Nurse practitioners (NPs) are critical for success in the healthcare landscape. From filling gaps in physician shortages to providing holistic wellness, NPs are leading the charge in providing accessible preventative care to patients nationwide. NPs have also been found to receive high satisfaction levels, reduce wait times, and provide high-quality care. Yet, the restrictive scope of practice regulations continues to act as a limiting factor in NP autonomy within their career.
Understanding Scope of Practice Laws
Full Practice
In full practice states such as Alaska, Colorado, and Delaware, NPs have the authority to fulfill tasks such as evaluating patients, interpreting tests and diagnosing conditions, and managing treatment plans. Some states offer a hybrid model, where the scope of practice is restricted until certain standards are met. For example, NPs in California are under the restricted model unless they have completed 4,600 hours of work in the field or have attained at least 3 years of clinical experience. Despite the initial restrictions, most California NPs are on track to become independent by 2026, and the state also classifies them as primary care providers (PCPs).
Reduced Practice
In reduced practice states, NPs have more freedom than their restrictive counterparts as they can treat patients without direct supervision. However, they must collaborate with a physician in at least one aspect. Indiana is one such reduced practice state, and (like California), they also classify their NPs as PCPs. However, there are limits to the types of medications they can prescribe, and they also must work in collaboration with physicians.
Similar to California’s restricted/full practice model, there are reduced/full practice models as well. Illinois once required all NPs to collaborate with physicians, but a 2017 amendment to the Illinois Nurse Practice Act opened the doors for NPs to have more autonomy. Under this amendment, NPs who meet certain levels of education and training, 4,000 hours of collaboration experience with a physician, and 250 hours of continuing education, can begin practicing without physician collaboration.
Restricted Practice
Under the restricted model, NPs must practice under a physician’s direct supervision. Usually, this includes limitations on how NPs can treat and diagnose patients. While NPs are sure to gain beneficial knowledge while working with physicians, the lack of autonomy can be frustrating and risk limiting an NP’s growth potential in the field. In some cases, such as Texas, the restrictions also require NPs to pay physicians a fee for supervision.
“What other profession has a signature fee as large as six figures, only a signature, and it doesn’t improve productivity? … This pay-to-play model is just, it’s not right, and it’s not helpful. It’s detrimental to our patients; it’s detrimental to our health care systems.”
— Texas Nurse Practitioners (TNP) President Erin Pérez
Perez goes on to explain how these restrictions, which include halting treatments if their supervising physician passes or retires, are unfair not just to NPs, but to their patients who suddenly cannot receive care.
Unlocking NP Autonomy
While advocates continue to support legislation for increased autonomy across the country, NPs must still maneuver the varying practice laws. As NPs strive to enhance their career alongside the respective laws of their state, there are three things to consider:
- Staying Compliant with State Regulations: Understanding state-specific licensing requirements is critical for NPs to understand how to legally practice in their home state. However, shifting attitudes toward NPs can affect regulations. NPs must stay informed by consistently following state boards or participating in professional organizations, such as the American Association of Nurse Practitioners (AANP), that help members stay abreast of NP-related news.
- Transitioning to Practice in New States: NPs relocating to other states must research the requirements to practice in their target state, especially when moving to a reduced or restricted practice. Even if an NP moves from one restricted practice state to another, requirements to practice can still vary.
- Advocating for Full NP Autonomy: NPs, especially those practicing in reduced or restricted states, can play a leading role in advocating for full practice authority in their home states. Those who want to take part in the cause can join organizations, such as AANP or other state-specific NP chapters, and push for new legislation. By staying informed and encouraging new policies, NPs will have more authority in their career while offering enhanced patient outcomes.
Breaking Barriers for NPs
Despite the importance of NPs in filling healthcare gaps, the variability in state scope of practice laws continues to limit their full potential. Some states offer full autonomy, but others have strict regulations in place that hinder NP autonomy. By staying informed, adapting to new regulations, and advocating for increased autonomy, NPs can continue to advance their profession and contribute to a more efficient and accessible healthcare system.
