Tennessee NPs: The Fight for Full Practice Authority

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Rather than engaging in “turf wars” between NPs and MDs, it is time to develop a stepped approach for NPs to achieve full practice authority and to benefit from precepted postgraduate experience as they build confidence and expertise in their diagnostic and treatment skills.
-Dr. Susan Adams, Vanderbilt University

For nurse practitioners across the country, not all U.S. states are created equally. In regions such as Alaska, Colorado, and Oregon, NPs have full practice authority and enjoy relative autonomy in treating patients, working to the utmost extent of their training and credentialing. In places such as Tennessee, however, NPs labor under restricted practice conditions and may be treated as mere mid-level providers who require physician supervision throughout their careers.

Interestingly, in July 2017, the legal terminology surrounding APRN practice changed from physician “supervision” to “collaboration,” but this was a purely cosmetic update. In fact, the Public Chapter 334 legislation states that its intent is a change in terminology only and “not to alter or amend the relationships and designated responsibilities [emphasis added] between APRNs and physicians.” As it stands, NPs must pay for physician oversight over many of their common professional activities, including prescribing medications. Furthermore, the “collaborating” physicians must visit their clinical sites every 30 days, which can be a hindrance for healthcare clinics in more rural regions of the state.

Tennessee is expected to face a severe shortage of primary care physicians by 2025. According to the U.S. Department of Health and Human Services (2017), there will be approximately 4,410 PCPs in Tennessee by 2025, but there will be a demand for 5,460—a shortfall of 19.2 percent. Considering that 86.6 percent of NPs are trained and certified in an area of primary care, these graduate-trained professionals are prepared to help address this looming problem, particularly in underserved rural areas.

Additionally, Tennessee is one of three states that does not allow NPs to write prescriptions for buprenorphine, a substance used in treating opioid addictions. The problem is that half of all U.S. counties do not have a federally approved physician available to write these prescriptions, and the opioid crisis continues to ravage communities across the country.

So why are Tennessee’s NPs so limited in their professional practice? A few years ago, The Tennessean described a “turf war” between doctors and APRNs. While the vast majority of NPs in favor of full practice authority support a team-based model of healthcare and early career supervision, doctors question whether even the most experienced NPs can provide high-quality care. On the contrary, there is overwhelming evidence that NPs provide top-notch healthcare with outcomes on par with their physician colleagues but at a lower cost. Furthermore, there is APRNs may be more willing than doctors to live in and serve remote regions of the country.

For these reasons and more, there is a wealth of national organizations which have advocated for NP full practice authority. These include:

  • Institute of Medicine (IOM)
  • Bipartisan Policy Center
  • National Policy Forum
  • Department of Veterans Affairs
  • Macy Foundation
  • AARP
  • National Governors Association (NGA)
  • Federal Trade Commission (FTC)

As the population of the Volunteer State continues to grow and age, they are going to want to benefit from the untapped potential of experienced NPs. In interviews with five gracious APRNs and professors from Tennessee’s universities, NursePractitionerSchools.com once again makes a case for expanding full practice authority.

Interviews with Tennessee NP Professors

NursePractitionerSchools.com is grateful for the five APRN professors in Tennessee who were so generous with their time. Please note that the following interviews have been edited for length and clarity.

Advancing Full Practice Authority in Tennessee

Full practice authority for all advanced practice nurses would reduce costs and improve lives. APRNs do not want to replace physicians. We just want to help patients, and we can do that if we are allowed to practice to the full extent of our education and training. There is plenty of work for all of us to do.
Dr. Terri Durbin, University of Tennessee, Knoxville

NursePractitionerSchools.com has interviewed more than 50 NP (and other APRN) professors across the country, and the vast majority are in favor of implementing nationwide full practice authority. In Tennessee, allowing experienced NPs to work to the full extent of their training can help remedy the looming primary care shortage in the state, especially for underserved populations.

Physicians’ groups—the only consistent opponents to FPA—must realize that APRNs are not in competition with them, but rather striving to create a practice model that best addresses the healthcare needs of all Americans. In states with unfavorable practice conditions, talented APRNs may be tempted to relocate to other states; furthermore, residents of rural regions in restricted practice areas may see their only healthcare clinic shuttered if a supervising physician retires.

Overall, granting FPA in Tennessee will be to the benefit of healthcare providers, patients, and communities at large. There is overwhelming evidence that states with FPA enjoy lower healthcare costs for consumers, greater access to services, and smoother continuity of care by eliminating bureaucratic inefficiencies and duplicative regulatory agencies.

In addition to checking out this site’s FPA Toolkit, aspiring APRNs are encouraged to become active in the advocacy branches of their local professional groups such as the Tennessee Nurse Practitioner Association and Tennessee Nurses Association.

Jocelyn Blore

Jocelyn Blore


Jocelyn Blore is the Managing Editor of NursePractitionerSchools.com. 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.

NursePractitionerSchools.com is an advertising-supported site. Featured programs and school search results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other information published on this site.