South Carolina NPs: The Fight for Full Practice Authority

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Barriers to practice must be removed now in order to increase access to care, control costs, and improve outcomes—all of which impact economic development and quality of life.
Dr. Stephanie Burgess, Clinical Professor and Associate Dean, University of South Carolina

For nurse practitioners in South Carolina and other “restricted practice” states, providing treatment to patients can prove a struggle. According to the South Carolina Nurse Practice Act, NPs must practice within 45 miles of supervising physician, making it impossible to provide healthcare services in rural regions without doctors. Even though the vast majority of NPs have graduate-level training in primary care, they cannot serve as providers without the physical proximity of a medical overseer. Additionally, SC’s advanced practice nurses (APRNs) have severe limitations in ordering services for the disabled, home health services, Schedule II medications, and hospice care, further curtailing their ability to provide adequate treatment to people in need. Not only are South Carolina’s NPs being denied the ability to practice to the full extent of their advanced education, but more alarmingly, vulnerable populations in remote regions don’t have adequate access to care.

The Pulitzer Prize-winning Post and Courier (2018) explained a common problem with outdated “restricted practice” laws: when supervising physicians move or retire, NP-run clinics and facilities are forced to close. However, one way to meet rising nationwide demand for primary care providers is to allow NPs “full practice authority,” following the models in states such as Alaska, Arizona, Colorado, Oregon, Vermont, and many others. Of course, the main opponents to extending FPA are some doctors who claim that allowing NPs greater autonomy would “undermine the model of team-based, physician-led care.” The question is: who will treat patients when there are no physicians living within 45 miles of a healthcare facility? As Dr. Stephanie Burgess points out in her interview below:

  • There are less than ten physicians in private practice serving rural areas in SC
  • Forty-two out of 46 counties are designated as rural or “medically underserved” by the federal government
  • Eight counties have zero OB-GYN physicians: McCormick, Saluda, Lee, Fairfield, Williamsburg, Bamberg, Allendale, and Hampton

These days, more South Carolinians have access to health insurance. As a result, the demand for medical providers has increased dramatically. In fact, the University of South Carolina reported that 800,000 state residents received access to preventative care and routine exams with the passing of the Affordable Care Act. By one estimate, SC ranks 36th in the country for its relative lack of primary care physicians—a looming shortage affecting the whole country—and NPs are trained to provide many of the same essential services, including ordering diagnostic tests and prescribing treatments. Seventy to 80 percent of all APRNs provide primary care, and there’s ample evidence that NPs offer cost-effective and safe healthcare services with excellent outcomes. It’s no surprise that a wealth of national organizations have endorsed FPA for NPs, including the AARP, the Bipartisan Policy Center, and the Department of Veterans Affairs, which recently adopted FPA across its healthcare centers nationally. (NPS) has been privileged to interview 45 NP professors on the issue of practice authority. In two new interviews with prominent professors from South Carolina, NPS once again makes the case for expanding FPA nationwide.

Interviews With Two Exceptional South Carolina NP Professors

The following interviews have been lightly edited for length and clarity.

Advancing Full Practice Authority in South Carolina

This is not a coup d’état. Nurses do not aim to overthrow or replace MDs, only to work alongside them to provide the care that is so desperately needed...We need to more fully appreciate the unique contribution of each discipline to the holistic well-being of our patients.
Dr. Kimbi G. Marenakos, Medical University of South Carolina

As South Carolina’s population continues to grow and age, the demand for primary care providers is skyrocketing. One way to meet the needs of patients everywhere is to expand the pool of healthcare providers by granting full practice authority (FPA) to nurse practitioners. There’s overwhelming evidence that NPs provide safe, effective healthcare, typically at a lesser cost than physicians.

FPA has been endorsed by the the National Governors Association (NGA), the Macy Foundation, the National Policy Forum, and the Institute of Medicine (IOM), among many others. Notably, the Federal Trade Commission (FTC) has called for state legislatures to revise their regulatory models so NPs aren’t subjected to unnecessary doctor supervision. It cited an IOM finding that 16 states and Washington DC—regions with FPA—exhibited “no differences in [healthcare] safety and quality” compared to restrictive states such as South Carolina. Also, in the states with FPA, approximately half of NPs choose to work in traditionally underserved rural areas.

Overall, removing the burdensome practice restrictions in South Carolina and across the country is expected to:

  • Increase access to healthcare services, especially among vulnerable and underserved populations
  • Improve the continuity of care
  • Prevent healthcare clinics from closing when doctors retire or move
  • Decrease healthcare costs and bureaucratic inefficiencies
  • Enhance consumer choice

For aspiring NPs or South Carolinians who want to get involved, please check out the following resources:

Jocelyn Blore

Jocelyn Blore


Jocelyn Blore is the Managing Editor of After graduating from UC Berkeley, Jocelyn traveled the world for five years as freelance writer and English teacher. After stints in Japan, Brazil, Nepal, and Argentina, she took an 11-month road trip across the US, finally settling into lovely Eugene, OR. When Jocelyn isn’t writing about college programs or interviewing professors, she satirizes global politics and other absurdities at Blore’s Razor (Instagram: @bloresrazor). Thank you for being interested.

SEARCH FOR SCHOOLS is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.