Competitive effects of scope of practice restrictions: Public health or public harm?

The demand for healthcare professionals is predicted to grow significantly over the next decade. Securing an adequate workforce is of primary importance to ensure the health and wellbeing of the population in an efficient manner. Occupational licensing laws and related restrictions on scope of practice (SOP) are features of the market for healthcare professionals and are also controversial. At issue is a balance between protecting the public health and removing anticompetitive barriers to entry and practice. In this paper, we examine the case of SOP restrictions for certified nurse midwives (CNMs) and evaluate the effects of changes in states' SOP laws on markets for CNMs and on maternal and infant outcomes. We find that SOP laws are neither helpful nor harmful in regards to health outcomes but states that have no SOP-based barriers have lower rates of induced labor and Cesarean section births. We discuss the implications for state policy.

The use of simulation and a modified TeamSTEPPS curriculum for medical and nursing student team training.

INTRODUCTION: We describe our adaptation of the team strategies and tools to enhance performance and patient safety (TeamSTEPPS) for use as an educational intervention for medical and nursing students. We hypothesized that participation in a team training program using the modified TeamSTEPPS program would positively affect knowledge and attitudes toward teamwork skills and their ability to recognize the presence and quality of team skills. METHODS: Two hundred thirteen students participated in a 4-hour team training program that included a lecture followed by small group team training exercises. Nurse/physician pairs facilitated student team activities. Knowledge and attitudes were assessed before and after the educational intervention. Recognition of team skills was assessed using videos. RESULTS: Statistically significant differences were found with participant knowledge (P<0.001) and attitude (P=0.004). Students were able to identify the presence and quality of team skills in the video vignettes. Overwhelmingly, the students recognized team skills much better in the success video than in the opportunity video (P<0.001), and they rated the success video much higher than the opportunity video (P<0.001) with regards to the quality of team skills. CONCLUSIONS: We successfully adapted TeamSTEPPS for use with our medical and nursing students, educated facilitators, and implemented the course. Our students improved their knowledge of vital team and communication skills, attitudes toward working as teams, and were able to identify effective team skills.