One of the advantages of being a nurse practitioner (NP) is the autonomy in your practice that comes with the degree. Working independently, without physician supervision or direction, allows NPs to fully exercise their expertise as a practitioner. Certain states have adopted full practice authority for nurse practitioners, allowing NPs to work autonomously. However, many states are still limiting progress toward full practice authority for nurse practitioners.
So, how does full practice authority (FPA) impact the way that NPs function from state to state? This article will explore the benefits of FPA for NPs, the different state scope of practice regulations for NPs, and its impact on practice.
Scope of practice can be defined as what care an NP is legally allowed to provide in a professional role. According to the American Association of Nurse Practitioners (AANP), NP services include, but are not limited to: assessment; ordering, performing, supervising and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment including prescribing medication and non-pharmacologic treatments; coordinating care; counseling; and educating patients and their families and communities.
State scope of practice regulations for NPs are divided into three categories:
- Full practice
- Reduced practice
- Restricted practice
Each state has its own designation for practice authority in one of the above three categories. The AANP conveniently organized this data in a state practice environment map to easily illustrate which states in the U.S. are making progress toward the goal of full practice authority for nurse practitioners.
What is Full Practice Authority?
AANP states that “full practice authority” is the authorization of nurse practitioners (NPs) to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments—including prescribing medications—under the exclusive licensure authority of the state board of nursing.” In states where NPs are granted FPA, they do not have to work under the direction or be overseen by a physician. In fact, NPs in states with FPA can own and operate their own health care businesses. NPs can function independently in all aspects of their practice, whether in a traditional or entrepreneurial role. Fortunately, progress in granting NPs FPA continues to gain ground, with approximately half of the U.S. recognizing the importance of this goal.
According to AANP, there are currently 25 states, including Washington, D.C., that allow NPs FPA. Delaware NPs are celebrating their recent addition to the list of states with FPA. Two U.S. territories have also joined the ranks of those who can practice independently. These states are:
- New Hampshire
- New Mexico
- North Dakota
- Rhode Island
- South Dakota
Some states have adopted a partially restricted role for NPs, called “reduced practice.” Reduced practice limits NPs in at least one area of practice, denying them the ability to function to the fullest extent of their training and expertise. Limitations may include restrictions for prescribing medication or requiring collaboration with a physician for oversight.
States with reduced practice laws for nurse practitioners according to AANP are:
- New Jersey
- New York
- West Virginia
In addition, American Samoa, Puerto Rico, and the Virgin Islands are included in the U.S. states that reduce NPs practice.
Restrictive practice is in the states with the most prohibitive laws for NP practice. In this category, NPs are bound to laws that require them to be supervised by an onsite physician. Luckily, the number of states operating under restrictive practice for NPs is diminishing.
States still under restrictive practice are:
- North Carolina,
- South Carolina
On a positive note, California has made progress in removing the barriers to practice for NPs by the year 2023. With the passage of California senate bill 890, NPs in California will be able to work independently under their own license by 2023.
There are many benefits to being a nurse practitioner. However, NPs with full practice authority find increased gratification in their roles. There are many benefits for the community and society by allowing NPs to work to the fullest extent of their ability, in addition to the satisfaction of working autonomously.
By granting NPs full practice authority, many vacant positions in health care can be filled by NPs. According to the Bureau of Labor and Statistics, NPs are a valuable solution to the population needs caused by “increased emphasis on preventive care and demand for health care services from an aging population.” By removing restrictions to practice, NPs can function independently, allowing them to work in areas and positions that could previously only be filled by physicians.
NPs are in demand in all areas of health care. It costs less to employ NPs compared to physicians. With full practice authority, NPs can function similarly to a physician, which can translate to cost savings upfront for health care institutions. In addition, patients may benefit from the reduced cost of care when seeing an NP compared to a physician.
2. Nurse Practitioners Fill the Gap in Rural and Underserved Areas
Nurse practitioners have been essential to fill vacant provider positions in rural and underserved areas with physician shortages. With full practice authority, NPs can fully step in and treat patients where providers are in short supply.
