Skip Navigation
Explore our COVID-19 Resources and Updates
CHS blue logo square
Home > Our Work > All Publications > 2010


Our publications keep professionals working across the public, private, and academic sectors informed on the most important developments and issues in health security and biosecurity.

Find an article or report by keywords:

Find an article or report or see all by area, author, or year:


Expanding Practitioner Scopes of Practice During Public Health Emergencies: Experiences from the 2009 H1N1 Pandemic Vaccination Efforts

Brooke Courtney, Ryan Morhard, Nidhi Bouri, Anita Cicero
Date posted:
September 15, 2010
Publication type:

Biosecur Bioterror 2010;8(3):223-231

Mary Ann Liebert, Inc.
Open access
See also:

Article available on publisher’s site: HTML • PDF


In a public health emergency involving significant surges in patients and shortages of medical staff, supplies, and space, temporarily expanding scopes of practice of certain healthcare practitioners may help to address heightened population health needs. Scopes of practice, which are defined by state practice acts, set forth the range of services that licensed practitioners are authorized to perform. The U.S. has had limited experience with temporarily expanding scopes of practice during emergencies. However, during the 2009 H1N1 pandemic response, many states took some form of action to expand the practice scopes of certain categories of practitioners in order to authorize them to administer the pandemic vaccine. No standard legal approach for expanding scopes of practice during emergencies exists across states, and scope of practice expansions during routine, nonemergency times have been the subject of professional society debate and legal action. These issues raise the question of how states could effectively implement expansions for health services beyond administering vaccine and ensure consistency in expansions across states during catastrophic events that require a shift to crisis standards of care. This article provides an overview of scopes of practice, a summary of the range of legal and regulatory approaches used in the U.S. to expand practice scopes for vaccination during the 2009 H1N1 response, and recommendations for future research.



Our Mission

To protect people’s health from epidemics and disasters and ensure that communities are resilient to major challenges.