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.
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What Is Scope of Practice?
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:
Taking vital signs, such as blood pressure
Safely lifting and moving patients
Monitoring patients for warning signs of serious conditions or complications
Changing dressings and other forms of wound care
Using feeding tubes
Administering medications, including IV medications
Catheterization and administering enemas
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.
What Is Practice Authority?
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.
Nurse practitioner full practice authority permits nurse practitioners to perform any task in their NP scope of practice without a physician’s supervision or partnership. This includes diagnosing conditions, ordering tests, and prescribing treatment, including medications. In full practice authority states, a nurse practitioner can operate a practice independently.
In some states, a nurse practitioner must work under the supervision of, or in collaboration with, a physician for a period of time before being authorized to practice independently. States may also require additional education before a nurse practitioner can prescribe controlled substances. Because this is a temporary rather than a permanent condition, these states are still considered full practice authority states.
In reduced practice states, nurse practitioners can perform certain tasks without a physician’s supervision or collaboration, but not all tasks. Typically, reduced practice states limit a nurse practitioner’s authority to prescribe medications or certain types of medications. In most of these states, nurse practitioners can diagnose conditions and order tests and prescribe certain types of treatments.
In restricted practice authority states, NPs must perform all tasks under physician supervision or with physician collaboration. They may be able to prescribe medications as long as it is listed in the collaborative agreement or in their scope of practice. Within their nursing scope of practice, NPs may have a high level of autonomy and make decisions independently, but they are not allowed to practice independently.
These three categories of practice authority are a subject of debate. Some groups argue that nurse practitioners should all have full practice authority, while others argue that nurse practitioners should have reduced or restricted practice authority, within their scope of practice.
Scope of Practice vs. 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.
Resources for RNs Looking To Become NPs
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.
Elizabeth M. Clarke, FNP, MSN, RN, MSSW
Elizabeth Clarke (Poon) is a board-certified family nurse practitioner who provides primary and urgent care to pediatric populations. She earned a BSN and MSN from the University of Miami.
Clarke is a paid member of our Healthcare Review Partner Network. Learn more about our review partners here.
Page last reviewed November 11, 2021
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