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Advanced Practice Nurses can bridge Arizona’s health gap

Patient demand for health care in Arizona has never been greater.

As front-line health care professionals working in both metro Phoenix and the White Mountains, we see it every day. Graying members of the Baby Boomer generation require more care with each passing year. And policy actions at the state and federal level have brought hundreds of thousands of Arizonans and tens of millions of Americans into the traditional health care system.


Ali Baghai

Meanwhile, the Association of American Medical Colleges projects that the U.S. faces a shortage of up to 31,000 primary-care physicians by 2025.

Who is going to meet our growing health care needs? In Arizona, we believe that Advanced Practice Nurses can help bridge the gap.

That is why the Arizona Nurses Association and groups representing our state’s nearly 6,500 Advanced Practice Nurses have banded together under the banner of the Arizona Coalition of Advanced Practice Nurses. What the Coalition seeks is an update of Arizona’s Scope of Practice for the four Advanced Practice Nursing groups: Nurse Practitioners, Nurse Midwives, Certified Registered Nurse Anesthetists (CRNAs) and Clinical Nurse Specialists.

As supporters of this effort, we are grateful a joint state committee of House and Senate legislators recently gave a positive recommendation to this Scope of Practice expansion. We are also mindful this was but the first step in the legislative process that lies ahead.

Advanced Practice Nurses have graduate-level education, advanced clinical knowledge and specialized focus. They work in areas like family practice, pediatrics, geriatrics, psychiatric/mental health and women’s health.


Steven Washburn

Some sections of the existing statutes governing Advanced Practice Nurses are antiquated, dating back decades or more. Other provisions are confusing or misleading, such as a provision requiring CRNAs to provide anesthetics “under the direction of and in the presence of a physician or surgeon.”

What does “under the direction of” mean? The statute doesn’t define it and there is no case law. Additionally, requiring that CRNAs operate “in the presence” of a physician is both unnecessary and, frankly, impossible in rural and other settings where the physician is likely scrubbing in, reviewing test results in another room, assisting another patient or conducting any of a thousand other tasks necessary in today’s busy health care world.

Here’s a reality check: a lack of area anesthesiologists means CRNAs are safely and securely providing virtually all anesthetic services to patients in the White Mountains.

Likewise, other Advanced Practice Nurses are performing ably all over the state. These dedicated professionals don’t need anyone to hold their hand.

So, it has been disappointing to watch as some physician groups advocate for keeping in place the outdated regulations shackling the very nursing colleagues they work with daily. Most often, these critics raise the specter of safety risks to patients – though they never point to studies or research to validate their claim. They have none.

To the contrary, study after study has demonstrated the safe care provided by Advance Practice Nurses. Just one example: A 2010 report jointly issued by the Institute of Medicine and Robert Wood Johnson Foundation stated, “Now is the time to eliminate the outdated regulations and organizational and cultural barriers that limit the ability of nurses to practice to the full extent of their education, training, and competence.  The current conflicts between what (Advanced Practice Nurses) can do based on their education and training and what they may do according to state and federal regulations must be resolved so that they are better able to provide seamless, affordable, and quality care.”

Interestingly, while some physician organizations are opposing expanded authority for nurses, many individual physicians are strongly supportive. Roughly 70 Arizona physicians have already signed letters of support, among more than 700 such letters submitted by nurses, patients and others asking legislators to grant greater independence to Advance Practice Nurses. Community groups ranging from AARP to the Goldwater Institute are also backing the effort.

And then you have the two of us, a White Mountains orthopedic surgeon and a metro Phoenix CRNA, standing together on this issue.

We each want what is best for Arizona patients. That’s why we support empowering Advanced Practice Nurses.

Dr. Steven Washburn works in Lakeside, Arizona, and specializes in orthopedic surgery and orthopedic sports medicine. Ali Baghai is a Certified Registered Nurse Anesthetist at Tempe St. Luke’s Hospital, and is president of the Arizona Association of Nurse Anesthetists.


  1. This is long needed legislation. I am a Family Nurse Practitioner who sees approximately 1500 new patients per year across the state of Arizona including these communities: Apache Junction
    Bullhead City
    Casa Grande
    Dolan Springs
    Golden Valley
    Green Valley
    Lake Havasu City
    Show Low
    St. Luis

    Many residents in Arizona struggle to get the health care they need. Disparity is worse in rural communities. Many patients have received quality health care because Nurse Practitioners, Nurse Midwives, Certified Nurse Midwives, Clinical Nurse Specialists and Certified Registered Nurse Anesthetists are in their communities; however there still are barriers to health care access to these providers.

  2. Reasonable article, but may I add a little history and context.

    Non-anesthesia Nurse Practitioners already have full-practice privileges in Arizona. This was accomplished without the help of that segment of advanced-practice nurses known as anesthetists.

    Nurse anesthesia is a unique specialty in advanced practice that has long segregated itself from the rest of advanced-practice nurses. They have primarily only been concerned about themselves and have not been pro-active in helping any other advanced-practice specialty achieve the autonomy they are looking for themselves in Arizona.

    This is not a fight or difference of opinion; this is simply a reflection of the indifference that anesthetists have had for the rest of advance practice specialties. If Nurse Anesthetists would like my help in granting them expanded practice, then it would be nice if they would step forward and join the effort in about 25-30 other states in helping non-anesthesia advanced practice nurses to gain the autonomy that they are asking for in Arizona.

  3. I am a psychiatric clinical nurse specialist with prescriptive authority in 5 states and I am eligible to apply in 31 other states- not Arizona, at least so far. I do locum tenens and jobs come up in Arizona for Psych NP’s. The Psych CNS Has the same scope of practice as the Psych NP. The Psych NP developed from the Psych CNS. It would be nice if AZ and a few other states would open their doors to us. And yes, there is a need!t

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