Should Nurse Practitioners Have Full Practice Authority?

Granting full practice authority to nurse practitioners has benefits for both patients and nurses, says this nurse practitioner.

For a long time, nurse practitioners (NP) have occupied a unique position in the healthcare industry.

From questions surrounding credentials, patient safety, and professional scope of practice, giving NPs full practice authority has been a contentious subject.

Wisconsin was one of the most recent states to grant NPs full practice authority earlier in August. According to the Wisconsin Nurses Association (WNA), this means that APRNs will have their own licenses and be able to operate independently as certified nurse midwives (CNM), certified registered nurse anesthetists (CRNA), clinical nurse specialists (CNS), and NPs.

"The major benefit to be realized is Wisconsinites gaining access to timely, quality, exceptional, and economical care delivered by a highly educated and experienced advanced practice registered nurse workforce," said WNA executive director Gina Dennik-Champion in a press release.

The value of autonomous practice  

For many years, NPs have operated under the supervision of physicians who had to oversee all their work, according to Wendy Wright, owner and president at Wright & Associates Family Healthcare.

"All of my visits were billed out under that physician, and basically, I was an entity that was invisible," Wright said. "People had no idea what I was able to generate [and] what I was doing because all of it fell under that physician's title."

Wright practices in New Hampshire, a state that has had full practice authority for NPs since 1983.

"What I tell people about full practice authority is it allows me to work to the upper level of my license without a mandated supervisor or collaborator," Wright said.

When thinking about full practice authority, Wright explained that many might assume that there is no collaboration with physicians or other clinicians, or that NPs are working in silos. Wright emphasized that this is not the case.

"What it means is I don't have to work to the paperwork," Wright said. "I don't have to have things signed off as long as I'm working within my scope of practice and I don't have mandated collaboration."

Full practice authority, according to Wright, removes barriers to care, not only for NPs but also for patients because time is saved when NPs don't have to find a supervisory physician to sign off on paperwork. NPs with full practice authority are also able to fill care gaps in patient populations where physicians aren't present.

"Full practice authority is giving us the ability to work within our scope of practice and to provide the care that we've been trained to provide without mandated supervision or collaboration," Wright said.

Impact on nurses and patients

First and foremost, the primary impact of granting full practice authority is that it typically leads to an increase in providers that enter the state, especially NPs, according to Wright. This increases patient access to care.

Adopting full practice authority also has a positive impact on the physician and nursing shortages, since more NPs will enter states to provide more care, and NPs with independent practices can employ more nurses.

"That increase and influx into the state by providers also provides tax revenue," Wright said, "because now we have people that are opening clinics, we have people that are being employed in that state, which all counts toward increasing the tax base as well."

Granting full practice authority could lead to more nurses seeking advanced credentials because it opens the possibility of alternative career paths in nursing, Wright explained.

"Right now, we're graduating somewhere in the vicinity of about 20,000 nurse practitioners a year, [and] 70% or more are entering into primary care," Wright said. "I think it's a real possibility that when states open up, nurses will see that [and think], 'hey, this is something that I could do,' particularly those who say, 'I might want to own my own clinic in the future.'"

According to Wright, NPs also educate in the communities they live in, and they often stay in those communities.

"We see that other disciplines often don't educate where they grow up, they move away and often times never go back," Wright said. "That's often not the case for nurse practitioners."

This is part one of a two-party story. Part two will be published on December 1.