Advocating for Full-Practice Authority as a Nurse Practitioner

Updated August 19, 2022 · 5 Min Read

Reviewed by Elizabeth Clarke
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To advance the fight for NP full practice authority nationwide, this toolkit includes Senator contact information and three sample scripts.

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Advocating for Full-Practice Authority as a Nurse Practitioner
Credit: Solskin | DigitalVision | Getty Images

In 1965, the first nurse practitioner (NP) program was established at the University of Colorado. Despite the years of history, the scope of a nurse practitioner's authority is not consistent from state to state. Full-practice authority (FPA) has long been debated in medical circles. Some experts believe full-practice authority will help plug the gaps in healthcare quality and efficiency.

Using full-practice authority, nurse practitioners can diagnose, treat, and prescribe medications without physician oversight. They may also establish their own practice. However, the American Medical Association (AMA) has an initiative designed to limit a nurse practitioner's practice authority.

The initiative is called the Physician-Led Team Model of Care. According to the AMA, physicians should have authority for all patient care. The teams can include nurses, NPs, social workers, physician assistants, and pharmacists. But the AMA believes that team leadership should be maintained by the physician.

Toward this end, the group is working to support legislation that opposes the independent practice of advanced practice registered nurses (APRNs).

The plan is to introduce this to legislatures in all states and effectively end autonomous APRN practice. One study published in the American Journal of Medicine showed that even with longer face-to-face time with their doctors, patient satisfaction did not improve.

It is critical that nurse practitioners, nursing students, and even those who are not healthcare professionals make their wishes known to their state legislators. This benefits everyone in healthcare as the looming physician shortage across the U.S. is destined to impact patient care.

The estimated physician shortage could reach 124,000 by 2034. This includes shortages in primary and specialty care. The pandemic has underscored the disparities in healthcare and highlighted the difficulties in access to care.

Research suggests that NPs in emergency and critical care improve patient outcomes and may help alleviate the rising demand for service. According to the National Nurse-Led Care Consortium, full-practice authority expands access to care, reduces healthcare costs, and improves care.

Despite NPs having higher patient satisfaction, the AMA continues to oppose independent practice for APRNs. Should they be successful, significant changes to patient care options will be felt across the U.S. It is important to take action now to ensure that nurse practitioners gain and retain full-practice authority and can fully participate in improving patient outcomes.

Find out how you can get involved and advocate for NP full-practice authority.

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How to Advocate for FPA

Full-practice authority gives patients greater access to healthcare practitioners. There are three levels of practice authority recognized in the U.S. In addition to full practice, a state may have restricted or reduced authority.

Under reduced-practice authority, currently in 16 states and territories, NPs must have a collaborative agreement with a healthcare practitioner to practice patient care. Other restrictions may vary depending on the state, including limiting the practice settings in which NPs may work.

Under restricted-practice authority found in 10 states, nurse practitioners must have physician oversight in at least one element of practice. This can include diagnosis or treatment. How the regulations are interpreted and enforced varies from state to state.

The National Academy of Medicine restated their recommendation for full-practice authority thus "removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving healthcare access, quality, and value.”

Communicating with your U.S. senator is one effective method of advocating for full-practice authority in your state. Below are the online contact forms for the senators in all states with reduced and restricted authority.

You will find email contact information for each senator. Some also provide their phone numbers if you want to speak with them. We suggest looking at the sample scripts below as well for ideas on how to format your emails.

States With Reduced NP Practice Authority and U.S. Senator Contact Information


States With Restricted NP Practice Authority and U.S. Senator Contact Information


States With Full NP Practice Authority and U.S. Senator Contact Information

Although these states currently have full-practice authority, the AMA continues to oppose the legislation. Use this information to indicate your support of FPA to your U.S. senators.

Sample Letter Scripts for Reaching Out to U.S. Senators

You don't have to be a nurse practitioner, nursing student, or even in healthcare to advocate for full-practice authority. All that is required is a concern for access to quality healthcare. We encourage you to use the contact information above to write to your U.S. senators.

Below are suggested scripts for your emails if you are an NP, nursing student, or not a healthcare professional. Your advocacy is needed to protect the healthcare system. It takes just minutes to make your voice heard.

For NPs

Dear [Senator's name]:

National Nurse Practitioner Week is November 13-19. Did you know there are more than 234,000 solutions to the physician healthcare shortage facing the United States? These are the country's nurse practitioners who are already licensed and working in all 50 states.

In our state, NPs work under [reduced/restricted] practice, meaning that they cannot provide healthcare services to the full extent of their education and training. Despite the overwhelming evidence that NPs provide safe, high-quality, and cost-effective healthcare, they're still unable to practice to the full extent of their graduate education and clinical training in [state].

Please support the expansion of their practice to include evaluating patients; diagnosing; ordering and interpreting tests; and initiating and managing treatments, including prescribing medication, under the exclusive authority of our state board of nursing.

Thank you,

[Your signature]

For nursing students

Dear [Senator's name]:

There is no time like the present to acknowledge the 230,000+ nurse practitioners who work in this country. In fact, National NP Week is November 13-19. I'm advocating for full-practice authority for NPs in [state]. I am currently an NP student at [name of school, if desired]. As a student, I am specializing in the [name of field] and completing [number] of clinical hours in this specialty.

We have a looming physician shortage in this country, and many people need to wait for weeks to see a primary care physician or specialist. Nurse practitioners are already working to provide needed care, but they have [reduced/restricted] practice authority in this state. Despite the overwhelming evidence that NPs provide safe, high-quality, and cost-effective healthcare, they're still unable to practice to the full extent of their graduate education and clinical training in [state]. As a future NP, I ask you to support full-practice authority for NPs in [name of state] and to acknowledge nurse practitioners during National NP Week.

Thank you,

[Your signature]

For those who are not healthcare professionals

Dear [Senator's name]:

National Nurse Practitioner Week is November 13-19. I am grateful for the many nurse practitioners that serve our state. There are more than 230,000 nurse practitioners across the country, providing excellent healthcare and helping to offset the looming physician shortage. NPs have full-practice authority in more than 20 other states, but not in ours.

Many states allow nurse practitioners to fully evaluate patients; order and interpret tests; initiate and manage treatment; and prescribe medication under the authority of their state board of nursing. This is not true in [state], where NPs practice under a [reduced/restricted] setting.

Despite the overwhelming evidence that NPs provide safe, high-quality, and cost-effective healthcare, they're still unable to work to the full extent of their graduate education and clinical training. Please support change in our state and be sure to thank all of these invaluable healthcare providers during National NP Week.

Thank you,

[Your signature]

Page last reviewed August 7, 2022

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