Tennessee should remove nurse regulations to better health care and lower costs | Opinion
As nurses, we are compelled to speak out when the self-interests of one professional group trump the interests and well-being of Tennesseans. What if we told you there is a way to improve access to primary care and other needed health services and generate significant cost savings in Tennessee? The answer lies in allowing the state’s Advanced Practice Registered Nurses, APRN, to practice at the top of their licenses.
These APRNs include nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and clinical nurse specialists, health care professionals many Tennesseans prefer to see for their needed health care. Yet, our current restrictive laws bind APRN practice to physician collaborators, many of whom charge exorbitant oversight fees and may not desire to work in the communities that need health care services the most.
As one of the nation's 11 most restrictive states, Tennessee is missing an opportunity to provide needed health services in a state with poor health outcomes−ranked 44th out of 50 states−and garner significant economic benefits, all without a cost to the state.
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How less restrictions can benefit Tennessee
An economic impact analysis published by a physician health services researcher, a health care economist, and the two of us forecasted substantial job and economic gains at the state and local levels associated with allowing Tennessee’s APRNs to practice without unnecessary and outdated restrictions.
According to our economic impact study, the projected financial increases would have amassed an added $3.2 billion for Tennessee's economy over eight years (2017 to 2025). When adding the current economic impact of APRNs to the tally, the result exceeds $8.6 billion, demonstrating the APRN workforce's vast contribution to the state's economy.
Admittedly, the 2019 Tennessee-based study included the effects of Medicaid expansion, which the state has failed to enact. However, even with the impact of Medicaid expansion removed from these projections, the economic gains remained substantial at more than $1 billion.
A portion of these projected economic gains stems from increased employment. The economic impact study found that Tennessee would gain over 25,000 jobs from the direct, indirect, and induced effects of unrestricted APRN practice over the eight-year study period. The induced impacts are related to the multiplier or ripple consequences of gains in one sector resulting in spillover gains in other economic sectors.
Some may argue that these are only projections. Still, similar Texas, North Carolina, and Florida studies found comparable robust effects on their economies and labor markets. Furthermore, another study by University of Tennessee health services researchers in 2022 found significant correlations between Tennessee communities' economic health and mortality rates, pointing to additional expected health improvements from increased APRN workforce and economic activity across the state.
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Primary care shortages and high costs are also alleviated
While economic gains from easing APRN practice restrictions are substantial, the resultant improvements in primary care access and robust system-wide cost savings are more compelling.
Tennessee is home to more than two dozen primary care shortage areas. APRNs are more likely to work with underserved patients when not tethered to physician practices and could meet these shortfalls if allowed to practice to the full extent of their education and credentialing. Improved access to primary care reduces hospitalizations (by treating health problems before they warrant higher levels of care). It also results in a healthier workforce, adding to the state's productivity and economic development, especially in the underserved areas suffering from economic instability and poor health.
It is hard to justify Tennessee's current APRN practice restrictions when you add these projected economic and job gains to the robust evidence of cost-effective, high-quality APRN-provided care, improved access, and patient satisfaction. It is even harder to defend not better utilizing Tennessee's APRNs to strengthen the state’s health and health care while generating significant economic benefits.
It's time to promote the interests of all Tennesseans over professional self-interests by removing unnecessary and outdated regulations that constrain competition and limit Tennessean’s health care choices.
Contact our state leaders and encourage them to take legislative action to remove APRN practice restrictions, as legislators in more than half of the states and U.S. territories have already done. Tennesseans will gain better access to needed health care services without increasing state expenditures (while improving health and supporting economic development across the state).
Tracey Stansberry, PhD, APRN, AOCN, Lecturer at the University of Tennessee College of Nursing and Health Services Researcher.
Carole R. Myers, PhD, RN, Professor Emerita at the University of Tennessee College of Nursing
This article originally appeared on Nashville Tennessean: Removing nurse regulations would benefit Tennessee's health care system
