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Interview by Jodie Elrod

Watch as Lindsay Harris, MSN, APRN, discusses her presentation at Heart Rhythm 2025.

Hi, my name is Lindsay Harris. I am an EP nurse practitioner at Brigham and Women's Hospital. I'm also the senior director for Advanced Practice Nursing at Brigham and Women's Hospital. I'm going to talk today about the scope of practice for advanced practice providers (APPs), specifically, physician assistants, physician associates, and nurse practitioners. 

My talk at HRS 2025 examines the landscape or scope of practice, meaning where do we stand, what are some of the key considerations, and what is needed to move forward. The reason that scope of practice for APPs is so important is because we know that there is a shortage of healthcare providers across the US. Certainly, most notably, primary care physicians, and APPs have a great opportunity to meet and mitigate some of those access needs and challenges that are being created by the healthcare provider shortage. 

There is a statistic from the US Bureau of Labor Statistics that shows that from the decade of 2012 to 2021, the workforce of APPs actually increased by over 94%. In order to meet the needs of some of these access challenges, state laws have begun liberalizing APP scope of practice, so that they can practice more independently. However, in some areas, that has been met with resistance due to concerns about quality, safety, and fragmentation of care. 

So, my talk at HRS today was to examine some of that debate and some of the data surrounding APP scope of practice modernization and expansion. What the data really does show is that APPs have the ability to provide high-quality, safe care. So, there is APP scope of practice, which are the elements of practice, which are things like order, diagnose, and interpret testing, and then there is also working at the top of their license, and that can apply to APPs but it can also apply to physicians as well, where everybody is working within the scope of their training, education, certification, and licensure. There is data to show that when APPs work at the top of their license, everyone's actual RVU increases, including physicians. I think there has been a narrative in the past that if we liberalize APP scope of practice, that in some way that is going to take away from our physician colleagues, and that is not the case. The data does not support that narrative. 

The take-home messages are that the data does support APP scope of practice expansion and liberalization. It is safe to do so. I think another key takeaway is that there is no one size fits all option for APP utilization. What works in an academic medical center versus a surgical center versus an EP lab versus an outpatient setting is not going to be the same. Also, I think APP and physician collaboration and expansion of scope of practice are not mutually exclusive. Both of those things can go hand in hand together, and it should be teamwork, not necessarily legal mandates, that help us work together to navigate the changes and challenges of our current healthcare landscape.

The transcripts were edited for clarity and length.