Nurses, pictured with association president-elect Sheilah Yohn at a June 1, 2026, rally in Harrisburg, pushed to expand their scope of practice. Most of the Commonwealth’s neighbors, except Ohio, allow providers to operate independently of the physician. (Photo: Whitney Downard/Pennsylvania Capital-Star)
Last year, the Family Practice and Counseling Network hired a psychiatric nurse practitioner to aid meet the mental health needs of “medically underserved clients.”
However, CEO Emily Nichols said it would be almost six months before they saw a single patient at the Federally Qualified Health Center in Philadelphia because Pennsylvania requires nurse practitioners (NPs) to practice under the supervision of a physician.
“And that’s just one NP. We could hire four more depending on the needs we see, but we don’t have the resources and we don’t have collaborating physicians,” Nichols told the Capital-Star. “And we have to pay for (collaborating physicians). We are a community health center; we operate on a pretty slim margin.”
Pennsylvania is a so-called “limited practice state,” which means registered nurses must have a written collaborative agreement with a licensed physician in order to work. However, attempts to introduce legislation to change this rule have repeatedly failed despite broad, bipartisan support.
Pennsylvania Nurses Coalition notes that NPs can evaluate patients, diagnose conditions, order and interpret tests, develop treatment plans, prescribe medications, and coordinate patient care – provided the supervising physician consents to consultations, reviewing records and charts, and more.
Other states, including almost all of Pennsylvania’s neighboring states, do not have the same restrictions. Supporters argue that NPs can fill gaps as the number of Commonwealth doctors declines, particularly in rural areas. However, the number of NPs increases in both urban and rural environments.
More than two dozen states, like the Veterans Affairs health care system, are more elastic. Rep. Nancy Guenst (D-Montgomery), a U.S. Army veteran, said, “If it works for our veterans, it can work for Pennsylvanians.”
“We don’t have to guess whether this will work,” Guenst told a crowd of lawmakers on Capitol Hill. “Study after study has shown improved access to care, particularly in rural communities, without compromising quality or patient safety.”
Nichols, who lives in Philadelphia, called her center “lucky” because she has a supportive partner to work with, and added that many other centers don’t have NPs at all because of such requirements. However, on a daily basis, doctors still have to sign for routine items, such as specialized shoes for diabetic patients.
“When the nurse admits you as a patient, they can just sign this form and you can go get what you need,” Nichols said. “But there is an obstacle to doing this.”
Support at the General Meeting
Senator Camera Bartolotta (R-Washington) began her current term in 2018 and introduced Senate Bill No. 25 annually to expand the NP’s practice. Despite this consistency, even with maintaining the same bill number across two administrations, the bill has yet to reach the governor’s desk.
The first version of Bartolotta recognizes this 21 other states and the District of Columbia allow NPs “full practice authority.” Today that number is 28.
“I don’t want to see 49,” Bartolotta said at Monday’s rally. “We reached a tipping point a long time ago. It’s not, ‘Someday it might be okay.’ That day is behind us… What the hell are we waiting for?”
In its early years, NP legislation passed the Senate with only a handful of opponents but did not receive a hearing in the House of Representatives at least four years in a row. Now it seems that this hesitation came from here leadership of her own chamberas House Minority Leader Jesse Topper (R-Bedford) stated. own pilot version left the House chamber while a rank-and-file member in 2020.
This year’s version of House, House Bill 739is sponsored by Guenst. Neither Bartolotta’s Senate bill nor Guenst’s bill have received committee hearings yet.
One of the biggest opponents of expanding NP responsibilities is the Pennsylvania Medical Society, which Bartolotta says has “exercised significant influence in Harrisburg and contributed to the delay of legislation despite broad bipartisan support.”
The Medical Society did not immediately respond to a request for comment Monday, but generally opposes expanding responsibilities for non-physician physicians, including pharmacists. Online, body indicates studies demonstrating that non-physician care increases health care costs, stating that “Optimal patient care is most effectively provided by health care teams.”
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“We are not trying to replace doctors,” Bartolotta emphasized. “(NPs) are working with them, being able to fill all the gaps that continue to turn into chasms. They are here to fill the gaps in really good, high-quality health care for people who desperately need it.”
In contrast to ongoing efforts focused on educating fresh providers, Bartolotta noted that NPs “are ready to go” now at no additional cost to the state and can refer high-level cases to physicians if needed.
Some members of the Pennsylvania Legislature have secured jobs out of state, like addiction specialist Justin Rohrback. He began practicing in Maryland instead of his hometown in York County. He said disruptions to medical supervision unrelated to patient care at his previous job risked derailing recovery treatment plans and could only be prevented at “great (financial) cost.”
“When we discuss health policy… we need to remind ourselves what these numbers represent. They are not just prescriptions. They are mothers, fathers, sons, daughters, neighbors and friends,” Rohrback said. “We are losing skilled health care workers to regulatory bureaucracy.”
Are you leaving money on the table?
Licensed NP MP Tarik Khan (Philadelphia) jokingly noted that few things have received so much attention that they have gained support from political opponents such as President Donald Trump and former President Barack Obama.
“We have the support of the Democrats. We have the support of the Republicans. We have the support of the Senate. We have the support of the House of Representatives,” Khan said. “Let’s settle this.”
This support is reflected in the application process for the federal Rural Health Transformation Plan. Last year, the state received $193 million from a program intended to offset billions in Medicaid losses over the next decade.
Federal funding for rural health care in Pennsylvania does not compare to the projected loss of Medicaid
Despite Pennsylvania having the third-largest rural population in the nation, Pennsylvania’s per capita bounty was just $78 compared to an average of $157 nationwide. Several scoring mechanisms work against the commonwealth, including its status as a “limited practice state” for NPs.
The program application emphasizes states that “help rural providers practice at the highest level of licensure,” citing both NPs and physician assistants as examples.
“We are running out of time to delegate full practice authority before the state submits (another) application to the federal government,” said Sheilah Yohn, chair-elect of the NP Coalition.
“We must be able to clearly state that we are a fully practicing state,” she continued ahead of the August 30 deadline. She added that in some counties in the Commonwealth, health centers are top-notch health care providers, but they must work with a doctor outside their community to provide care.
“A full practice is a win-win for everyone,” Yohn concluded.
