APRN independent practice threatened.

Montana Advanced Practice Registered Nurses (APRNs) have enjoyed a broad and independent scope of practice since the inception of APRN enabling legislation. Through strong standards for advanced practice education, certification, and maintenance of competency, Montana APRNs have experienced tremendous growth in practice opportunities and respect from patients and practitioners.

Vicki Thuesen, APRN, FNP, WHNP, and Shari Healy, APRN, FNP, developed the Gold Street Clinic in Butte, Montana about four years ago and enjoyed a robust primary care practice working collaboratively with other health care practitioners in the community. Without provocation, the APRNs received notice from the physician director of radiology/pathology at St. James Hospital that he would no longer accept referrals for imaging "other than routine X-rays" from them without physician supervision.

Complaints to the Board of Medical Examiners authored by the radiologist, alleging that the APRNs were "practicing medicine," were dismissed. Despite that success, the APRNs were unable to reach a satisfactory agreement with the hospital and radiologist. Vicki Thuesen and Shari Healy ultimately filed a lawsuit for restraint of trade against the radiologist and hospital.

The APRNs have received strong support from patients and community members, nurses across the state of Montana, and APRNs across the country. The Montana Nurses Association has committed funds to file an amicus brief in support of their case and numerous individuals have contributed funds to help cover legal costs. Action on the lawsuit continues and it is anticipated that the case could go to court in early 2008.

The impact of the final decision in the lawsuit could have wide-range implications for APRN practice across the country. Hailed as Nurse Practitioners of the Year in October 2007, Healy and Thuesen remain committed to seeing the process through for the sake of their patients and the future of advanced practice nursing.

Despite community and professional support, the road blocks to independent practice that APRNs Healy and Theusen experienced have resulted in the closure of the Gold Street Clinic effective January 31st, 2008. The inability to recruit other APRNs, the prohibition of access to the diagnostic tools necessary for the safety of the 6100 patients in the practice, and the weight of the impending lawsuit have contributed to the decision to close the otherwise successful practice.

"It is imperative that Montana Nurses Association continue to support independent nursing practice," said Barbara Prescott, Chair of the MNA Council on Advanced Practice. She added that it has been recommended that the ANA advance policy through the pursuit of legislation and regulatory language that protects the rights of all APRNs to practice fully within their scope of practice, unencumbered by legal, business, institutional, or regulatory barriers and to monitor development and oppose activities that would constitute restraint of trade against APRNs.

Kim Powell, APRN, ACNP-BC