In the Healthcare industry, there is an increasing demand for qualified healthcare providers as well as affordable, effective healthcare services. The presence of nurse practitioners (NPs) and advanced practice registered nurses (APRNs) appears to fill the gap for the demand that continues to rise in communities across the nation. Currently, there is a nationwide shift towards states’ implementation of full practice authority for APRNs and NPs; however, NPs/APRNs’ scope of practice continues to be restricted or reduced in many states.
Full practice authority allows NPs to evaluate and diagnose patients, order and interpret diagnostic tests, and initiate and manage treatment—including full prescriptive authority. States’ adoption of full practice authority would create greater access to care in underserved urban and rural areas, remove delays in treatment, prevent the unnecessary duplication of services and billing costs, and it would allow patients to see the provider of their choice.
The COVID-19 pandemic, coupled with the preexisting shortage of primary care providers, illuminated an already established need for healthcare services, especially in rural and underserved areas. In anticipation of a surge for the need of healthcare services, many states that have not already implemented full practice authority took temporary measures to expand the scope of practice for certain healthcare professionals. Despite the gap NPs/APRNs filled during the peak of the pandemic, those states’ temporary orders are due to expire as early as the end of March 2021.
Shift Towards Full Practice Authority
In January 2021, Massachusetts became the latest state to grant full practice authority to NPs/APRNs. Now patients in 23 states, the District of Columbia and two U.S. territories are able to benefit from full and direct access to NPs/APRNs and overall primary care. The remaining states have a practice environment that reduces or restricts NPs/APRNs’ scope of practice by either requiring a career-long collaborative agreement with a medical doctor further limiting one or more elements of an NP practice.
Although more states are recognizing the benefit of expanding NPs/APRNs’ scope of practice and some are passing legislation with that need realized, the American Association of Nurse Practitioners (AANP) publicly criticizes states’ passing of laws that fall short of granting full practice authority. In September of 2020, California’s governor signed a bill into legislation, designating it as a grant of full practice authority for NPs, beginning in January of 2023. The AANP withheld its support of the bill’s passing, stating that the bill would establish “a cascading set of new restrictions on NP practice that would maintain California’s position among the most heavily regulated and restrictive in the nation.” The bill does grant full practice authority, but only after an extensive set of requirements are met, including a unique to California, state-based certification exam, that the AANP criticizes as “a duplicative and costly process.”
This March, Arkansas’ Senate passed a bill that authorizes full practice authority for NPs that have completed a minimum of 6,240 hours of practice under a collaborative practice agreement with a physician. If signed into law, it will be another bill meant to expand the scope of practice by granting full practice authority, contingent on additional requirements beyond program accreditation and licensure.
The National Academy of Medicine and National Council of State Boards of Nursing have recommended that all states provide NPs/ARPNs full practice authority. Despite the data that shows that there is a need, NPs/APRNs continue to receive pushback from physicians and physician organizations, such as the American Medical Association. The most common objection from physicians is that many of the restrictions of NPs/ APRNs’ scope of practice, like the collaborative agreements with physicians, protect patients by ensuring oversight. However, existing studies do not show any negative differences in clinical outcomes in primary care for patients treated by NPs/APRNs instead of doctors.
Evolving Laws
Currently Pennsylvania has a full practice authority bill pending, as it awaits a vote by Pennsylvania’s House of Representatives. Reduced practice bills, which do not authorize full practice authority but reduce some restrictions on NPs/APRNs, are currently pending in Florida, Indiana, New Jersey, North Carolina, Ohio, and Texas. That leaves seven states—Oklahoma, Missouri, Michigan, Tennessee, South Carolina, Virginia, and Georgia—that are the most restrictive of NPs/ APRNs’ scope of practice and are not, currently, making any effort towards the trend of full practice authority.
What Can You Do?
You can call your local, state, and federal representatives and request that they support the pending legislation or introduce new legislation that will provide full practice authority to Nurse Practitioners today. You can educate your friends, family and patients on the need to expand full practice authority to NPs/APRNs because it will directly impact their community well beyond COVID. Lastly, you can join advocacy organizations, associations, and activists in sounding the alarm on the disparities that can only be addressed by granting full practice authority to nurse practitioners nationwide.
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Sources
aanp.org
aanp.org
nurseledcare.phmc.org
ualrpublicradio.org
nurse.org
forbes.com