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AANP president weighs in on full practice authority laws

It’s no secret our healthcare system is needlessly complex and full of mounting challenges that often make it complicated for patients to navigate and get the care they need.

full practice authority

By Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP

Outdated nursing licensure laws are one of those challenges — and one we can address together.

Each state issues individual nursing licenses that are just like driver’s licenses, which authorize individuals to drive automobiles — except for the fact that authorization for practice can end at the state line.

Imagine for a moment what it would be like if you owned your car and had a state-issued driver’s license, but had to obtain a permission slip from a neighbor before you could drive?

These permission slips also could limit your ability to drive on the highway or even make right-hand turns. Sounds pretty ridiculous, right?

We’d end up with traffic jams and kids late for school. As far-fetched as this sounds, a version of this happens to nurse practitioners (NPs) in states around the country every day.

Full practice authority rules and regulations

It’s illegal for nurse practitioners in 28 states to practice their profession without a “permission slip” — a collaborative agreement with a physician.

This creates bottlenecks in the workforce, increasing healthcare costs and, even worse, leaving patients with unmet healthcare needs.

Healthcare providers and policymakers need a clear understanding of the impact of outdated scope of practice licensure laws and the benefits full practice authority offers patients, communities and our entire healthcare system.

The benefits of full practice authority include:

  • Helping states better address challenges to accessing primary care that impacts millions of patients.
  • Lowering the costs of healthcare in states that embrace the model.
  • Increasing our nation’s capacity to combat the opioid crisis by expanding the pool of providers authorized to prescribe medication-assisted treatments.

As state legislators gear up to consider full practice authority bills in 2020, the American Association of Nurse Practitioners (AANP) is calling on lawmakers — and partnering with our nursing colleagues — to recognize the value of embracing the National Council of State Boards of Nursing’s APRN Model Practice Act as the gold standard for implementation.

For those pondering what it all means for our profession and patients in your state, below are some key points to know in the effort to secure adoption of full practice authority nationwide.

Definitions matter

First, it’s important to understand how scope of practice laws are defined and classified by each state. The AANP has created a helpful map for easy visual reference that shows you where each state stands.

On the map, states are coded:

  • Green for full practice authority
  • Yellow for reduced practice
  • Red for restricted practice

State practice and licensure laws permit all NPs to:

  • Evaluate patients
  • Diagnose, order and interpret diagnostic tests
  • Initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing

Reduced and restricted practice states have any number of regulations that prohibit NPs from engaging in some aspect of their practice, even though they are educated, trained and licensed to provide care for patients.

These states also often require NPs to maintain some form of a collaborative, supervisory or delegation agreement with a physician to treat patients. This career-long obligation also might limit the type of care and setting in which an NP can practice.

Full practice authority can address pressing challenges

One of the most profound ways outdated laws affect patients is in geographic health disparity areas or health provider shortage areas.

Full practice authority helps remedy this because it’s about allowing patients full and direct access to NP-provided care wherever they seek care.

When 60% of states fail to modernize their scope of practice laws, patient access and satisfaction goes down. At a time when America faces such serious health challenges such as the opioid crisis, ongoing physician shortages and lack of access to primary care services, it’s hard to justify keeping these outdated laws in place.

According to my recent op-ed published by TheHill.com, I noted that states with full practice authority have healthier residents and consistently rank higher on state health report cards.

In fact, eight of the top 10 healthiest states — Colorado, Connecticut, Hawaii, Iowa, Minnesota, Rhode Island, Vermont and Washington — have full practice authority laws, which enable patients to directly access NP care without restrictions.

By contrast, the 11 lowest-ranking states have laws that directly limit NP practice.

That’s a pretty stark contrast considering patient populations’ overall health, but it also applies to other mounting challenges such as the opioid epidemic.

In a recent Time magazine article, former Secretary of the Department of Health and Human Services and Governor of Wisconsin, Tommy Thompson, and AANP CEO David Hebert rightly noted failing to enact full practice authority has negatively impacted NPs’ ability to prescribe critical treatments to combat opioid use disorder.

“These restrictions don’t just impact medication-assisted treatment prescribing, they deter NPs from practicing at all,” the article said. “In fact, states with laws that limit NPs’ scope of practice have 40% fewer NPs per capita than states without. That’s why they make so little sense — particularly in states where the opioid epidemic is especially dire.”

NPs are uniquely qualified to take on these challenges — and others — while also providing high-quality, comprehensive and cost-effective care.

But it is also important we work together to show policymakers at the federal and state levels that taking the necessary steps toward full practice authority will help ensure all Americans, regardless of where they live, have access to the care they deserve.

Significant support exists for full practice authority

As we dig deeper into the reasons full practice authority is so vital to our healthcare system, it’s important to consider the breadth and diversity of agreement among industry leaders.

AANP — along with more than 40 nursing organizations, the National Academy of Medicine, AARP and several other national health leaders — support full practice authority as the pinnacle standard for licensing and regulating nurse practitioners.

Adopting this model nationwide would end the patchwork, streamline regulations and decrease unnecessary regulatory costs states incur from needless requirements and improve overall healthcare access.

