Benefits of Full Practice Authority for Nurse Practitioners

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Even before the COVID-19 pandemic, the U.S. healthcare system faced many challenges. An aging population requiring more care, limited access to healthcare in rural and other areas in the country, and the ongoing opioid crisis have all strained healthcare providers to their limits and beyond.

Healthcare industry experts say that advanced practice registered nurses (APRNs) — which includes nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives — may be part of the solution in meeting those challenges. This is especially true for nurse practitioners who have full practice authority or practice autonomy.

Nurse professionals who are interested in expanding their experience and skill set, and who want to be part of solving these and other healthcare issues, should consider a Master of Science in Nursing (MSN) program.

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There are three levels of practice authority for nurse practitioners (NPs): full practice authority, reduced practice authority, and restricted practice authority. Each state and territory establishes the level of autonomy it allows NPs.

Full practice authority permits NPs to evaluate, diagnose, and manage treatments for patients, as well as order and interpret medical tests. NPs with full practice authority may own their own practices as physicians do. They are licensed by the board of nursing in their state.

In the U.S., 24 states, the District of Columbia, and two U.S. territories allow for full practice authority.

During the COVID-19 pandemic, some states lifted restrictions on NPs to alleviate pressure on the healthcare system. Nursing advocates call for the restrictions to be removed permanently to improve healthcare access and lower the costs of care, which are just two of the benefits of full practice authority for nurse practitioners.

The other levels of practice authority include:

• Reduced Practice Authority: In states with reduced practice authority, NPs can diagnose and treat patients, but physicians must handle certain tasks such as prescribing medications. Fifteen states have established reduced practice authority.
• Restricted Practice Authority: Restricted practice authority means NPs must have physician oversight to diagnose and treat patients. Patients may have to see the physician as well as the NP. The remaining 11 states are restricted practice states.

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According to the American Association of Nurse Practitioners, there are stark differences in healthcare costs between states that allow full practice authority for NPs and states that don’t. Access to healthcare, medical costs, and population health are all impacted by how states restrict practice authority for NPs.

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According to the U.S. Department of Health and Human Services (HHS), some 85 million Americans live in regions that are known as primary care Health Professional Shortage Areas (HPSA). NPs in states with full practice authority often live and work in these HPSAs, and as a result fill a need for healthcare. This is especially important in rural and low-income areas. HHS estimates that HPSAs will need more than 15,000 primary care medical practitioners to meet healthcare needs in those regions.

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One of the benefits of full practice authority for nurse practitioners is more efficient care. Patients can receive treatment without waiting for physician approval. This streamlines care delivery, removing the wait for physician authorization and eliminating the need for an additional doctor visit. It can also decrease costs, because only one healthcare provider is billed.

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According to several studies, Medicare and Department of Veterans Affairs patients who have complex conditions such as diabetes require less acute care when treated by NPs and physician assistants. Similar studies have shown the effectiveness of care under NPs for patients with other chronic conditions, such as asthma and high blood pressure. States that offer full practice authority saw lower outpatient costs and prescription drug costs compared to states with restricted practice authority.

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According to the U.S. Department of Health and Human Services, more than 10 million people abused opioids in 2019. Additionally, the Centers for Disease Control and Prevention (CDC) announced in late 2021 that U.S. drug overdose deaths topped 100,000 in a 12-month period for the first time, propelled by opioid abuse. The opioid crisis largely impacts low-income and rural regions, which are often also HPSAs. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act of 2018 allows NPs to prescribe medications to treat opioid addiction.

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A study by the publication Nursing Outlook showed that hospitals with more NPs on staff saw higher patient satisfaction. Other metrics of improved care quality included a shorter average length of stay, lower readmission rates, and lower 30-day mortality rates.

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In 1965, Loretta Ford and Henry Silver, a nurse and doctor, respectively, developed the nurse practitioner role to increase access to healthcare in rural areas. Over the decades, several states have adopted the NP model. They’ve seen the benefits of full practice authority for nurse practitioners in keeping healthcare costs low while increasing access among underserved communities.

Despite opposition from the American Medical Association, which claims that full authority will lead to lower care quality and higher costs, the number of states granting full practice authority to NPs continues to grow, with Delaware becoming the latest state in 2021. California’s law to offer full practice authority goes into effect in January 2023.

Advocates for full practice authority see the COVID-19 pandemic as an illustration of the advantages of full practice authority. States that lifted all or some of their restrictions during the pandemic did so to respond to healthcare shortages. Although some of these executive orders have expired, they show how NPs and other APRNs can do more than fill gaps in care. They are providers in their own right.

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As states realize the advantages that full practice authority can bring to patient care, the opportunities for NPs will grow. Maryville University’s online Master of Science in Nursing program offers a sound foundation in gerontology, pediatrics, and family health, among other coursework. It can prepare you for a leading role in confronting the challenges of modern healthcare, and help you build a rewarding career as an NP. Explore the program today.