3. Excellent Job Outlook
NP are in demand across the U.S., but job possibilities are endless for those who can exercise full practice authority. In addition to working in hospitals, clinics, and offices, NPs who can practice independently have many additional exciting entrepreneurial career options that increase their profitability and demand for their expertise.
Some interesting, innovative NP career options include:
- Clinic owner such as aesthetic, weight loss, men’s health, or infusion
- Health coach
- Mobile testing or practice owner
- Continuing education provider
- Online store owner such as supplements and health food
4. Makes Delivery of Patient Care More Effective
Patients benefit by increasing the number of providers available to meet demands for preventative and routine health care due to provider shortages. Patients are able to have better access to health care overall with more provider options for treatment, less waiting for appointments, and quicker follow-up. NPs with full practice authority can efficiently see patients without waiting to collaborate or have physicians sign off on orders, making the patient care process run more quickly and smoothly.
5. Nurse Practitioners Are Popular with Patients
NPs’ approach to medical care is different from a physician who is focused on disease treatment. NPs are trained to look at a patient from a holistic perspective, incorporating the whole person, and providing patient-centered care that focuses on disease prevention and management. This type of care translates to high patient satisfaction and lower out of pocket costs for the patient.
6. Help in Opioid Crisis
For patients with addiction problems, NPs who have full practice authority to prescribe and treat this population, are an invaluable resource for the current opioid crisis.
NPs bring an integrative approach to their treatment plans, instead of simply writing a prescription for pain. By understanding and incorporating the patient’s needs along with alternative treatments for care, a patient may avoid relying heavily on addictive medications for pain management. This is especially important in rural and underserved areas where patients with addictions may have limited access to treatments.
7. Aging Population
According to the U.S. Census Bureau, those in the aging population of 65 and over are growing rapidly. With the increasing need for health care in the geriatric population, along with the aging workforce retiring, there could be a health care crisis due to an insufficient medical workforce to meet the supply and demand for care. NPs who have full practice authority could easily step in and assist in filling this disparity in health care.
Limitations of Role for Nurse Practitioners in Restrictive Practice States
States that curtail NPs from fully practicing according to their degree and ability are limiting a valuable resource for patients and the health care industry. Restrictive practice creates patient access barriers and drives up costs for health care across the state. Rural and medically underserved areas in states with restrictive authority create additional barriers to health care access for patients. NPs have the ability to offer care independently to provide more opportunities for health care access.
In addition, regulating and eliminating tasks that an NP can perform may result in serious patient care delays. Requiring physician referrals or signatures for tests, hospitalization, home health care, and nursing home placement are just a few examples of restrictions on NPs that can disrupt treatment flow.
Where Does Tennessee Currently Stand in the Scope of Practice for Nurse Practitioners?
Currently, Tennessee is one of the few remaining states with restrictive practice laws for NPs. These laws require full physician supervision on-site at all times or have regular oversight visits from a physician.
The US faces an ever-increasing physician shortage, and Tennessee is not exempt from this problem. According to Health Professional Shortage Areas (HPSAs), Tennessee has 101 areas of mental health and primary care provider shortage.
A report from the Robert Graham Center in Tennessee suggests that “Tennessee should consider strategies to bolster the primary care pipeline” due to an expected severe primary care physician shortage by 2030. Without full practice authority, the ability for NPs to help supply the demand for providers in Tennessee is severely limited.
Implications for Nursing
Nurses have always been essential voices when it comes to advocating for change for their patients, profession and healthcare system. Now more than ever, NPs have the opportunity to step up and campaign for greater autonomy in their practice. The American Nurses Association (ANA) “believes that advocacy is the pillar of nursing.”
Nurses considering a career as a NP may enroll in an MSN-FNP program, knowing they will be in demand across the US more than ever following graduation. However, it is important to understand what laws pertain to each state regarding the scope of practice for NPs. If you want to fully utilize your degree and expertise, practicing in a state with full practice authority for nurse practitioners is essential for graduate nurses when looking at job opportunities.
