Facing Workforce Shortages, States Expand Authority of Health Professionals

Facing Workforce Shortages, States Expand Authority of Health Professionals

Scope of practice changes can allow more providers to offer a wider range of care, especially in underserved areas.

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Last year, several states modified the practice authority for behavioral health workers and others, including nurse-midwives, registered nurses, dental hygienists and physician assistants.

The nationwide shortage of health care workers poses a challenge for states as demand for services increases. Expanding the authority of nonphysician health care practitioners is one of many strategies that states might use to address health workforce shortages.

The types of services health practitioners are allowed to provide are described in states' scope of practice laws, which also cover supervision requirements; authority to administer vaccines and/or prescribe medications; and other authorized roles and responsibilities.

At least 27 states enacted more than 50 bills in 2023 regarding health practitioners' scope of practice, largely addressing practice and prescriptive authority.

Practice Authority: Services and Supervision

During 2023 legislative sessions, at least five states modified the practice authority for nurse-midwives, registered nurses, behavioral health workers, dental hygienists, dental therapists and physician assistants.

New Hampshire modified the services that alcohol and other substance use professionals may perform if they meet certain education requirements. The state also expanded the types of services that optometrists may provide. North Carolina developed certification standards and requirements for addiction counselors and other behavioral health practitioners. Washington state created a program to increase the trained behavioral health workforce by allowing providers credentialed in other states to practice in Washington if they meet certain standards.

Other states have modified the supervision requirements for certain practitioners. California allowed certified nurse-midwives, under a collaborative agreement with a physician, to provide more childbirth services, such as attending to patients with previous cesarean sections and managing common gynecologic conditions independently. Illinois amended an existing law to allow physician assistants to continue providing care after a written collaborative agreement with a physician ends. In Maine and Oklahoma, dental hygienists and therapists may perform certain activities-such as administering local anesthesia and prescribing, dispensing or administering fluoride and mouth-rinsing antimicrobial solutions-upon completing special training.

Prescriptive Authority: Medications and Telehealth Prescribing

In 2023, at least 15 states enacted legislation to authorize certain practitioners to administer vaccines and/or prescribe medications, with required training. For example, some states and territories-including Oklahoma and Puerto Rico-allowed pharmacists to administer medications and vaccines after completing certain training programs approved by the Accreditation Council for Pharmacy Education. Michigan allowed pharmacists to order and administer vaccines to individuals 3 and older without physician supervision. Vermont and Georgia allowed pharmacy technicians to administer vaccines to individuals under certain conditions if they meet specific certification, training and education requirement approved by the accreditation council. Arkansas authorized pharmacists to provide patients with HIV pre-exposure prophylaxis and postexposure prophylaxis. Rhode Island allowed pharmacists, and Indiana and Vermont allowed both pharmacists and pharmacy technicians, to prescribe and dispense self-administered, FDA-approved hormonal contraceptives if they receive training on contraceptive counseling.

Wisconsin gave more prescriptive authority to nurse practitioners and physician assistants. Illinois and Iowa granted prescriptive authority to nurse practitioners and physician assistants, respectively, for certain regimens.

Some states also modified practitioners' authority to prescribe medications via telehealth. New Hampshire expanded authority for physicians and other practitioners to prescribe via telehealth nonopioid and opioid-controlled drugs classified in Schedules II through IV of the Drug Enforcement Administration's drug scheduling system.

Emerging Professions in Scope of Practice Legislation

States may use allied health professionals to extend the reach of existing health providers by establishing boards or task forces to study, implement statutory changes or regulate certain professions, and by updating regulations to extend the reach of these occupations.

Tennessee created a medical services board with duties that include establishing standards for the activities and operation of emergency medical and ambulance services. Similarly, Louisiana created a workforce board to develop regulations and track employment trends for community health workers throughout the state.

California and Maine called for the development of community paramedicine programs and the adjustment of licensing requirements under certain circumstances, respectively. Community paramedicine may expand the coverage area of health care services, especially in rural and underserved areas, and can reduce rehospitalization and increase health literacy.

To increase access to respiratory services, Hawaii now allows respiratory therapists to practice under physician assistants and advanced practice registered nurses.

In addition to formalizing standards for allied health professionals, more states are focusing on how to use health professionals' education and training to bridge gaps in health care access in wake of nationwide shortages in the health care workforce. Scope of practice changes can allow more providers to offer a wider range of services and care, especially in underserved areas.

For up-to-date information on scope of practice legislation across the 50 states, territories and Washington, D.C., please visit NCSL's Scope of Practice legislative database.

For other health workforce policy trends, please visit NCSL's Health Care Workforce Resources.

Razan Badr is a policy analyst with NCSL's Health Program.

This resource is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services as part of an award totaling $875,000 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS or the U.S. government.