National NP, midwifery, and PA organizations have developed documents and policies that establish criteria by which professionals are credentialed, criteria which are adopted by state boards and other regulatory bodies to monitor and regulate clinical practice, deem it safe or unsafe, and discipline clinicians. Such documents and policies include:

  • philosophies of practice;
  • codes of ethics;
  • standards of practice;
  • competencies for entry into practice and excellence; and
  • practice guidelines and policies such as institutional privileging and collaborative practice agreements.

Similarly, accrediting bodies develop mechanisms to accredit educational programs and certifying bodies establish programs for professionals to obtain and maintain certification.

Organizations representing NPs, midwives, and PAs have established a number of essential documents, policies, and mechanisms to assure clinical competence, safety, and quality care.

Academic programs use these standards and competencies as the basis for curriculum development and program accreditation, and to prepare graduates for certification. Most national organizations also have state chapters and practice committees that play an important role in the implementation, review, and revision of regulatory and credentialing documents. Because professional regulation is implemented at the state level through licensing boards and legislative action, members of state practice organizations and committees must provide essential formal and informal expertise to these boards and agencies.

For more information on these professional organizations and their functions, see “Practice Essentials” which provides links to resources from professional organizations, accreditation, and credentialing bodies.

How Individual Practitioners Can Participate in Scope of Practice Determinations

Participation in our professional organizations is a responsibility for all health professionals. If the professions fail to provide leadership in developing, maintaining, and advancing professional standards and responsibilities, then licensing boards and legislatures will take the lead.

Given the great number of bills proposed in state legislatures each year, state or national professional associations are better positioned than individuals to gather and monitor this range of information. To be privy to this information and play a role in what is happening legislatively, individuals need to affiliate themselves with a professional organization active at the state level. Individuals and associations must remember that “early and often” contact with legislators is preferable to an “only in a crisis” approach. That is, practitioners–individually and through their state professional organizations–need to continuously educate legislators about the value of their services. They must also emphasize that their patients and the public (the legislators’ constituents/voters) are best served by laws that promote the fullest utilization of providers’ ever-evolving clinical abilities.

What Professional Organizations Do for Individual Practitioners

Although the essential practice documents of each professional role are developed at the national level, each of the professional organizations has regional or state chapters or affiliates. The constituent and state nurses associations (C/SNAs) affiliated with the American Nurses Association can be found here. They provide a variety of services to members, including lobbying at the state legislature and representing the profession before government agencies. C/SNAs also review and implement standards of practice and education, and in many states provide collective bargaining services. They encompass an active community of peers that can effect change and respond to challenges in politics, practice, and labor as well as advocate for nursing and quality health care.

“Do the Math!” Because NPs, midwives, and PAs represent a small fraction of the total health workforce (and registered nurses are the largest single cadre of health professionals) it is important to work with state nursing organizations. These state nursing organizations generally have experienced government relations committees and lobbyists who are knowledgeable about practice laws and regulations, and they maintain formal relationships with medical and nursing regulatory boards on behalf of their profession. State PA chapters contribute to collaborative advocacy efforts by working with state medical and nursing organizations.

Similarly, support, leadership and community at the state level is provided by the organizations that represent NPs, PAs, and midwives:

  • American Association of Nurse Practitioners (AANP) is organized into regions, each comprised of states in their geographic area.
  • American College of Nurse-Midwives (ACNM) works at the state and local level through a network of affiliates.
  • American Academy of Physician Assistants (AAPA) is organized into constituent chapters–based within five regions (for state chapters) and five federal service areas.

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