Heroes in the Fight for Full Practice Authority

The United States is expected to suffer a shortage of between 40,800 and 104,900 doctors by the year 2030, and there’s one little-discussed legislative solution which would expand the pool of available primary care providers: extending full practice authority to NPs across the nation. As it stands, not all states grant their nurse practitioners the same professional autonomy. In “restricted practice” states such as California, Florida, and Texas, NPs are denied the ability to engage in at least one aspect of independent practice and must maintain “collaborative agreements” with supervising physicians in order to perform common patient treatment duties for which they’re fully trained. While the bulk of the evidence shows that NPs provide safe, cost-effective healthcare with outcomes on par with physicians’—sometimes better—there are still states which limit the professional activities of NPs.

Read on below to see interviews with NP professors, researchers, and clinicians across the nation, or check out the NP Full Practice Authority Toolkit to call on your local legislators to change the laws on this important issue.

NP Heroes by State

Nurse practitioners in reduced or restricted practice states are limited in their clinical responsibilities. These interviews explore how NPs are affected by local laws and their advice to petition for legislative change.

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One of the most contentious issues in healthcare today is whether nurse practitioners should be granted full practice authority (FPA). NPs’ ability to provide services in accordance with their level of training and certification isn’t equally guaranteed across American states.

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While most people are aware of the looming primary care provider shortage across the country—especially in Florida—many aren’t aware of a solution which can help alleviate that problem: extending full practice authority (FPA) privileges to NPs.

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For nurse practitioners in Georgia, and across the nation, the struggle for full practice authority remains one of the most contentious issues in healthcare today. Defined as the ability of an APRN to practice to the full extent of his or her education and credentialing, practice authority conditions vary widely by state, from restricted to full practice.

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In Massachusetts and beyond, one of the most pressing issues in the nurse practitioner community is the fight to modernize practice regulations. In some states, NPs cannot provide healthcare to the full extent of their education and credentialing.

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While Michigan NPs still need physician oversight to prescribe schedule 2-5 controlled substances and cannot sign death certificates or workers’ compensation claims, there has been one recent legislative victory to expand their ability to practice: MI HB 5400. This bill was signed by governor Rick Snyder in January 2017, and it allows NPs to prescribe nonscheduled drugs, as well as to dispense complimentary starter doses of qualifying pharmaceuticals; go on hospital rounds; perform independent house calls; and order physical or speech therapy without a collaborating physician.

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Nurse practitioners such as Dr. Hemmer are justifiably frustrated with the practice conditions within Missouri. It’s no surprise that many NPs finishing their studies choose to practice in other states where it’s easier (and more lucrative) to go into business as a relatively independent healthcare provider.

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In the national battle for NP full practice authority, North Carolina’s tireless activists have made great strides, introducing more bills in recent years than other “restricted practice” states. Regions such as California, Florida, and North Carolina deny advanced practice nurses the ability to work to the full extent of their training and abilities.

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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.

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In states 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.

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One of the most contentious issues in healthcare today is the fight for full practice authority among nurse practitioners. NPs in Texas and beyond are trained to work as independent healthcare professionals, but they’re legally restrained from working to the utmost extent of their education and training.

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While the United States is consumed by debates over how to combat the opioid addiction plight or how to get Americans insured, there’s a less-discussed crisis looming on the horizon: the shortage of primary healthcare providers.

NP Heroes By Specialization

The issue of practice authority affects NPs in all specializations. The following interviews demonstrate how these invaluable healthcare professionals are prevented from working to the full extent of their training and abilities.

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Despite the abundant evidence that NPs provide safe, high-quality, and cost-effective healthcare, they’re still unable to practice to the full extent of their graduate education and clinical training in many states.

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Family nurse practitioners make up the largest proportion of NPs in the country.The AANP reports that 55.1 percent of the more than 220,000 licensed NPs nationwide work in the field of family health. Despite the abundant evidence that NPs provide cost-effective, quality healthcare and thrive in states with full practice authority, there’s still an ongoing fight to grant NPs professional autonomy.

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The existence of “full practice authority”—i.e., the ability of NPs to work to the utmost extent of their education and credentialing, especially as it relates to prescriptive abilities and professional independence—varies widely by region.

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Certified nurse-midwives—advanced practice healthcare professionals with graduate-level degrees and credentialing—still struggle to practice autonomously in some U.S. states. The issue of practice authority varies widely by region, affecting the ability of CNMs to work in accordance with their high level of training and certification.

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PMHNPs offer a holistic approach to illness, paying thought to both physical and mental health considerations; diagnosing psychiatric problems and illnesses; prescribing medications; offering counseling and therapy; developing multi-pronged treatment plans; coordinating care between varied healthcare professionals; and educating patients and families on psychiatric conditions. Despite mounting evidence that NPs provide safe, cost-effective healthcare, there has still been significant opposition—particularly from physician groups—against expanding “full practice authority” to NPs across the country.

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In three exclusive interviews, this piece celebrates the invaluable contributions of PNPs across the country and advances the case for granting full practice authority nationwide. NP practice authority still varies widely among states.

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Women’s health nurse practitioners play an invaluable role in offering holistic, comprehensive, and culturally competent health services across the U.S. One of the most contentious issues in the advanced practice nursing community is whether or not a practitioner should be authorized to work to the full extent of his or her education and training.