Nurse Types / Nurse Practitioner / Scope of Practice Currently, there are 23 states, along with the District of Columbia, that grant
nurse practitioners (NPs) full practice authority. With full practice authority, NPs can perform many of the same tasks as physicians. Some of these tasks include prescribing medications, ordering physical therapy, diagnosing and treating medical conditions, and
interpreting diagnostic tests. Some people inaccurately perceive nurse practitioners as less experienced than physicians. However, numerous studies have shown that is not the case. In many ways, nurse practitioners provide the same level of care as physicians. In this post, we will explore the following: Every state has different specifications for nurse practitioner scope. Some states are more strict than others. For example, in Florida, nurse practitioners cannot
diagnose or treat patients without a physician available. Meanwhile, in Washington state, nurse practitioners are able to diagnose, treat, and prescribe medications, including medical marijuana. For nurse practitioners, ‘scope of practice’ refers to the responsibilities and duties they can perform based on their license. For example, a nurse practitioner has a broader scope of responsibilities than a
registered nurse. However, they generally have a smaller scope of practice than physicians. There are three different levels of practice that a nurse practitioner can have in a given state. These levels are full practice, reduced practice, and restricted practice. In a
full practice state, nurse practitioners can evaluate patients, diagnose illnesses, order and interpret diagnostic tests, and prescribe medication. They are granted permission to perform these tasks through the state board of nursing. With reduced practice, nurse practitioners can participate in at least one element of NP practice. For example, elements of practice that may be restricted include prescribing certain medications or performing certain medical
procedures. They must also enter into a regulated collaborative agreement with a physician to provide patient care. The state board of nursing outlines the NPs scope of practice as they vary from state to state. What is the scope of practice for NPs in each state?
What is ‘scope of practice’?
Full practice
Reduced practice
Restricted practice
The main difference between ‘reduced practice’ and ‘restricted practice’ is the amount of oversight required. In states with restricted practice, nurse practitioners cannot engage in at least one aspect of NP practice. The state law requires that NPs work with a physician throughout their careers to provide patient care.
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Why are nurse practitioners in more demand?
The demand for NPs has increased for two principal reasons. The first reason is that the expanded access to care created by the Affordable Care Act has insured 20 million more Americans. This expanded access has made it necessary for more physicians and nurse practitioners to enter the field.
According to the Association of American Medical Colleges, the projected shortage of nurse practitioners will be between 61,700 and 94,700. This leaves a vacuum for nurse practitioners to fill.
Additionally, the aging population requires more physicians to help. By 2025, the population over 65 will grow by 41%, while those younger than 18 will increase by 5%.
Given these two factors, there’s a desperate need for nurse practitioners.
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New York, Kansas, Massachusetts, and Delaware Become the latest States to Adopt Full Practice Authority for Nurse Practitioners
Client AlertWhile the COVID-19 pandemic certainly created many obstacles and hardships, it also created many opportunities to try doing things differently. This can be seen in the instant rise of remote work opportunities, telehealth visits, and virtual meetings. Many States took the challenges of the pandemic and turned them into an opportunity to adjust the regulations governing licensed professionals, including for advanced practice registered nurses (APRNs).
On April 15, 2022, Kansas became the latest state to remove practice restrictions on nurse practitioners and allow them to practice completely independent of any regulatorily mandated contractual relationship with a physician. This was very shortly after similar changes were made in New York, Massachusetts, and Delaware. In total, 26 States, the District of Columbia, and two U.S. territories (Guam and Northern Mariana Islands) now permit nurse practitioners to practice without any mandated collaborative agreement or supervision. Many other States, including Ohio, are currently evaluating legislation to implement full practice authority for APRNs. A map illustrating the current position of all U.S. States and territories regarding full practice authority can be found here.
It should be noted that each full practice authority State is different with regards to the requirements to practice independently. For example, some States require a transition to practice period where the APRN practices under supervision or regulatory collaboration for a minimum period of time before being licensed to practice independently.
The trend towards adopting full practice authority for APRNs will have a direct impact on the number of patient care roles that will be filled by APRNs. Over the course of seven years (as reported in 2020), the number of nurse practitioners in the U.S. more than doubled. Additionally, the U.S. Department of Labor expects the number of jobs held by nurse practitioners, CRNAs, and certified nurse midwives to increase 45% between 2020 and 2030.
If you have questions about APRN practice rules or starting an APRN-driven business, please don’t hesitate to contact Jeana Singleton by email at: , or by phone at: (330) 253-2001 or another member of the Health Law Department at Brennan, Manna & Diamond.
Posted by Jeana M. Singleton
Blog Post, Client Alert