5 Reasons Nurse Practitioners Need to Advocate for Full Practice Authority

Nurse practitioner with medical team
Nurse practitioner with medical team

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Being a nurse practitioner (NP) is one of the most challenging yet rewarding careers. Most NPs couldn’t dream of a different career choice. In fact, a recent survey of health care professionals indicated that NPs are more satisfied than other health care disciplines. NPs successfully navigate the complex health care market, while maintaining self-satisfaction, by combining patient-focused care and compassion with advanced training and expertise. Patients consistently rate the care of NPs as outstanding, however, without full practice authority (FPA), NPs are unable to reach their full potential.

What is Full Practice Authority?

According to the American Association of Nurse Practitioners “Full practice authority is the authorization of nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments—including prescribed medications—under the exclusive licensure authority of the state board of nursing.”

Full practice authority validates the knowledge, skills, and abilities of NPs and recognizes that the state board of nursing is the appropriate oversight agency to regulate NPs. States with FPA legislation allow NPs to operate independently without collaboration from a medical board or supervision from a physician.

As of January 2021, 23 states and the District of Columbia have authorized FPA for NPs. FPA legislation is broken down into two sub-categories, FPA on initial licensure and FPA after a provisional period.

Jurisdictions with Full Practice Authority on Initial Licensure

1.   Alaska

Alaska offers FPA to all NPs, including the ability to prescribe class 11 – V controlled substances. Prescriptive authority for controlled substances is a separate application than the authority to diagnose and treat medical conditions.

2.   Arizona

NPs are granted FPA and full prescriptive authority through the Arizona State Board of Nursing. Prior to prescribing medications, NPs must submit a Controlled Substance Prescription Monitoring Program (CSPMP) application and register with the Drug Enforcement Agency (DEA).

3.   Hawaii

The Hawaii State Board of Nursing recognizes the full practice authority of NPs. Prior to prescribing medications,  NPs must take advanced coursework in pharmacology.

4.  Idaho

In addition to offering FPA, Idaho has partnered with its neighboring state, Wyoming, to allow NPs to work in both states under a single license. To earn prescriptive authority, NPs must complete 30 hours of qualifying continuing education courses.

5.  Iowa

NPs in Iowa can treat, diagnose, and prescribe independently. To prescribe controlled substances, up to schedule 11, NPs must separately apply for a Controlled Substance Registration and be authorized by the DEA.

6.  Maryland

NPs in Maryland may practice independently and there is no provisional period. However, in an attempt to curb opioid use, NPs who prescribe narcotics must register with the state’s Prescription Drug Monitoring Program (PDMP).

7. Montana

NPs are granted full practice authority in Montana. However, they must be board certified and have graduated from an accredited NP program that included a preceptorship.

8. Nebraska

In Nebraska, NPs may work independently and prescribe medications. They must complete 10 hours of pharmacology continuing education every 2 years to maintain prescriptive authority. To order scheduled drugs, they must have an active DEA registration. 

9. Nevada

NPs in Nevada have FPA. To prescribe medications, NPs must apply for a license from the Nevada Board of Pharmacy.

10. New Hampshire

The New Hampshire Board of Nursing regulates the scope of practice of NPs and grants them FPA after completing the licensure process.

11. New Mexico

In New Mexico, NPs are granted FPA on original licensure and may prescribe medications, including class 11-V scheduled drugs. Prescribing scheduled medications requires registration with the DEA.

12. North Dakota

NPs in North Dakota have FPA, including prescriptive authority. To prescribe medications, they must complete 30 hours of coursework in pharmacology every 3 years. Newly graduated NPs may apply their NP coursework in pharmacology to their 30 hour requirement.

13. Oregon

In Oregon, NPs have FPA with prescriptive authority. However, to practice outside of their original population focus, the Oregon Board of Nursing requires an oversight relationship with a physician.

14. Rhode Island

Although NPs may practice independently in Rhode Island, they must be on the Uniform Controlled Substance Registration to prescribe medications.

15. South Dakota

In 2017, changes to South Dakota’s Nurse Practice Act granted NPs FPA. Granting FPA in South Dakota is an important milestone, given the state’s large rural population and need for providers in underserved communities.

16.  Washington State

Washington state offers NPs FPA and prescriptive authority, including scheduled drugs.  However, applicants who graduated more than 1 year ago must provide documentation that they have worked at least 250 hours as a NP within the past 2 years. 

17. District of Columbia 

NPs apply for licensure through the Board of Nursing, which is under the Department of Health. To prescribe controlled medications, NPs must complete a separate application to be on the controlled substance registry

18.  Wyoming

NPs in Wyoming reap the benefits of FPA and have the option of working in the neighboring state, Idaho, with their Wyoming NP license.

Gloved hand with stars and stripes heart

States that Offer Full Practice Authority After a Provisional Period

1.   Colorado

NPs in Colorado are granted FPA after completing 1000 hours of practice with provisional prescriptive authority. During the provisional period, there is a requirement for oversight from either a physician or another NP. The collaborative agreement must be registered with the state board of nursing.

2.   Connecticut

Connecticut and Colorado have similar FPA requirements. Like Colorado, NPs have a provisional status before being granted FPA. The provisional period in Connecticut is three years and a minimum of 2000 hours. 

3.   Maine

The Maine board of nursing requires some advanced practice nursing specialties to have 24 months of supervision before applying for independence. NPs may prescribe medications in addition to diagnosing and treating medical conditions.

