Nursing Scope of Practice vs. Practice Authority: What’s the Difference?

Both “scope of practice” and “practice authority” determine what activities a nurse or nurse practitioner is legally authorized to do. Nursing scope of practice refers to the activities that a nurse is considered both authorized and competent to perform. Practice authority describes the extent to which a nurse practitioner may perform those tasks independently. This guide will help you understand the differences and how nursing scope of practice and nurse practitioner practice authority may affect your work and career.

Nursing scope of practice describes the tasks that you are expected to be able to perform competently as a nurse. The more common tasks include but are not limited to:

Nursing school curriculums are designed around each state’s nursing scope of practice. On a day-to-day basis, you might consult your nursing scope of practice when you aren’t sure if you should perform a specific task.

Each state also has a Nurse Practice Act, the law that determines the legal requirements for nursing and to earn a nursing license. The nursing scope of practice describes the tasks that the Nurse Practice Act authorizes for nurses.

Practice standards are a related concept. Standards of practice describe how the tasks within the scope of practice should be performed. The American Nurses Association, for example, offers Standards for Excellence that include such resources as the Code of Ethics for nurses. You might consult standards of practice to understand the best way to perform a task.

Practicing to the top of one’s license is another related concept. This refers to healthcare professionals focusing their time and energy on the most complex parts of their scope of practice. For example, a nurse practitioner is practicing at the top of their license when diagnosing patients and ordering tests, but not when they are checking supply counts. While it refers to nursing licenses, it’s really about how nurses can make the best use of their time within their scope of practice.

Sometimes people confuse practice authority with scope of practice. While they both determine what a nurse does, practice authority is about the conditions under which a nurse practitioner performs those tasks, rather than a set list of tasks.

Practice authority describes the conditions in which a nurse practitioner can practice independently. There are three tiers of practice authority: full, reduced, and restricted. Practice authority is determined at the state level, so if you change states, you will need to understand that state’s practice authority.

While the nursing scope of practice outlines what a nurse is legally allowed and trained to do, practice authority is about how independently a nurse practitioner can carry out those tasks. Specifically, practice authority determines whether a nurse practitioner works under a physician’s supervision/collaboration or not.

Practice authority is a controversial topic. Those who advocate for nurse practitioner full practice authority argue that limits on the nursing scope of practice are enough to ensure that nurse practitioners do not perform tasks for which they aren’t qualified. They also argue that allowing full practice authority will increase access to healthcare and reduce healthcare costs. Those opposed argue that in full practice authority states, nurse practitioners are being used to replace physicians, which creates a false savings if it leads to worse outcomes. They also argue that prescribing and diagnosing medical conditions requires a physician’s more extensive education and training.

If you’re considering becoming a nurse practitioner or are already a nurse practitioner, practice authority may be an important consideration in deciding what kind of role you want as well as where you want to work. If you want to manage your own practice or to work with as much independence as possible, you’ll want to work in a full practice authority state. If you want to work as part of a team or in a hospital, whether you work in a full, reduced, or restricted practice state is less important.

RNs make the transition from RN to nurse practitioner for different reasons. Some of these reasons may be because nurse practitioners have more professional autonomy, a wider scope of practice, and in full practice authority states, can even run their own nursing practice. Nurse practitioners also enjoy a considerably higher salary than RNs.

The growth of online nurse practitioner programs expands your range of options. While the programs can be challenging, being a nurse practitioner can be an exciting and rewarding career.