order to serve patients. It remains under consideration in the Senate.

Michigan Nurses Association (MNA) board member Jeremy Lapham, a family nurse practitioner from Ann Arbor, said the mandate can be a burden for nurse practitioners during their workdays, and can cut into time they would otherwise spend with patients.

“The current mandate requiring nurse practitioners to contract with a supervising physician can affect their workdays in several ways. This requirement can lead to increased administrative tasks, such as seeking approval for treatment plans and obtaining physician signatures on specific documents.”

— Jeremy Lapham, board member, MNA

The constraint can lead to less efficient healthcare delivery, longer wait times for patients, and increased costs for both patients and the healthcare system as a whole, Lapham said.

“In contrast, when nurse practitioners have full practice authority, they can make timely decisions and focus on patients’ needs,” he said. “Studies have shown that nurse practitioners with full practice authority deliver care that is comparable to physicians, in terms of patient outcomes, safety, and satisfaction.” 

MNA is confident in the ability of nurse practitioners to serve patients autonomously, given their extensive education, training, and clinical experience, Lapham said.

“Nurse practitioners typically hold a master’s or doctoral degree in nursing, with specialized training in primary care, acute care, or a specific patient population,” he said. “Additionally, they must pass a national certification examination to become licensed.”

Nurse practitioners have shown the capacity to diagnose, treat, and manage a range of health conditions, prescribe medications, and order diagnostic tests in states with full practice authority, Lapham said.

“By allowing nurse practitioners to practice autonomously, Michigan can foster an environment in which they can utilize their full range of skills and expertise, ultimately improving healthcare delivery and patient outcomes. This will also make Michigan more attractive to current and future nurse practitioners.”

— Lapham

SB 279 would help alleviate healthcare provider shortages, Lapham said.

“The passage of SB 279, which grants full practice authority to nurse practitioners, could significantly help increase access to care in Michigan,” he said. “By removing barriers to autonomous practice, this legislation would enable nurse practitioners to work at the top of their licensure and expand their reach in serving communities with limited access to healthcare services.”

Studies have shown that nurse practitioners can play a crucial role in addressing health provider shortages, as they are often more likely to work in primary care settings and underserved areas compared to physicians, Lapham said.

“Ultimately, granting full practice authority to nurse practitioners would contribute to a more robust and resilient healthcare system in Michigan, capable of meeting the diverse needs of its residents and addressing the disparities in access to care,” he said.

Removing the mandate has the potential to significantly improve access to care in rural areas, Lapham said.

“Rural communities often face healthcare provider shortages and limited access to primary care services due to geographical barriers, financial constraints, and an aging population. By granting nurse practitioners full practice authority, they can more effectively serve rural communities, which often struggle to attract and retain physicians.”

— Lapham

Nurse practitioners are known for their strong focus on primary care, patient education, and preventive services, which are all crucial in addressing the healthcare needs of rural populations, Lapham said.

“Moreover, with increased autonomy, nurse practitioners can collaborate with other healthcare providers to create comprehensive, patient-centered care networks,” he said. “This can lead to more accessible, cost-effective, and high-quality care for residents in rural areas, thereby helping to bridge the gap in access to healthcare services, and improve overall community health outcomes.”