APRN Full Practice Authority
SPN Healthcare Policy and Advocacy Committee
Written by, Heidi McNeely, PhD, RN, PCNS-BC
The term full practice authority is about allowing advanced practice registered nurses (APRNs) the ability to use their knowledge, skills, abilities, and judgement to work to the full extent of their education and training (ANA, 2022). Full practice authority allows APRNs to provide critical services to patients in areas where there are shortages of primary care and specialty care providers and gives patients more options in the care they seek. Removing practice barriers helps increase patient’s timely access to care especially in underserved areas.
APRNs are made up of four specific roles: certified nurse midwives, certified registered nurse anesthetists, clinical nurse specialists, and nurse practitioners (NCSBN, 2022). There are several organizations who have supported and advocated for removing any barriers for this to occur. These organizations include the National Academies of Science, Engineering, and Medicine, the National Governors Association, the Federal Trade Commission, the Bipartisan Policy Center, American Nurses Association, National Council of State Boards of Nursing, the Brookings Institution, and others.
There are licensing barriers and funding barriers to APRNs working at their full scope of practice. A funding barrier is many Medicaid plans reimburse APRNs significantly less than what physicians are reimbursed for the same services (ANA, 2022). Also, not all types of APRNs are able to bill and get paid for the services they are trained to do. For example, not all states cover the services of certified registered nurse anesthetists and clinical nurse specialists like they may do for nurse practitioners and certified nurse midwives (ANA, 2022).
State statutes, rules and regulations may also prevent APRNs from practicing at full scope (National Governor’s Association, 2022). Due to differences in practice regulation across states nurses need to be aware of what defines their practice in the state where they are working or where they intend to practice (ANA, 2022). The American Association of Nurse Practitioners (AANP) maintains a map of nurse practitioner state practice environments looking at those states with full practice for NPs, reduced practice, or restricted practice (AANP, 2022). For states with reduced or restricted practice NP practice is limited in one or more practice elements and there is a requirement for career-long supervision, regulated collaborative agreement with another health provider, limited settings where they can practice, or delegation and management from another health provider for the NPs provision of patient care (AANP, 2022).
All nurses should be aware of their own scope of practice and consider being advocates for full practice authority. As practice regulation may change, it is important to stay informed about changes within your own state. The Improving Care and Access to Nurses (ICAN) Act (H.R. 8812) was introduced to the 117th Congress and would help remove outdated barriers in the Medicare program that currently prevents APRNs from practicing to the full extent of their scope in full practice authority states. SPN supports full practice authority and as an organization we signed on to a letter for Congresswoman Roybal-Allard and Congressman Joyce to support this act and move us closer towards full practice authority across all states.
References:
117th Congress. (2022). I CAN Act H.R. 8812. Retrieved from https://www.congress.gov/bill/117th-congress/house-bill/8812
American Association of Nurse Practitioners. (2022). State practice environment. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment
American Nurse Association. (2022). Advanced practice registered nurses (APRN). Webpages: Medicaid coverage of advanced practice nursing, State law and regulation, Finance and reimbursement, and Scope of practice. Retrieved from https://www.nursingworld.org/practice-policy/aprn/
Bipartisan Policy Center. (2013). Strengthening the health professional workforce. Washington, DC. Retrieved from https://bipartisanpolicy.org/blog/strengthening-health-professional-workforce/
The Brookings Institution. (2018). Improving efficiency in the health-care system: Removing anticompetitive barriers for advanced practice registered nurses and physician assistants. Report. Washington, DC. Retrieved from https://www.brookings.edu/wp-content/uploads/2018/06/AM_Web_20190122.pdf
Federal Trade Commission. (2014). Policy perspective: Competition and the regulation of advanced practice nurses. Washington, DC. Retrieved from https://www.ftc.gov/system/files/documents/reports/policy-perspectives-competition-regulation-advanced-practice-nurses/140307aprnpolicypaper.pdf
National Academies of Sciences, Engineering, and Medicine. 2021. The future of nursing 2020–2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982.
National Council of State Boards of Nursing. (2022). APRN consensus model: The consensus model for APRN regulation, licensure, accreditation, certification and education. Chicago, IL. Retrieved from https://www.ncsbn.org/nursing-regulation/practice/aprn/aprn-consensus.page
National Governors Association. (2022). State efforts to expand the healthcare workforce (Commentary). Washington, DC. Retrieved from https://www.nga.org/news/commentary/state-efforts-to-expand-the-healthcare-workforce/