Nurse practitioners play a critical role in healthcare. States should get out of their way.
As a nurse in rural Colorado after World War II, Loretta Ford described herself as a lone ranger. “Whatever went on in health, I was called,” she said. “I took care of it.”
Ms. Ford, who died in January at the age of 104, co-founded America’s first nurse practitioner program. She believed that nurses were more than doctors’ helpers: They were decision-makers capable of treating patients.
In one speech, she recounted how physicians had rigid ideas about the line between nursing and medicine—that it was okay for a nurse to use a stethoscope while taking blood pressure, “but if she moved that stethoscope eight inches, oh, that was medicine.” “I used that stethoscope in lots of places at 3 a.m. I could never figure out who they thought was making all these decisions.”
Today, there are almost 400,000 nurse practitioners in the United States. Thanks to Loretta Ford’s pioneering program, nurse practitioners in many states now diagnose and treat patients independently without physician supervision. Not in California, however. Until 2020, nurse practitioners couldn’t practice in California unless they were operating under a collaboration or supervision agreement with a physician. Although this might sound reasonable, in practice, the arrangement is a lucrative handout to physicians: They get to cash checks and restrict competition. The physicians typically have little or no involvement in medical decisions for the nurse practitioners’ patients.
This is a real problem. There’s a severe healthcare shortage in California. In San Diego County alone, for example, a third of residents live in an area without adequate primary care. To its credit, the California Legislature passed (and Governor Newsom signed) legislation addressing the shortage. It created two pathways for nurse practitioners to practice independently.
But that’s when the bureaucracy kicked in. The California Nursing Board promulgated regulations that require nurse practitioners to practice in a group setting (like a hospital) for three years under the supervision of a physician before they can apply for certification to practice independently. That may be fine for someone new to the profession, but what about nurse practitioners who have been treating patients for decades?
Two nurse practitioners, Kerstin Helgason and Jamie Sorenson, are now suing the regulatory board. They have been treating patients in California—with physician supervision—for decades. The new regulations would require them to complete at least 4,600 “transition to practice” hours in a group setting before they can work independently. That would mean abandoning their practice (and patients) to find work in a hospital or other group setting—which is not what the California Legislature intended when it passed the bill. (Legislators wanted to support the most qualified nurse practitioners, not run them out of business.)
“I’m fully licensed in Montana,” Jamie told Pacific Legal Foundation, which is representing her and Kerstin in the lawsuit. “If I went there tomorrow, I could just start my own practice, no restrictions, no supervising physicians. As is true for the majority of the states.” But not so in California, which has significant healthcare provider shortages.
These restrictions make even less sense when you consider how desperately America needs healthcare providers right now. In 2023, the American Association of Colleges of Nursing reported that U.S. nursing schools turned away 65,766 qualified applicants because of a nursing faculty shortage. Hostile laws and regulations aren’t helping to keep good nurses working or train future nurses.
Meanwhile, when nurse practitioners are confronted with emergency health situations, they consistently prove they are capable of treating patients independently and effectively. A Florida nurse practitioner saved a six-month-old baby having a seizure on an American Airlines flight in 2017. Another nurse practitioner saved a blue-faced and unresponsive passenger on a Jet Blue flight in 2023. Two more nurse practitioners helped a passenger having stroke symptoms mid-flight in 2024.
“We’re trained to do that anywhere, whether it’s on the ground or 30,000 feet in the air,” one of the nurse practitioners heroes explained. “It’s kind of an innate behavior and action that we’re really used to doing. We’ve done it for our entire careers.” That’s just as Lorretta Ford believed.
