Full Practice Authority for Nurse Practitioners
Individuals studying to become a nurse practitioner (NP) may naturally wonder, “what is my scope of practice?” Though the nurse practitioner educational program has been around since 1965, the answer isn’t so simple.
States vary in the amount of autonomy they grant nurse practitioners, and increased health care demands have prompted a re-evaluation of traditional roles to provide patients with better outcomes.
Full practice authority for nurse practitioners is a contentious debate in some medical circles today, as a number of experts say that NP graduates and professionals are demonstrating they are trained and capable of delivering specialized, comprehensive care to improve patients’ overall quality of life. They also believe that without full practice authority, primary care will continue to experience gaps in quality and efficiency.
What Is Full Practice Authority?
State laws vary in the authority they grant nurse practitioners (NPs):
Restricted: NPs require physician oversight to engage in at least one element of NP practice, such as diagnosing and treating patients.
Reduced: NPs have the ability to engage in at least one element of NP practice and are regulated through a collaborative agreement with a health care provider so they can provide patient care. Reduced practice may also limit the setting of one or more elements of NP practice.
Full: NPs can diagnose, treat, and prescribe medications without physician oversight and may establish their own private practice.
Nurse practitioners generally carry out a wide range of duties within the varying levels of practice authority. Responsibilities include performing physical exams, ordering lab tests, and helping their patients manage diseases.
On one hand, the American Medical Association has lobbied extensively against granting full practice authority for nurse practitioners, arguing that gaps in training will threaten patient safety. Physicians say the lack of clinical experience renders NPs incapable of adequately caring for patients in private practices.
Increasingly, the argument against granting full practice authority is seen as an outdated one by some in the nursing field. According to the American Association of Nurse Practitioners (AANP), full practice authority states commonly see NPs practicing in rural and underserved areas, where they adhere to high quality and safety standards. By comparison, states with restricted authority have higher geographic health care disparities, higher costs of care, and primary care shortages.
What States Are Full Practice Authority?
The following U.S. states and territories now provide full practice authority to NPs (as of October 2021):
- District of Columbia
- New Hampshire
- New Mexico
- North Dakota
- Northern Mariana Islands
- Rhode Island
- South Dakota
Reduced authority states include: Alabama, Arkansas, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, New Jersey, New York, Ohio, Pennsylvania, Utah, West Virginia, and Wisconsin.
Restricted authority states include: California, Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia.
The Enhanced Nurse Licensure Compact (eNLC), passed in January 2018, allows registered nurses and licensed practical/vocational nurses to practice in person or through telehealth services using just one multistate license. All nurses undergo a federal and state criminal background check before receiving a license.
However, the eNLC does not apply to NPs, a type of advanced practice registered nurse (APRN). Instead, the APRN Compact, enacted in Delaware and North Dakota, permits advanced practice registered nurses to acquire a multistate license that allows them to practice in other compact states. The APRN Compact will go into effect in seven states once they have enacted the legislation.
How Will Full Practice Authority Impact Patients?
The health care industry is quickly evolving. The passage of the Affordable Care Act, the COVID-19 pandemic, the rise of telehealth services, and the aging baby boomer population have all contributed to an increased demand for health care services in recent years. Nurse practitioners with full practice authority can work in hospitals, long-term care facilities, and more, to deliver high-quality, complex care to a range of individuals.
Patients treated by full practice authority NPs may enjoy a number of benefits:
Improved access to care. NPs sometimes practice in underserved communities and rural locations, where their expertise and services are seriously needed. Patients may also opt for telehealth services from their NPs, if offered.
Increased choice. Patients may be able to choose from an expanded pool of qualified and eligible health care providers.
Streamlined care. Granting full authority to NPs in all states can potentially remove obstacles to providing effective care. NPs won’t have to wait for an overseeing physician to sign off on medication or treatments they know their patients need right away.
Lowered cost. Receiving overlapping care from both physician and NP could result in unnecessary office visits, duplicative billing, and increased expense due to collaborative fees.
Having more nurse practitioners on staff can lead to higher patient satisfaction scores and better quality outcomes, according to a large-scale study conducted by the Center for Health Outcomes and Policy Research at UPenn Nursing and the Hospital of the University of Pennsylvania and released in 2021. Researchers found hospitals with more NPs had 21% fewer deaths after common surgical procedures, shorter length of stays, and 5% lower Medicare costs per patient. Nurse practitioners on staff led to better patient satisfaction scores, lower instances of nursing staff burnout, and diminished rates of hospital readmission due to improved patient education.
In a public statement, study co-author and UPenn Hospital CEO Regina Cunningham, PhD, RN, said this about their findings: “Our study shows that NPs in advanced clinical roles in inpatient care are a very valuable addition to excellent RN and physician care. This important study shows that nurse practitioners enhance hospitals’ success achieving clinical excellence, patient satisfaction, and lower per patient expenditures while also contributing positively to overall clinician well-being during challenging times.”
Operating as a full practice authority nurse practitioner comes with great responsibility, but may also be rewarding. Full practice authority NPs are not just members of the health care team; they’re front and center in patients’ lives. They can confidently perform all the services they’ve been trained to do, without bureaucratic delays or mistrust impeding patient care.
Citation for this content: Nursing@Georgetown, the online MSN program from the School of Nursing & Health Studies.