South Dakota, for example, now saves an estimated $70,000 a year since adopting full practice authority in 2017.

Professional development and growth potential

By granting NPs full practice authority, they have greater mobility to practice in new communities where the patient demand is highest. They may even consider opening their own practices and/or choose to work in primary care.

And with the majority of NPs practicing in primary care — more than any other provider — reinforcing our critical role and value to underserved areas is a central component to our advocacy of full practice authority in the states still lacking adequate patient access.

Modernizing licensure isn’t just needed for NPs. Updating our nursing licensure laws ensures RNs and other advanced practice registered nurses (APRNs) can practice at the top of their education and certification to transform and improve healthcare.

The capacity of the nursing profession to radically address the challenges of chronic disease and an aging population and reshape a healthcare system to better promote whole-person health is only possible when our laws permit us to bring all of our nursing expertise to every patient encounter. That’s the bottom line.

During my presidency at AANP, I pledge to explore ways to elevate our collective nursing voice and contribution so we can get back to doing what we do best — treating our patients as if they were friends or family, with the kind of care and attention they deserve. That’s what helps make a healthy and prosperous society.

While this is a brief overview of the scope of practice landscape for NPs, there is so much more to discuss and share from each of our states.

I look forward to traveling to full practice authority and non-full practice authority states over the coming two years to listen and learn from NPs about the challenges they face and how our continued effort to bring about full practice authority will help them treat more patients.

We welcome and appreciate opportunities to showcase a growing body of evidence indicating NPs are increasingly important to our healthcare system and why more patients are choosing NPs as their provider of choice.


Take these courses related to full practice authority:

Protect Yourself: Know Your Nurse Practice Act
(1 contact hr)
Nurses have an obligation to keep abreast of current issues related to the regulation of the practice of nursing not only in their respective states but also across the nation, especially when their nursing practice crosses state borders. Because the practice of nursing is a right granted by a state to protect those who need nursing care, nurses have a duty to patients to practice in a safe, competent, and responsible manner. This requires nurse licensees to practice in conformity with their state statutes and regulations. This course outlines information about nurse practice acts and how they affect nursing practice.

Advanced Practice Nurse Pharmacology
(25 contact hrs)
This course will help advanced practice nurses meet the new ANCC 25-contact hour pharmacology requirement for re-certification beginning Jan. 1, 2014. Written and rigorously peer reviewed by pharmacists and advanced practice nurses, this course features a wide range of medical conditions and the medications associated with them. Chapter topics include hypertension, diuretics, GI, critical care, sexually transmitted diseases, asthma, oncology, non-opioid analgesics, diabetes, weight loss, mental health conditions such as anxiety, bipolar disorder, depression and much more. The chapters highlight clinical uses, dosing, interactions and adverse effects for the common medications used in your practice. APN tips are featured throughout the chapters to help you in your prescribing practices.

Team-Based Healthcare: Helping to Improve Patient Outcomes
(1 contact hr)
Use of the interprofessional team approach has led to improved outcomes in some patient populations and disease states. Many different models exist and all can be adapted to fit specific population needs. As healthcare reimbursement continues to evolve, team-based approaches may be warranted to optimize patient care.

Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP
Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, is a licensed nurse practitioner (NP) in the state of Louisiana and president of the American Association of Nurse Practitioners (AANP).

3 Comments

  1. Avatar
    Lee September 16, 2019 at 4:33 pm - Reply

    I have all the respect in the world for NPs; but in no uncertain terms should they be used in place of a licensed physician. Physicians spend many more hours of classroom, clinical and research time to learn to effectively analyze symptoms, diagnose and treat illnesses. A nurse-practitioner may get approx. 650 hours of clinical instruction during their entire education which is less than what a physician receives during their first year of a three year residency. And I don’t want to hear the argument that NPs have spent many hours working as nurses before becoming nurse-practitioners. That in no way equates to any part of a physician’s education and training. In no way do I deny the hard work it took for someone to become an NP; but it is not the same as going to medical school. The bottom line is that they are not qualified to make medical decisions as an MD or DO and should never be utilized in that manner and should not be allowed to practice without a collaborative physician agreement .

  2. Avatar
    Cheryl September 17, 2019 at 1:57 am - Reply

    Lee, even as a Registered Nurse, who graduated 40 yrs ago (in the dark ages), when you were actually required to spend time in a classroom & with an instructor, I agree with you 100%! I have met many wonderful CRNP’s & no doubt they often have more time than the physician. However, I, like you, don’t believe that s CRNP should be practicing without benefit of a collaborative agreement. In fact, in some states, they have people who monitor how well the doctors & CRNP’s are following the collaborative practice rules! What a smart idea!

  3. Avatar
    Diane Bruessow, PA-C September 17, 2019 at 7:29 am - Reply

    Lee misses the point. One does not need the extensive training of a physician to work within their education and training. Every other licensed profession does it. It’a Time that NP and PAs do it too.
    The good news is that Lee and other physicians get a pony when their state’s NPs and PAs practice restrictions are removed: they no longer are held liable for the autonomous actions of the NPS and PAs they’re affiliated with. Especially now that most physicians are institutional employees and not employers.

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