Full Practice Authority for NPs May Increase Access to Health Care

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Full practice authority for Nurse Practitioners

Despite recent efforts to increase access and quality of health care to those in a variety of underserved communities, many individuals still lack the necessary facilities and medical professionals required to address their needs.

Veteran Affairs clinics remain understaffed, and individuals in rural areas must travel hours to receive basic care. More than 58 million Americans reside in areas with primary care physician shortages, according to a 2015 Kaiser Family Foundation study.

One way states have started to address these challenges is by granting nurse practitioners (NPs) full practice authority. The Pennsylvania Senate passed SB 717 in July 2016, which advocates say will improve health care quality, lower costs and expand health care access to those in a variety of communities. According to the Pennsylvania Coalition of Nurse Practitioners, the bill will be introduced again in 2017.

In December 2016, the Department of Veterans Affairs granted full practice authority to three types of advanced practice registered nurses within the VA system.

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What is full practice authority?

As a result of their training, NPs have the ability to order, perform and interpret diagnostic tests, diagnose and treat acute and chronic conditions like diabetes and high blood pressure and prescribe medication. In other words, NPs possess the skills and know-how to manage most aspects of patient care.

But in many states, NPs must have a “collaborative agreement” with a physician. In essence, these contracts allow NPs to practice to the full extent of their training, provided they meet the terms set in the agreement. The terms may include mandates to go over a certain number of charts on a quarterly basis with the physician or just paying a hefty annual fee. Collaborative agreements do not automatically transfer liability to a physician, but they do cost NPs tens of thousands of dollars each year and restrict their ability to effectively serve their communities, especially in rural areas.

Full practice authority laws remove the statutory requirement for NPs to enter collaborative agreements, which many advocates believe is an unnecessary drain on their practices. Right now, 21 states and the District of Columbia have full practice authority laws on the books.

These laws do not force patients to see an NP for their health care needs but allow patients to make their own decisions based on past relationships with NPs and other physicians. Since the scope of practice for NPs varies, advocates say they should be seen as providers who work in similar roles and often on the same team as other physicians.

Why do groups like the VA support full practice authority?

Independent researchers have repeatedly found equal or higher satisfaction rates among patients who receive primary care from NPs compared with those treated by physicians. Health Affairs, a peer-reviewed journal on health care policy and practice, has also released studies that find NPs and primary care physicians produce similar clinical outcomes.

In addition to the dearth of primary care physicians across the U.S., the shortage of nurses in rural areas is a particularly large problem. However, a study by the American Nursing Association found NPs were more likely to practice in rural areas when states allow for greater practice autonomy and were more likely to work in rural areas compared to physicians in both cases.

Moreover, millions of people in the United States outside of rural communities cannot receive timely access to simple health care services. Veteran Affairs clinics are chronically understaffed, and advocates of full practice authority laws say NPs are a viable solution to this problem. They claim there is no reason to defend restrictive legislation that impedes people’s access to quality care.

Ultimately, NPs are not attempting to replace doctors. Rather, they want the ability to practice to the full extent of their licensure and education. They wish to be regulated by their state boards of nursing, rather than receive oversight from physicians who are not well attuned to the practice of nursing and its precepts. They believe full practice laws will expand access to health care and reduce wait times for those who need treatment — without lowering the quality of primary care.

Who opposes full practice authority? Why?

Some physician groups maintain that NPs cannot replace primary care physicians or work free of physician collaboration. They say there is a major difference in the training received by both professions. Primary care physicians must go through six years of medical school after receiving a bachelor’s degree, during which they gain valuable clinical experience and a diverse medical education. By contrast, NP coursework and training range from around 3,500 to 6,600 hours, although the majority of this coursework is applicable to the care NPs hope to provide to patients and does not represent the full extent of their training.

Others believe more NPs will lead to a two-tiered medical system, where the wealthy have the option of seeking out a reputable MD while the less fortunate make do with someone who has “inferior” training. The shorter training time and lower costs of nursing school may also make medical school a less-attractive option, even as the U.S. faces a major shortage of nurses and physicians alike.

However, many NPs already serve rural and other underserved communities where access to a physician is difficult, if not impossible. As a result, NPs provide valuable health care services to an otherwise underserved segment of the population, areas where physicians have shown little interest in setting up practice in the past.

Of course, full practice authority does not mean NPs will stop collaborating with other medical professionals. In our increasingly interconnected world, few patients interact with only one physician or nurse. Rather, full practice authority attempts to eliminate a needless impediment for NPs hoping to provide quality health care to their communities.

What does the future look like?

More states, especially those with significant rural populations, are likely to pass full practice authority laws that enable NPs to utilize the full extent of their training.

Although granting NPs full practice authority may cause further fragmentation, many government agencies seem to think otherwise. The Federal Trade Commission has endorsed full practice bills in the past, arguing restrictions on NPs hamper competition, along with the National Academy of Sciences and National Governors Association.

In the future, full practice authority may empower NPs to serve their communities to the best of their abilities, while maintaining the strong collaboration networks among nurses, physicians and other health care professionals that exist in the present.

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