Want to learn more about the online MSN-FNP program or Post-Master’s FNP certificate at Carson-Newman? Contact an enrollment advisor for more information about an exciting career as a family nurse practitioner.
Donna Reese MSN, RN, CSN
Donna Reese is a freelance nurse health content writer with 37 years nursing experience. She has worked as a Family Nurse Practitioner in her local community clinic, as a school nurse, and in home health and rehabilitation, along with hospital nursing. Donna is passionate about the profession of nursing and supporting others. Along with health content writing, Donna writes weekly blogs to support and encourage nurses, in addition to those suffering from auto-immune conditions.
Overall, nurse practitioners are required to be loosely supervised by physicians in Tennessee. The physician must comply with mandatory site visits and chart reviews as well as be available to the nurse practitioner at all times but not necessarily in person.Do nurse practitioners in Tennessee have full practice authority? ›
Tennessee is one of 11 states with the highest level of restrictions for advanced practice registered nurses (APRNs) — nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists — requiring them to work under collaborative practice agreements with a physician.What are the four roles of the advanced practice nurse? ›
There are four types of roles for an Advanced Practice Registered Nurse (APRN): clinical nurse specialists, certified registered nurse anesthetists, certified nurse practitioners, and certified nurse midwives.Do nurse practitioners have full practice authority in Pennsylvania? ›
Full Practice: State law provides for nurse practitioners (NPs) to evaluate, diagnose, treat, and prescribe under the exclusive licensure authority of the state board of nursing.What is the greatest advantage of independent NP practice? ›
One of the advantages of being a nurse practitioner (NP) is the autonomy in your practice that comes with the degree. Working independently, without physician supervision or direction, allows NPs to fully exercise their expertise as a practitioner.What can a doctor do that a nurse practitioner Cannot? ›
A primary difference between physicians and NPs is the fact that all doctors can prescribe medication to patients as a part of their duties. Nurse practitioners also prescribe medicine, but in some states they must be directly overseen by a doctor or physician in order to do so.What states give nurse practitioners full autonomy? ›
- Alaska. In Alaska, all NPs have FPA. ...
- Arizona. In Arizona, licensure through the Arizona Board of Nursing includes full prescriptive authority. ...
- Colorado. ...
- Connecticut. ...
- Delaware. ...
- District of Columbia. ...
- Hawaii. ...
A nurse practitioner will give the same quality of care as a general physician. Most nurse practitioners spend many years working as registered nurses. In their capacity as nurses, they take care of patients, performing tasks like administering medication and monitoring patients.Is an APRN considered a doctor? ›
There can be a lot of confusion about the scope of practice for different health care providers. When you see a nurse practitioner prescribing your medication, diagnosing you, and doing procedures, you may wonder, "is a nurse practitioner a doctor?” The short answer is no.What are the benefits of utilizing an advanced practice nurse? ›
Consistently reported positive outcomes include greater patient satisfaction, improved access to health advice, and better chronic disease self-management.
newly-acquired knowledge/skills. patient/resident satisfaction. clinical outcomes.Are nurse practitioners higher than PA? ›
Is NP higher than PA? Neither profession ranks "higher" than the other. Both occupations work in the healthcare field, but with different qualifications, educational backgrounds, and responsibilities. They also work in different specialties.What can nurse practitioners bill for? ›
Services for Which an NP Can Bill Medicare
Part A covers hospitalization, skilled nursing facility services, and some home health services. Part B covers physician services, outpatient hospital services, laboratory procedures, medical equipment, and some home health expenses.
