Advocating for Full-Practice Authority as a Nurse Practitioner

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.

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.

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.

Page last reviewed August 7, 2022