Full practice authority states for nurse practitioners

Nurse practitioners (NPs) are revolutionizing healthcare delivery in America. As of April 2022, 26 states, the District of Columbia, and two U.S. territories now give patients full and direct access to the high-quality care NPs deliver. This year, both New York and Kansas took decisive action to adopt full practice authority (FPA). 

April Kapu, DNP

Propelled by the increasing demand for primary care and the growing numbers of patients nationwide living in areas with a shortage of primary care health professionals, more and more states are rightly considering legislation to ensure patients better access to the outstanding care NPs provide.

Each year, 355,000 licensed NPs see patients for primary, acute, specialty, and long-term care across every healthcare setting. In fact, 82% of American adults have been treated or know someone who has been treated by an NP.

Many patients choose nurse practitioners because they bring a comprehensive perspective to health care, which results in excellent outcomes for patients.

NPs are the fastest-growing primary care provider group, delivering comprehensive, person-centered care to millions of people of all ages and backgrounds in communities everywhere. NPs practice in nearly every healthcare setting, including clinics, hospitals, and emergency rooms, urgent care sites, private practices, skilled nursing facilities, and Veterans Health Administration and Indian Health Services facilities.

Full practice authority gives NPs the licensure authority to practice as they have been educated and trained, to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing.

This regulatory framework eliminates outdated requirements for the profession to hold a state-mandated contract with a physician as a condition of state licensure and to provide patient care.

Decades in the Making

Since the establishment of the NP profession in the mid-1960s, NPs have advocated for the ability to practice to the full extent of our education and clinical training. The inconsistency in regulations governing NPs began in the 1970s when states started to regulate NPs beyond their registered nursing license. Now, 26 states have worked to provide some uniformity in NP licenses, it’s time the other 24 follow suit.

FPA is a critical achievement for these states. Having full practice authority improves access to care, especially in underserved areas; it streamlines care and makes care delivery more efficient; it decreases costs by removing duplication of services and billing costs associated with outdated physician oversight; and it protects patient choice.

The results of enacting FPA speak for themselves. Research shows that states with Full Practice Authority laws are ranked among those with best access to care in the nation. In fact, in George Mason University’s “Healthcare Openness and Access Project 2020: Full Release” research paper, 19 of the ranked highest for access are states with Full Practice Authority laws. Unfortunately, in the remaining 24 states, outdated licensure laws reduce or restrict patient access to the services we provide, which means those states are more frequently to rank lowest in terms of access and quality. For example, nine of the bottom 10 states – ranked for overall health – have yet to grant FPA to NPs.

With some 95 million patients living in federally designated healthcare deserts, it is critical policymakers find solutions, like FPA, to ensure Americans have access to high-quality health care.

America’s NPs represent a vital solution to the healthcare equity and access challenges threatening the health of our nation. The AANP strongly encourages the trend of states adopting FPA to continue, and the vast majority of health consumers agree. Surveys show that overwhelmingly patients support policies and legislation that remove barriers to NP practice and strengthen patient choice in the selection of a healthcare provider.

NPs are leading the charge, working to provide the quality healthcare patients want and America deserves. We deliver patient-centered, accessible health care that should be available to all. When patients choose, patients win.

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April Kapu, DNP, APRN, ACNP- BC, FAANP, FCCM, FAAN, is president of the American Association of Nurse Practitioners. She has 30 years of experience in health care and 18 years as an acute care nurse practitioner. Currently, she is Associate Dean for Clinical and Community Partnerships, Vanderbilt University School of Nursing, with oversight for several nurse-led community practices.