FULL: NPs can prescribe, diagnose, and treat patients without physician oversight. Nurse practitioners who operate in full-practice states are also allowed to establish and operate their own independent practices in the same way physicians do.What are the main benefits to the NP of NP practice ownership? ›
The advantages to the public of NP practice ownership are: The patient gets the benefit of combined nursing and medicine. The patient reaps the benefit when the patient gets more face time with the provider. The patient may pay less or get more for the same money.Why NPs are better than doctors? ›
Of the 18 core questions, NPs had better scores than physicians on 15, according to The Clinical Advisor. In general, the findings indicated that NPs spend more time with patients, listen more closely, provide more feedback, show more respect for patients' opinions, and the like.What does full practice authority mean? ›
“Full practice authority” is generally defined as an APRN's ability to utilize knowledge, skills, and judgment to practice to the full extent of his or her education and training.Is there anything above a nurse practitioner? ›
Doctor of Nursing Practice (DNP)-Prepared Practitioner
The Doctor of Nursing Practice is a terminal nursing degree, meaning that it is the highest possible practice-based degree in nursing.
Hourly Doctor vs.
According to the Bureau of Labor Statistics, doctors typically earn approximately $100 per hour, on average. Nurse practitioners often make a little over $50 per hour.
NPs can obtain multiple degrees across multiple specialties, or they may choose to just focus on one area. Depending on your geographic region, knowledge about specialty NPs may be fairly uncommon, or a specialty certification may be the only way to get a job in a particular area.
|The Best States for Nurse Practitioners: Full Practice Authority|
|The Worst States for Nurse Practitioners: Restricted Practice Authority States|
States ranked by NPs per capita: Massachusetts is No. 1. Becker's Healthcare: Hospital.How much do nurse practitioners make? ›
|State||Per hour||Per year|
Can you go from NP to MD? An NP could become an MD by applying to medical school and going through all the requirements.How many patients should an NP see a day? ›
Generally, an NP needs to see 20 patients a day to generate enough money to make a practice profitable. However, that number depends on the fee schedule, the NP's salary and benefits, the practice's overhead expenses, and the practice's expectation of profit.How do you address a nurse practitioner? ›
'Ms. (Her Name)' is the standard form. 'Mrs. (Husband's Full Name)' might be right if you know her personally and kn0w this traditional form is her preference.What is the correct title for a nurse practitioner? ›
A nurse practitioner (NP) is a nurse with a graduate degree in advanced practice nursing. This type of provider may also be referred to as an ARNP (Advanced Registered Nurse Practitioner) or APRN (Advanced Practice Registered Nurse).Is a Aprn different from NP? ›
A nurse practitioner (NP) is a type of APRN. These nursing professionals diagnose and manage acute and chronic diseases, perform physical assessments, create treatment plans, and even prescribe medications in certain states.Is a nurse practitioner a masters or doctorate? ›
A nurse practitioner (NP) is the title bestowed upon a nurse who has earned a master's degree and completed additional clinical training that qualifies them to become certified in one or more specialties. An NP is one of four Advanced Practice Registered Nurse roles.What is the importance of good clinical practice? ›
GCP protects the rights, safety and wellbeing of study participants. Compliance with GCP assures patients and the public that the rights, safety and wellbeing of people taking part in studies are protected and that research data is reliable.
Clinical leadership uses the skills of the RN and adds components of general leadership skills, skills in management of care delivery at the point of care, and focused skills in using evidence-based practice for problem solving and outcomes management.Why do you want to be an advanced nurse practitioner? ›
The role of Advanced Nurse Practitioner is invaluable. It provides opportunity for patients to receive timely care and negate unnecessarily delay in receiving treatment, especially with the growing shortage of GPs in primary care.How are NPs making a difference? ›
Lowering Costs of Health Care
In a study comparing a physician-managed practice and a NP-managed practice, patients in the NP-managed practice had 43% fewer ER visits, 38% fewer inpatient days and an annualized patient cost 50% lower than that of the physician practice.
