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What it Means to Function Autonomously in 2017

Nurse practitioners serve a critical purpose in the health care industry. A growing number of states are recognizing the full capabilities of the nurse practitioner, granting them autonomy to work without the direct supervision of a physician or other health care professional. Functioning autonomously allows nurses to utilize their skills more than ever.

A nurse practitioner can practice independently in many states.
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In 2017, nurse practitioners can look forward to new advancements in the health care industry that may offer them more independence than ever.

What Is Full Practice Authority?

Full Practice Authority (FPA) refers to state practice laws that allow nurse practitioners to independently evaluate patients, diagnose medical conditions, order and interpret tests, prescribe medications, and manage treatment plans under the licensure authority of that state’s board of nursing. When nurse practitioners (NPs) are granted FPA, they do not require supervision, management, or delegation from a doctor or other health care professional. Full Practice Authority is also referred to as autonomous practice.

Autonomous practice does not mean that the NP is free of parameters or operates without oversight and regulations. Rather, it allows NPs to function more like physicians after completing on-campus or online nurse practitioner programs. According to the American Association of Nurse Practitioners (AANP), FPA NPs must meet all of their states’ educational and practice requirements. They are held accountable to the state board of nursing as well as to the public. NPs must maintain state licensure and national certification. FPA simply allows them to utilize their education to its full extent, providing patients with much-needed care in an increasingly understaffed space.

Who Has Full Practice Authority?

Full practice authority is granted on a state-by-state basis. It is now available in the following states, as well as the District of Columbia:

  • Alaska
  • Arizona
  • Colorado
  • Connecticut
  • Hawaii
  • Idaho
  • Iowa
  • Maine
  • Maryland
  • Minnesota
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Mexico
  • North Dakota
  • Oregon
  • Rhode Island
  • South Dakota
  • Vermont
  • Washington
  • Wyoming

In these states, nurse practitioners are free to practice without a supervising physician or other similar authority. They practice under the exclusive licensure authority of that state’s Board of Nursing.

Reduced Practice Authority is available in many other states. Here, nurse practitioners are limited in setting or scope. A regulated collaborative agreement is required for NPs to practice in these states. Areas with reduced practice authority include the following:

  • Alabama
  • Arkansas
  • Delaware
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Mississippi
  • New Jersey
  • New York
  • Ohio
  • Pennsylvania
  • Utah
  • West Virginia
  • Wisconsin

Nurse practitioners still face restricted practice laws in the remaining states. In those locations, nurse practitioners must have team management, delegation, or supervision from a third party to provide patient care.

The Recommended Model for NPs

Kaiser Health News (KHN) reports that Full Practice Authority originated in Alaska, Washington, Oregon, and New Hampshire in the 1980s. Remote populations in these states were facing severe physician shortages, which were easily resolved by granting autonomy to nurse practitioners. Other rural states soon followed suit. According to KHN, FPA is most common in areas where patients face limited access to health care. Granting more authority to NPs opens up new opportunities for health care access in areas where patients may otherwise find themselves without a primary care physician who can readily see to their needs.

The Institute of Medicine and the National Council of State Boards of Nursing established full practice status as their recommended model. The Institute of Medicine’s Future of Nursing Report indicated that their primary recommendation was to “Remove scope-of-practice barriers.” The report went on to argue that “Now is the time to eliminate the outdated regulations and organizational and cultural barriers that limit the ability of nurses to practice to the full extent of their education, training, and competence.”

Meeting a Growing Demand

Nurse practitioners with FPA are equipped to meet a growing demand for primary care practitioners. The Health Resources and Services Administration’s (HRSA) Health Workforce Simulation Model (HWSM) generated both national and regional projections for primary care physician supply and demand through 2025. This report projects an 11 percent increase in primary care physicians between 2013 and 2025 alongside a 17 percent increase in national demand.

There are marked regional differences in supply and demand for primary care physicians. The south region is expected to see the greatest shortfall with a deficit of approximately 13,860 full-time equivalent practitioners by 2025. According to the HRSA, 55 million Americans currently reside in areas without an adequate supply of primary care physicians. HRSA recommends one primary care provider for every 3,500 residents, but the nation needs another 15,000 providers to meet this goal.

In the coming years, one third of doctors are expected to retire. The Affordable Care Act now extends health care coverage to many Americans who previously went without, and the nation’s aging population is growing. Though there’s a marked demand for quality health care, there aren’t enough doctors to fill the void.

Meanwhile, there’s a projected surplus of primary care nurse practitioners. The NP supply will outpace demand if utilization continues unchanged. Providing FPA for NPs throughout the United States could mitigate the physician shortfall while making better use of the surplus NPs expected around the country.

How Autonomous Nurses Practice

In areas where autonomous practice is allowed, NPs fill many important roles. According to the Bureau of Labor Statistics, nurse practitioners can work in their own independent health care practices or treat patients in a group practice alongside physicians or specialists. NPs can work in many specialty areas, including geriatric health, pediatric health, and psychiatric health. NPs typically focus on health promotion, education, and disease prevention, referring patients to physicians or specialists as needed when the scope of care falls outside their expertise.

Hospitals & Health Networks Magazine reported that some NPs are even training to work as hospitalists. In rural areas, these NPs oversee small or critical access hospitals. FPA allows nurse practitioners to utilize their knowledge and capabilities to their full extent, supplying much-needed health care to underserved populations.

If you want to take advantage of the growing opportunities for nurses to function autonomously around the United States, your next step may be to advance your education through an online nurse practitioner program. The online Master of Science in Nursing from Maryville University is a 100% online program that prepares students to earn advanced credentials and become “physician extenders.”

Dedicated professionals who work to further their education and gain the necessary licensure and experience can explore new professional opportunities in health care. Join the effort to fill a critical void in primary patient care by joining the forces of dedicated NPs with FPA in participating states around the country.

Sources:

https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment

http://khn.org/news/stateline-nurse-practitioners-scope-of-practice/

http://c.ymcdn.com/sites/www.npamonline.org/resource/resmgr/imported/Full%20practice%20authority.pdf

https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-national-projections2013-2025.pdf

http://khn.org/news/stateline-nurse-practitioners-scope-of-practice/

http://www.hhnmag.com/articles/8140-need-a-hospitalist-call-a-nurse