By John Hood

For more than a decade, the North Carolina General Assembly has pursued a prudent and successful strategy of making our state one of the best places in the country to live, work and invest.

I call the strategy prudent because it reflects conservative governance at its best, with a focus on reducing the cost of living and creating jobs (through tax and regulatory reform) while also improving the return on public investment in services such as transportation and education.

I call the strategy successful because it has helped ensure a net inflow of capital and people. Over the past five years, North Carolina’s population grew 5.3 percent. The nation as a whole grew 3.6 percent. New York, by contrast, grew by only 2.1 percent. North Carolina ranks at or near the top of most measures of economic freedom. New York ranks at or near the bottom. There is no coincidence here.

In one regulatory arena, however, New York beats North Carolina. The Empire State is one of 27 states that extend full practice authority to advanced-practice nurses. In these jurisdictions, nurses with the requisite training are empowered to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of state boards of nursing.

In another 12 states, such nurses are afforded only limited scope of practice, with laws requiring either that some services be delivered in another setting or that the nurse practitioner operate under a “collaborative agreement” with a physician.

Finally, there are 11 states where nurse practitioners must provide at least one service under the supervision, delegation or team management of a physician. North Carolina is one of them.

For years, nurses and health care reformers have tried to change North Carolina’s draconian approach. For years, they’ve faced vociferous opposition from doctors. I hear from the latter every time I write about scope-of-practice reform. They argue that while they deeply appreciate and value the care provided by nurses, it is too dangerous to permit nurse practitioners to operate independently. Perhaps in most cases outcomes for patients will be fine either way, they concede, but in too many others a nurse practitioner will miss something that a doctor will see, or perform a procedure that a doctor ought to have performed. Why risk such adverse outcomes?

Some scope-of-practice reformers dismiss these arguments as self-serving, saying physicians simply don’t want to give up the revenue they derive from “supervising” nurse practitioners. But I believe at least some of my correspondents are sincere. They may well have witnessed an incident in which the presence of a physician proved critical. Or they may just find it implausible to believe that allowing nurses in independent practice to assume more primary-care responsibilities wouldn’t generate significant risks.

When it comes to patient care, I agree that policymakers ought not take leaps of faith. But the existence of a patchwork of different regulations across the country has given scholars a rich trove of data to mine. After all, we don’t have to guess what would happen if advanced-practice nurses were permitted to deliver the full scope of services for which they are licensed. Some states already do it. Others, including North Carolina, don’t.

My reading of the available research is that affording nurses more scope of practice does not typically result in a higher rate of adverse outcomes or a lower quality of care. The most recent study I’ve seen, published earlier this year in the journal “Nursing Outlook,” found that states that give nurses broader practice authority ranked higher than more-restrictive states on “overall state health, health outcomes, clinical care, quality of care, access to care, number of primary care providers per 100,000 population, and childhood immunizations.”

On March 25, a bipartisan group of state lawmakers filed new legislation to give North Carolina nurses full practice authority. I hope they succeed. On this one issue, we should, indeed, follow New York’s lead.

John Hood is a John Locke Foundation board member. His latest books, “Mountain Folk” and “Forest Folk,” combine epic fantasy with early American history.