The ROI of Giving APRNs Full Practice Authority

The lack of full practice authority puts more strain on an already overburdened system, according to this nurse practitioner.

After decades of practicing under supervision, nurse practitioners (NP) and other APRNs are gaining full practice authority across the country, state by state.

Currently, just over half of the United States has granted full practice authority, including the recent addition of Wisconsin. From a leadership perspective, it's important for CNOs to understand the ROI of NPs having full practice authority and how they fill critical gaps in the healthcare workforce.

According to Wendy Wright, owner and president at Wright & Associates Family Healthcare, describes the ROI as 'numerous.'

No more restrictions

In some states with restricted practice, Wright explains that some nurse practitioners have to pay physicians to sign off on their paperwork. For example, in Missouri, one family NP filed a lawsuit earlier this year challenging the state's collaborative practice agreement requirement.

"It results in a restraint of trade," Wright said. "There's so much work for all of us, the last thing I want someone doing is signing off paperwork that doesn't improve care and that doesn't change the care that's being delivered."

For Wright, the lack of full practice authority puts more strain on an already overburdened system.

"We have less access, we have less specialists, we have less primary care, and so those of us that are out there need to be able to work on our own and work on our feet," Wright said. "If we need a specialist or we need a physician, we will be the first ones to reach out."

In terms of ROI, NPs with full practice authority can fill gaps in patient access to care, which benefits the entire healthcare system by lessening burdens on health systems with workforce shortages and individual clinicians who are overworked.

"I don't have to pay a physician, that's huge," Wright said. "I don't have them doing tasks just to do tasks, and nothing that improves the overall quality of care, and all of that increases cost and serves to restrict access."

Advocating for full practice authority

For CNOs who want to advocate for full practice authority, Wright recommends becoming familiar with the states that have restrictions and what those restrictions are. According to the American Association of Nurse Practitioners (AANP), most of the restrictive states are in the south and southeast regions of the country.

"Some of the big states have restrictive practice, and what's sad about that is some of those states have some of the lowest quality metric healthcare scores as well," Wright said.

To Wright, what's important is that leaders advocate for advancing legislation throughout the states.

"We need nurses to advocate for these changes because for as many nurses as there are out there, there's also other specialties who don't want us to have full practice authority," Wright said.

Full practice authority also shines a light on the full scope of impact that NPs have on patient care, since their work isn't being filed under another physician. 

"It gives us the ability to really document what it is that nurse practitioners are doing in this country and what their care looks like," Wright said.

According to the AANP’s former president, Stephen Ferrara, NPs are seeing over one billion patients annually, and to Wright, that number will increase with less barriers to care.

"We need to make full practice authority available to every nurse practitioner in every state in America so that we can take care of the thousands and millions of patients who don't have access to care that we could provide if some of these artificial restrictions were removed," Wright said.

This is part two of a two-party story. Read part one here.