The debate over Full Practice Authority (FPA) has resurfaced in recent years. Exclusive licensure authority allows nurse practitioners and others to practice independently under the guidelines set by the state board of nursing. Proponents say it can increase access to care, improve health outcomes, and reduce costs, while critics express concerns about the quality of care and patient safety.
In our recent resource, we examine the pros and cons of full practice authority for nurse practitioners and what nurse leaders should know as they navigate this issue.
(For a quick overview of the issue and who it affects, check out this introductory article.)
Many states now allow full practice authority, allowing them to diagnose patients, manage treatment and prescribe medication without physician oversight, according to the American Association of Nurse Practitioners. In full practice authority states, nurse practitioners can operate independently from physicians after obtaining their licenses. Some allow reduced or restricted practice, meaning they can perform some activities but not others.
Because so many states now offer full practice authority, there’s plenty of evidence demonstrating what it can accomplish and the advantages it offers healthcare professionals and the patients they serve. Here are a few of the biggest advantages of full practice authority:
Data shows that patients do better when advanced practice registered nurses (APRNs) have more authority and independence to practice to the full extent of their education. Full practice authority for nurse practitioners can lead to higher patient satisfaction due to better access to care and a patient-centered approach. A 2014 study involving Medicare/Medicaid patients concluded that states with full practice of nurse practitioners have lower hospitalization rates in all examined groups and improved health outcomes in their communities.
When students and early career nursing professionals recognize the opportunities and autonomy available through FPA, they may be more inclined to pursue a career path as an advanced practice registered nurse. Clinical nurse specialists, along with nurse practitioners and other APRNs, play a crucial role in addressing healthcare challenges such as an aging population and limited healthcare access. In fact, according to Nurse.com, nurse practitioners are the fastest-growing primary care provider group. At a time when healthcare organizations of all sizes are struggling to attract and retain talent, FPA can help bring more people into the profession.
The physician shortage disproportionately impacts people who live in historically underserved places — like rural or lower-income areas. Rural and underserved areas face significant challenges in addressing adequate medical treatment. Broadening APRNs’ authorization helps fill the gap by increasing the number of available independent practitioners.
Advanced practice registered nurses in restricted or reduced authority states must ask their supervising physician to authorize prescriptions or referrals, which can slow processes, add more work to a busy physician’s plate, and make it more difficult for patients to access the care they need. But in full practice authority states, APRNs can move forward with care plans, reducing delays and streamlining the workflow for everyone involved.
A study published in Health Affairs using 2012 data on a cohort of medically complex patients with diabetes found annual costs for patients of NPs were $2,005 lower than patients of physicians, while physician assistant patient costs were $2,300 lower than those of physician patients.
In an article published by the Healthcare Financial Management Association, experts point out that NPs and PAs have more time to spend with each patient, so they can resolve concerns in fewer visits.
It’s important to recognize that full practice authority also comes with a few potential drawbacks. Patient safety concerns arise with the implications of granting full practice authority to nurse practitioners, emphasizing the need for effective communication and clear protocols.
Here are some of the most commonly cited concerns and challenges of FPA:
In reduced and restricted authority states, physicians are legally considered patients’ primary providers, even when they’re treated by an APRN under a physician’s supervision. While FPA grants APRNs more autonomy, it also means they can be named as a primary provider in a patient’s lawsuit.
Physician burnout is a growing issue that affects healthcare professionals at every level, and those in advanced practice roles are already at high risk. Being granted FPA means taking on even more responsibilities, like managing a team alongside a larger patient load.
As the old adage goes, "two heads are better than one." When APRNs are required to consult with physicians, it fosters opportunities for creative problem-solving. And although APRNs can always reach out to a colleague for insight or advice, there’s a concern that consultations or discussions about patient care will occur less frequently when they aren’t mandated by law.
In some cases, malpractice insurance is procedure-driven (not specialty-driven), so the more you’re authorized to do, the higher you can expect your premiums to rise. In states with FPA, APRNs may have to pay more for malpractice insurance, disciplinary insurance, and other policies. And while there’s no data to suggest increases in malpractice claims in FPA states, the potential increase in premiums is still worth noting.
In some FPA states, APRNs can only practice independently once they’ve fulfilled specific academic requirements or training certifications, particularly when prescribing medication. For some professionals, this could mean completing additional coursework.
The landscape of full practice authority continues to evolve, with increasing evidence supporting its benefits alongside ongoing debates about its potential drawbacks. Full practice authority allows nurse practitioners to order and interpret diagnostic tests independently, which can improve patient care and efficiency. As more states adopt FPA, nurse leaders must stay informed about the changing regulations and their implications on practice, patient care, and healthcare costs. Understanding the pros and cons of full practice authority is crucial for effective advocacy and leadership in nursing.
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.