Nurses Wonder: When is Enough, Enough?



Ad Nauseum is a Latin term describing something that has continued “to the point of nausea.” Merriam-Webster defines it as “to a sickening or excessive degree.” Ad Nauseum, then, holds the distinction of being the perfect word to describe the current status of research demonstrating the safety and efficacy of Advanced Practice Registered Nurses (APRNs).

As one nurse put it, “we may be the most studied profession out there. You certainly don’t see dentists being required to justify their practice through hundreds upon hundreds of studies over the course of decades before they are allowed to practice to fullest extent of their license.”

It’s been six years since the National Academy of Medicine concluded in its groundbreaking “Future of Nursing” report that “the contention that APRNs are less able than physicians to deliver care that is safe, effective, and efficient is not supported by the decades of research that has examined this question.” The Institute backed this up with mountains of peer-reviewed scientific evidence.

Since then, the evidence has continued to pour in. Kleiner, Park, and Wing found in 2014 that “more restrictive state licensing practices [for APRNs] increase the costs of medical care… and do not appear to influence health care quality….” Xue, Ye, Brewer, and Spetz found in a systematic literature review that “removing restrictions on NP scope of practice regulations could be a viable and effective strategy to increase primary care capacity.” Kurtzman et al concluded in 2017 that “[Nurse practitioner, ‘NP’] care is comparable to physician care in most ways and…the quality of NP-delivered care does not significantly vary by states’ NP independence status.”

These studies are just a smattering of scores of research published since the National Academy of Medicine, on the basis of decades of research, concluded without stipulation that APRNs practice just as safely, effectively, and efficiently as physicians.

And yet, 28 states still do not allow APRNs to practice to the full scope of their training and education. The VA recently allowed APRNs full practice authority, but excluded nurse anesthetists.

This is not for lack of effort. Nurses, consumers, patients, and advocacy groups have collaborated in various ways to ask legislators in the 28 states to allow full APRN practice in the interest of achieving the “triple aim” of improving patient outcomes, population health, and per capita cost. The Robert Wood Johnson Foundation, AARP, the FTC, the National Governors Association, and many other influential voices have also weighed in on the side of granting full practice authority to APRNs in all US states.

In many cases, these efforts have been thwarted by legislators and others who demand more evidence. But when decades of research ad nauseum clearly demonstrate the safety and efficacy of full APRN practice, many patients and nurses find themselves wondering: when is enough, enough?