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Understanding regulations: What is full practice authority?

Date: August 23, 2017

Nurse practitioners (NPs) work as primary care providers in a range of settings, from small independent clinics to larger hospitals. Some NPs specialize in certain areas of medicine, such as pediatric care, while others focus on family or internal medicine. As detailed in a fact sheet from the American Association of Nurse Practitioners (AANP), much like physicians, NPs are licensed to assess patients, make diagnoses and treat a range of medical conditions, with many licensed to prescribe medications.

NPs are permitted to order medical tests and make diagnoses based off the results of those tests. As elaborated in the AANP fact sheet, professionals in this field also are required to have a strong knowledge of preventative health care, with many NPs counseling patients with regard to preventative measures such as cancer screenings, smoking cessation, seasonal shots and more. Depending on the state in which you reside, the primary difference between NPs and physicians is the level of education required and autonomy to practice. NPs must complete an advanced degree program, such as a Master of Science in Nursing (MSN), before becoming licensed. Physicians, on the other hand, earn a doctorate in medicine.

Despite the NPs wide purview and the high level of education needed to obtain it, laws regarding the scope of NP practice are not uniform nationwide. Known as scope of practice laws, these mandates differ between states and establish the extent to which NPs can practice medicine, a resource page from Barton Associates specified.

Understanding regulations
According to researchers Debra Hain, Ph.D. and Laureen M. Fleck, Ph.D., writing in a study published by The Online Journal of Issues in Nursing, scope of practice laws vary considerably. In some states, an NP is required to practice only while being supervised by a physician. In others, NPs are able to practice alone but must do so within the confines of a collaborative agreement with a physician or health care organization. The collaborative agreement means that outside health authorities are essentially in charge of the NP in question, monitoring his or her work to ensure that standards are met.

The Henry J. Kaiser Family Foundation provided a detailed state-by-state guide to scope of practice laws. California has stringent regulations, with NPs unable to practice without the full supervision of a physician. They also are unable to independently prescribe medications. Illinois, however, is a state where a collaborative agreement is necessary for NPs to practice. Under collaborative agreements, NPs are precluded from prescribing medications independently.

Understanding full practice authority
Roughly over a third of states have adopted what is known as full practice authority for NPs. This term denotes the practice of NPs working independently, without the supervision of a physician and without the guidance provided by a collaborative agreement with an external health authority — designating these professionals with the autonomy to treat patients, make diagnoses, order tests and prescribe medications. Under full practice authority laws, NPs are answerable only to the state board of nursing. NPs who practice in full authority states still continue their education by meeting ongoing requirements for certification.

As of February 2017, the District of Columbia and 22 states grant NPs the authority to practice independently, journalist Bruce Japsen reported in Forbes, noting that South Dakota is one of the most recent states to allow full practice authority. An AANP press release observed that there are pushes in other states for new legislation allowing full practice authority, with lawmakers in places such as Pennsylvania and Arkansas reviewing possible legislation that would legalize independent practice.

Understanding the debate over full practice authority
A number of organizations, including AANP, The National Governors Association, the Bipartisan Policy Center and the Institute of Medicine all advocate for the nationwide implementation of full practice authority laws for NPs. The aforementioned groups claim that restrictive scope of practice laws preclude NPs from delivering the level of patient care that they are more than qualified to deliver.

As noted in the AANP fact sheet, research has been conducted for over 40 years exploring the efficacy of NP-delivered care, particularly in comparison to physician-provided care, with results primarily indicating that NPs are able to provide safe and quality health care comparable to that delivered by physicians. Hain and Fleck reported on a 2011 study from the Institute of Medicine, which concluded that restrictive scope of practice laws are a major concern in that they prevent more patients from seeing able health care providers and restrict access to high quality care. Put another way, strict scope of practice laws serve as a roadblock to making health care more accessible to a larger number of patients.

The Bipartisan Policy Center reached a similar conclusion regarding the introduction of full practice authority laws for nurses. The organization maintained that NPs are not being allowed to deliver an advanced level of care for which they are well-trained due to scope of practice mandates in certain states. Removing these barriers, the group concluded, would streamline the care process — there would be no back and forth between NPs and supervising physicians — and it would make care more accessible and affordable, particularly for underserved patient populations.

However, in his Forbes article, Jepsen argued that despite widespread evidence of the benefits of full practice authority laws, some resistance to their widespread implementation remains, particularly from physician groups. Journalist Ashok Selvam explained in Modern Healthcare how Virginia’s state medical society opposed full practice authority legislation that was being considered in 2010.

Benefits of full practice authority
While the debate presses on and some states continue to review their scope of practice legislation, full practice authority offers benefits that must be considered:

    • Patients are able to pay less when NPs practice independently.
    • Patients are able to access care in rural or underserved areas.
    • Patients can receive care from NPs that is comparable to that delivered by physicians.
    • NPs have the freedom to practice independently, which is far more time efficient for providers and patients alike, as NPs no longer will have to wait for directions or approval from a supervising physician.

Consider Bradley University
With 22 states and the District of Columbia allowing NPs full practice authority, now could be the time to transition your career. The first step begins with an application to Bradley University’s online MSN – Family Nurse Practitioner program.

Further reading
http://www.midwife.org/Full-Practice-Authority

Sources
http://www.aacn.nche.edu/media-relations/fact-sheets/apn-roles#Quality
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html
https://www.aanp.org/images/documents/publications/scopeofpractice.pdf
https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/
http://c.ymcdn.com/sites/www.npamonline.org/resource/resmgr/imported/Full%20practice%20authority.pdf
http://www.kff.org/other/state-indicator/total-nurse-practitioners/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
http://onlinedegrees.bradley.edu/nursing/msn-fnp/
https://www.forbes.com/sites/brucejapsen/2017/02/24/another-state-lifts-patient-hurdles-to-nurse-practitioners/#1f50ba0c5fc8
https://www.aanp.org/press-room/press-releases/192-press-room/2017-press-releases/2063-nurse-practitioners-salute-south-dakota-for-new-health-care-law
http://www.modernhealthcare.com/article/20130419/MAGAZINE/130419964

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