Updated: Dec 3, 2019
Why do we need to expand the scope of practice for Nurse Practitioners?
Expanding the scope of practice for Nurse Practitioners (NPs) is an important political issue that requires policy reform because there is currently a shortage of Primary Care Providers in the United States. This workforce shortage hinders equitable access to healthcare for millions of Americans. It is expected that this shortage will only continue to rise due to unnecessary hospitalizations and the rapidly growing aging population. There are poor health outcomes related to inadequate primary care follow-up due to this shortage. Continuity of care improves when advanced practice registered nurses (APRNs) are granted full autonomous practice authority to take care of patients in primary care settings with full practice authority. However, state and federal laws and regulations, as well as hospital bylaws and policies, create roadblocks to patients’ access to the provider of their choice, if that provider is an APRN. Removing these barriers reduces costs, increases consumer choice, and improves health care quality.
Physician oversight of NP's does not result in safer care. Rather it is based on a traditional model that is outdated, and not evidence-based. Physician oversight of NP's does not allow NPs to bill or get paid directly from insurance companies, or be credentialed, own their practice without a collaborative agreement or provide all services they are trained to do, including writing prescriptions.
The solution and role of the Nurse Practitioner
The role of the NP aims to bridge the gap. There are scope of practice rules, licensure and other requirements which vary across states for the profession. Rules and requirements in some states deviate from evidence-based research of advanced skills of nurse practitioners and there is no national standard. Restrictive and limited scope of practice laws and regulations affect access to health care and its quality. The solution to this issue is to allow Nurse Practitioners to take on an independent role as primary healthcare providers to practice to their full practice authority (FPA) in every state. Implementing FPA for NPs will address the primary care provider shortage by removing delays in care, improving continuity of care and removing barriers to patients accessing care. It will also increase the cost effectiveness of healthcare utility for insurance providers and expand consumer and family choice. There are currently 24 states with full FPA. Other states either have reduced or restricted practice authority. Find out if your state has full, limited or restricted FPA here.
If you are interested in policies like this, find out how to get more involved here.
Organizations favorable to NP FPA Reform
Organizations against NP FPA Reform
AANP Advocacy Center
The Success story of The Department of Veteran Affairs
In December 2016, The Department of Veterans Affairs (VA) granted FPA to all NPs working at the VA within the scope of their employment. While 56% of remaining the states prohibit APRNs from practicing at the full scope of practice, the VA is paving the way for change to occur in other organizations and states to improve quality and access to care in our nation. May we continue to lead by this example of policy success enacted!