4.   Massachusetts

In 2021, Massachusettsbecame the 23rd state to authorize FPA for NPs. Under the new law, NPs may apply for full practice authority after completing two years of qualified supervised practice. 

5. Minnesota

NPs starting their practice after July 1st, 2014 must work in a collaborative agreement for at least 2080 hours prior to being granted FPA. The board of nursing requires a signed affidavit from the NP confirming the completion of the provisionary period. 

6.   Vermont

Prior to obtaining FPA in Vermont, NPs must enter into a collaborative agreement with a physician or a NP for two years and a minimum of 2400 hours.

African American male nurse practitioner holding stethoscope up to young child

Benefits of Full Practice Authority

A recent policy brief by the American Association of Nurse Practitioners outlines the tangible benefits of FPA for both patients and providers. 

Based on the policy brief, there are five specific reasons NPs need to advocate for FPA

1.   It increases patients’ ability to access care.

By eliminating unnecessary legislation that limits the autonomy of NPs, more providers are available to see patients.

2.   FPA results in more choices in the health care market.

NPs tend to seek employment in regions that offer more career advancement. When there are more providers per capita, patients have more choices and increased access to health care.

3.   It creates a more efficient health care system.

The NP model of education focuses on collaboration. NPs are astute at identifying problems that need further evaluation and facilitating appropriate referrals to specialists.

4.   It lowers health care costs.

Multiple studies have demonstrated that NPs provide high quality care at a lower cost than their physician counterparts.

5.   It increases job satisfaction among NPs.

Many nurses choose to become NPs because they want to have a more autonomous role and have a larger impact on the health of their patients. Full practice authority allows NPs to accomplish these goals.

NPs Are Advocates for Change

Nurses and NPs consistently advocate for patients’ rights and for increased access to care. The American Nursing Association (ANA) emphasizes the important role of advocacy in nursing. According to the ANA, “Advocacy is a pillar of nursing. Nurses instinctively advocate for their patients, in their workplace, and in their communities; but legislative and political advocacy is no less important to advancing the profession and patient care.”

Echoing the need for political advocacy to advance the profession, NPs have taken their passion for improving patient care to the policy level. A recent study published in the Journal of the American Association of Nurse Practitioners highlights how changes in the health care market, like the passage of the Affordable Care Act in 2010, have been leveraged to increase FPA for NPs. Between 2011 and 2016, eight states passed full practice authority legislation for NPs, which is an eight-fold increase from the previous 10 years.

The Expanding Role of Nurse Practitioners

NPs’ scope of practice is still significantly limited in some states despite the fact that NPs are an essential part of the U.S. health care system and have been providing affordable, safe, and quality health care to millions of patients since the 1960’s.. The ability of nurse practitioners to work independently and provide the best care to their patients increases when they are granted full practice authority.

Policies that increase the autonomy of NPs are well founded and improve patients’ access to care. A recent systemic review published in the Journal of Evidence Based Nursing indicates that patients are more satisfied with the care they receive from NPs versus physicians. This may be because NPs tend to have a longer consultation time and do a more thorough investigation of the patient’s chief complaint.  Furthermore, the systemic review indicated that there is no decrease in health outcomes when patients are cared for by NPs.

Nurse Practitioners Deserve Full Practice Authority

NPs consistently demonstrate their worth in the health care market. Patients are more satisfied with the level of care provided and health care costs are lower in markets in which NPs have FPA. These statistics are not surprising given the rigor of NP education programs. The AANP policy statement on FPA clearly outlines why NPs should be granted FPA throughout the U.S.: 

  • NPs are required to meet national education standards.
  • Prior to practicing, NPs are required to obtain national certification in their specialty.
  • The NP model of care encourages collaboration among disciplines.
  • NPs are held accountable for the quality of care that they provide by their state board of nursing and the public.

Nurse in blue scrubs putting on gloves

Advocating for Nationwide Full Practice Authority

NPs need to advocate for expanding FPA privileges in the remaining 27 states in which their scope of practice is limited. There are five key ways that expanding FPA privileges benefits the U.S. health care market.

  1. It increases patients’ ability to access care.
  2. It results in more choices in the health care market.
  3. It creates a more efficient health care system.
  4. It lowers health care costs.
  5. It Increases job satisfaction among NPs.

NPs fill a critical role in the U.S. health care system. They tend to serve in underserved areas, drive down the cost of health care, and provide phenomenal care. Multiple studies have demonstrated the benefits of FPA for NPs. Furthermore, states that restrict NPs’ scope of practice have a higher shortage of primary care providers and lower standings on national health metrics. Increasing the number of states that offer FPA to NPs improves patient care and advances the profession of NPs.

A Catholic university in Arlington, Virginia just across the river from Washington, D.C., Marymount University offers a long history of success, high rankings, clinical placement services and outstanding student pass rates for certification exams.

By enrolling in one of Marymount’s online NP programs, including MSN-FNP, DNP-FNP, MSN to DNP or Post-Master’s Certificate-FNP you can have a role in leading Nurse Practitioners to Full Practice Authority throughout the United States. Becoming a FNP with Full Practice Authority will help increase compassionate care and improve patient outcomes for all patients.

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Guest Author:

Rebecca Brunelle, PNP is a pediatric nurse practitioner with experience in telephone triage, pediatric critical care, and pediatric cardiology. She is currently living in Buenos Aires, Argentina. Since moving abroad, she has kept active in the nursing profession by doing international missions, writing nursing blog posts, and working in copy/editing for nursing curriculum.