The concept of Full Practice Authority (FPA) for advanced practice registered nurses has become a topic of frequent discussion in recent years as hospitals and primary care providers look for new ways to deal with rising costs, recruitment and retention challenges, and increasing administrative demands.

Our latest guide explores the history, impacts, and regulations surrounding FPA, offering nurse leaders a comprehensive understanding of its implications.

Here’s a quick summary of what you need to know. 

The History of Full Practice Authority

According to the American Association of Nurse Practitioners (AANP), FPA authorizes advanced practice registered nurses (APRNs) “to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments — including prescribing medications — under the exclusive licensure authority of the state board of nursing.”

Discussion around Full Practice Authority has risen in recent decades, but it’s not a new concept. Since the first nurse practitioner program was created in the mid-1960s at the University of Colorado, APRNs have been helping to bridge the gap between nurses and physicians. The initiative aimed to address healthcare provider shortages, especially in underserved areas. As APRNs began to take on more advanced roles, their scope of practice expanded, and by the 1970s, a growing number of states started to regulate NPs beyond the scope of their RN licenses. This led to a complex landscape of practice authorizations, where each state developed its own set of rules and regulations.

The early push for greater autonomy was driven by the need to improve healthcare access and outcomes. Over the years, research and advocacy have continued to support the notion that APRNs can provide high-quality care independently. Despite this, achieving uniform practice authority across all states remains a work in progress.

Who Is Impacted By Full-Practice Authority?

Full Practice Authority doesn’t only impact Nurse Practitioners (NPs). The National Council of State Boards of Nursing’s APRN distinction encompasses Certified Nurse Practitioners (CNPs), Clinical Nurse Specialists (CNSs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse-Midwives (CNMs) — all professions that require advanced degrees, training, and the knowledge necessary to make sophisticated clinical decisions.

In FPA states, APRNs' licenses are not contingent on contracts or oversight from a physician. This autonomy means patients have direct access to APRN services at the point of care, eliminating the delays and inefficiencies associated with regulatory-mandated contracts with physicians. This direct access can significantly improve patient satisfaction and outcomes, as patients receive timely and coordinated care without unnecessary bureaucratic hurdles.

Full Practice Authority can positively impact healthcare delivery in rural and underserved areas, where physician shortages are more pronounced. APRNs in these regions can practice to the full extent of their training and education, filling critical gaps in the healthcare system.

Full Practice Authority Regulations

Today, laws regulating APRNs vary by state. While each state has its own specific terms and verbiage, these laws fall into three general categories:

Full Practice

In states that have adopted full practice authority, the state board of nursing grants APRNs licensed authority to evaluate and diagnose patients, order and interpret diagnostics, manage treatments, and prescribe medications and other controlled substances. This level of autonomy enables APRNs to operate independently, enhancing their ability to deliver comprehensive care.

Reduced Practice

States with reduced practice laws limit APRNs’ ability to engage in one or more elements of FPA. Laws in these states require APRNs to have regulated collaborative agreements with other health providers in order to provide any patient care, or otherwise limit at least one element of practice. These limitations can vary widely but generally involve a mandatory relationship with a physician or another healthcare provider.

Restricted Practice

Like reduced practice, restricted practice state laws restrict APRNs from engaging in one or more elements of FPA. However, it also requires another health provider to supervise, delegate to, or manage APRNs in order for them to provide patient care. This model significantly curtails the autonomy of APRNs, making them dependent on physician oversight.

It’s important to note that some FPA states also require a period of supervision post-licensure or other “transition-to-practice” requirements that can delay an APRN’s full practice authority. According to a report from the ANA, “These legislative restrictions are modeled in concept after the state of Maine’s 1995/2007 legislation, a supervised practice provision of 24 months.” The report also notes that these changes are not based on actual clinical evidence but rather are the result of political compromise.

Nursing leaders and other FPA advocates worry that transition-to-practice requirements could create barriers for APRNs and additional burdens for the preceptors and mentors tasked with supervising them during those periods. For example, it can prevent APRNs from billing for services independently, which can create administrative backlogs. Additionally, some employers may hesitate to hire newly graduated APRNs because they lack the ability to practice independently right away.

The Future of Full Practice Authority

The Improving Care and Access to Nurses (ICAN) Act has failed to pass in previous years but was recently reintroduced and is quickly gaining support from organizations across the United States.

While the future of FPA on a federal level is still unclear, a recent increase in federal support could translate into more support at the state level, creating an easier path to independent practice for more APRNs. For now, advocates and opponents are carefully monitoring data from places with FPA, and the successes of healthcare organizations in those states could help pave the way for less restrictive licensing models.

For a more in-depth look at how nurse leaders can navigate the complexities of FPA and advocate for the full utilization of APRN skills and expertise, download our latest eBook.