In the face of widespread physician shortages, rising patient demand, and access disparities, the topic of NP autonomy, scope of practice (SOP), and full practice authority (FPA), have been hotly debated topics in healthcare. Today we’ll talk about why it matters, what’s at stake, and how NPs can be part of the movement.
Scope of practice defines the services, procedures, and responsibilities NPs are permitted to perform based on their qualifications, education, and licensure. According to the AANP, full practice authority allows NPs to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments.
Practice limitations are technically decided at the state level. Today, 27 out of 50 states have granted full practice authority to nurse practitioners, with more beginning to consider the possibility. There is a severe shortage of primary care physicians in the US, but nurse practitioners are eager to fill the gap in providing these much-needed services.
Last week we discussed how listening to nurse voices helps to prevent moral injury, the mental toll of having to make decisions that contradict your values. SOP limitations are a big contributor to moral injury in NPs. For example, when a NP is required to wait for physician oversight to prescribe medication that a patient needs, despite being fully trained and capable of providing that care immediately.
Thus, FPA presents opportunities for both NP fulfillment and patient well-being.
NPs want what’s best for their patients, and that means eliminating some of the administrative barriers that prevent them from exercising their full education, training, and licensure to help those in need. When these restrictions were lifted temporarily during the height of the COVID-19 crisis, NPs proved they were more than capable of rising to the challenge.
Ultimately the goal of FPA is to increase access to care, especially areas where care shortages are most acute, by allowing NPs to fully contribute. FPA is not about replacing physicians or eliminating the role of physician-led teams where appropriate. Rather, it’s about ensuring that NPs are allowed to fully exercise their education, certifications, and training, for the benefit of patients.
A vital component in advancing FPA is to make NP voices heard. Organizations like The AANP or local NP associations can provide advocacy resources and opportunities to mobilize. In the workplace, NPs can urge their practices to review unnecessarily restrictive internal policies.
Another important step in the push for full practice authority is to educate others about FPA and the role of NPs in providing care. For example, leveraging social media or workplace discussions to bust common misconceptions (e.g., “FPA means practicing like a doctor” — it doesn’t!) or sharing facts about NP training, licensure, and patient outcomes with those who may misunderstand the role.
NPs can also advocate for FPA-related legislation by staying in the know on current legislative efforts and urging legislators to support these measures. One important piece of legislation to keep an eye on at the federal level is the Improving Care and Access to Nurses (ICAN) Act, a bipartisan bill which was reintroduced in February 2025 and aims to remove barriers to care for Medicare and Medicaid patients.
