The practice boundaries of advanced practice nurses: an economic and legal analysis

The purpose of this study is to examine the causes and effects of State regulation that determines the extent of professional independence of advanced practice nurses (APNs). We analyze determinants of these regulations in panel data across States. We find that in States where APNs have acquired a substantial amount of professional independence, the earnings of APNs are substantially lower, and those of physicians' assistants are substantially higher, than in other States. These results are striking since physicians' assistants are in direct competition with APNs; the only real operational difference between these groups is that physicians' assistants are salaried employees who must work under the supervision of a physician. The implication is that physicians have responded to an increase in professional independence of APNs by hiring fewer APNs and more physicians' assistants.

The Practice Boundaries of Advanced Practice Nurses: An Economic and Legal Analysis

The purpose of this study is to examine the effects of State regulation that determines the extent of professional independence of advanced practice nurses (APNs). We find that in States where APNs have acquired a substantial amount of professional independence, the earnings of APNs are substantially lower, and those of physicians’ assistants (PAs) are substantially higher, than in other States. These results are striking since PAs are in direct competition with APNs; the only real operational difference between these groups is that PAs are salaried employees who must work under the supervision of a physician. The implication is that physicians have responded to an increase in professional independence of APNs by hiring fewer APNs and more PAs. The finding that earnings of APNs decline when they attain more professional autonomy vis-à-vis physicians reinforces work by Sass and Nichols on physical therapists. Copyright Springer 2005regulation, professions, nursing, panel data,

Treating Cancer Pain

To the Editor: The truth often hurts. Being a medical oncologist, I had pain that reached a score of 10 on reading the article by Cleeland and colleagues (March 3 issue)1 on the inadequate management of pain in outpatients with cancer. Like many medical oncologists, I find myself staying busy just fighting pain, and I take pride in the superb level of pain control achieved in most of my inpatients and hospice patients. However, the management of pain in outpatients with cancer remains challenging for several reasons. First, inadequate tools alone cannot be blamed for poor assessment of pain as