Health Policy: Full Practice Authority for Nurse Practitioners

Health Policy, Medical Practice / Office Ownership, Podcast, Professional Nursing Practice 7

The Nurse Practitioner Show Podcast Episode 30 Full Practice Authority for Nurse Practitioners with Dr Rachel Danford NP

Click play above to hear The Nurse Practitioner Show™ podcast episode 030 Health Policy: Full Practice Authority for NPs

What is Full Practice Authority?

According to the American Association of Nurse Practitioners (AANP), full practice authority is “the collection of state practice and licensure laws that allow for nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the of the state board of nursing.”

Currently, 29 states require physician collaboration with a signed agreement in order for the NP to provide care; therefore, these states neither allow an NP to practice autonomously nor for the NP to practice to the full extent of their knowledge and training.

Who Recommends Full Practice Authority for NPs?

The Institute of Medicine

The primary push for full practice authority originates from the Institute of Medicine (IOM) Report on the Future of Nursing: Leading Change, Advancing Health within chapter 7. The IOM made several national-level recommendations reflecting the need for changes within all state nursing licensing organizations to promote full practice authority. These recommendation was based on published evidence, the Robert Wood Johnson Foundation Nursing Research Network, and IOM committee members expert judgement and experience.

The National Governors Association

The National Governors Association reviewed the literature and concluded states should consider improving legislative laws impacting NP scope of practice restrictions, as well as the need for modification of reimbursement policies for NPs. Legislative changes to implement full practice authority would increase access to care, as well as decreased cost on the healthcare system.

Bipartisan Policy Center

The Bipartisan Policy Center makes a point to share that many healthcare professions are not able to practice to the full extent of their training and education. Furthermore, research indicates limiting the practice of nurse practitioners limits healthcare professionals to provide cost-effective healthcare.

Josiah Macy Foundation

The Josiah Macy Foundation noted that states with more restrictive legislative laws lose potential NPs to less restrictive states. There NPs move to states with more supportive practice acts and regulations that govern NP practice. In essence, this leads to a “brain drain” of healthcare providers relocating to states more supportive of NPs.

Current Map by AANP 4/14/2016
Current Map by AANP 4/14/2016. Green states have supportive legislation granting full practice authority for NPs, yellow states have reduced practice, and red states have restrictive practice state laws. Click on the map to read more.


American Association of Retired Persons

The American Association of Retired Persons (AARP) encourages states to permit NPs to practice to the full extent of their knowledge and training. The AARP recommends states amend current scope of practice laws and regulations so that NPs may provide healthcare for which they have been trained and certified.

Why Should FPA Be Implemented?

  1. Increased Access To Care
  2. Cost-Effective Healthcare
  3. Protects Patient Choice – the Federal Trade Commission (FTC) has voiced concern with consumer choice and competition with their Advanced Practice Registered Nurse (APRN)-related advocacy filings.
  4. Research indicates the care NPs provide is of comparable quality to their physician counterparts and provide safe healthcare.

How Can Full Practice Authority Be Implemented In Your State?

If you are interested in advocating for issues related to NP practice, the AANP has a free State Policy Toolkit.

If nurse practitioner legislation is proposed in your state, please contact the AANP State Government Affairs office at (512) 732‐2320 or AANP welcomes the opportunity to work with state stakeholders to shape legislation that is beneficial and appropriate for patients, nurse practitioners, and the health care community.

When Will The Federal Government Make Changes?

The U.S. Department of Veterans Affairs (VA) has proposed granting APRNs full practice authority. The VA proposes FPA to optimize access to care for veterans within the VA healthcare system. This would permit APRNs to assess, diagnose, prescribe medications and interpret diagnostic tests without physician oversight. The VA believes this would be positive step forward to remove barriers preventing APRNS from providing full range of healthcare services for their veterans.

Granting this proposal would help to provide faster care for nearly 6 million veterans. Typically, veterans have long wait times for appointments due to limited number of providers. This also would permit a greater distribution of resources. Proposed Rule AP44 issued by the U.S. Department of Veterans Affairs can be found for comment at, your voice for federal decision making. Comments must be received by July 25, 2016.

In addition, you can email Secretary Robert McDonald of the U.S. Department of Veterans Affairs via the AANP Advocacy Center.

More information is also available at The Office of Federal Register, the daily journal of the U.S. Government.

Thank you to Gebauer’s Pain Ease for sponsoring this episode of The Nurse Practitioner Show™.

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