States that restrict or reduce NPs' ability to practice by limiting licensure authority are more closely associated with geographic health care disparities, higher chronic disease burden, primary care shortages, higher costs of care and lower standing on national health rankings.How do APRNs contribute to healthcare? ›
It trains candidates to provide quality care that considers many factors that affect health. Specialized education allows NPs to offer a full range of health care services such as health promotion and disease prevention, as well as health education and counseling.What are the 4 P's in nursing care? ›
The four Ps (predictive, preventive, personalized, participative)  (Box 21.1) represent the cornerstones of a model of clinical medicine, which offers concrete opportunities to modify the healthcare paradigm .What are the 6 C's of nursing? ›
Advanced level nursing practice has four pillars of practice, which the advanced practitioner must have as part of their core role and function. These four pillars are: Clinical/direct care • Leadership and collaborative practice • Improving quality and developing practice • Developing self and others.What states do NP have autonomy? ›
Currently, Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, and Wyoming are full practice authority states.What is the Tennessee nurse Practice Act? ›
The Tennessee Nurses Association will be introducing state legislation to update the Nurse Practice Act to give nurses the ability to provide direct patient care without the need for costly oversight of their practice by a physician.
|The Best States for Nurse Practitioners: Full Practice Authority|
|The Worst States for Nurse Practitioners: Restricted Practice Authority States|
How much does a family nurse practitioner make in Tennessee? The average FNP salary in Tennessee is $48.67 an hour, which multiplies out to $8,430 per month or $101,230 annually.Why is full practice authority important? ›
Decreases Costs — FPA avoids duplication of services and billing costs associated with outdated physician oversight of NP practice. FPA reduces unnecessary repetition of orders, office visits and care services. Protects Patient Choice — FPA allows patients to see the health care provider of their choice.What does NP full practice authority mean? ›
The American Association of Nurse Practitioners has offered a definition of full practice authority as “the collection of state practice and licensure laws that allow for nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe ...Which state has the most NP? ›
States ranked by NPs per capita: Massachusetts is No. 1. Becker's Healthcare: Hospital.Can a nurse practitioner open a clinic in Tennessee? ›
What legal considerations did you take into account in opening the clinic? Nurse practitioners in Tennessee are not allowed to practice independently so Dr. Rozmond will need to sign a portion of Mimi's charts to remain in compliance with state law.How does the nurse Practice Act impact my professional practice? ›
The laws and regulations set out in a state's Nurse Practice Act have been put together to reduce the risk of harm to patients and to protect them by ensuring the highest level of competence. The Nurse Practice Act aims to ensure that patients receive quality care while promoting patient safety.What is Bill 124 about for nurses? ›
Passed by the Ford government in 2019, Bill 124 imposes a hard cap of 1% per year to wages and benefits for nurses and other health care professionals for a three-year period.What state has highest NP salary? ›
According to data from the U.S. Bureau of Labor Statistics, California is the highest paying state for nurse practitioners. Entry-level nurse practitioners in the state earn over $50 hourly and average about $107,310 yearly. NPs with ten to nineteen years can earn up to $165,140 yearly.Which nurse practitioner specialty is in highest demand? ›
Which In-Demand Nurse Practitioner Specialty Is The Most Popular? The most popular NP specialty is a family practice. This is most likely due to the flexibility the job offers. If you pursue FNP in school—you can work in family medicine, urgent care, and most specialty clinics, including palliative care and hospice.
Featured Online MSN Programs.
|State||*Number of Jobs|
|1. New York||21,870|
Tennessee is the state that pays Nurse Practitioners the lowest average annual salary. The average annual wage for an NP in Tennessee is $95,120. Meanwhile, the average hourly wage is $45.73. The state employs about 11,360 NPs.What do the top 10% of nurse practitioners make? ›
According to BLS data, NPs can expect a general salary range of $79,470 for the lowest 10% and up to $163,350 for the highest 10%. Within this range, however, several factors influence NP salary levels, such as certifications, education level, years of experience or experience type, and practice setting.How can a NP make a lot of money? ›
- Pursue Continuing Education or Additional Certifications. ...
- Explore New Areas of Nursing. ...
- Gain Work Experience. ...
- Negotiate Better Nursing Contracts. ...
- Produce Medical Writing.