What Is Full Practice Authority for Nurse Practitioners?

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A nurse practitioner speaks with a patient in an exam room.Ever since the role of nurse practitioner (NP) was created in the mid-1960s, NPs have proven decade after decade that they are capable of delivering high-quality patient care and are pivotal in achieving positive patient outcomes. In today’s health care landscape, NPs continue to make contributions in primary care as well as several areas of specialty care.

NPs fall under the category of advanced practice registered nurses (APRNs), which means that they have at least a master’s degree in nursing. According to the American Association of Nurse Practitioners (AANP), the majority of active NPs are certified in and deliver primary care services to patients.

The APRN designation also means that NPs can work either independently or in collaboration with physicians and other health care providers; however, the scope of patient care that an NP is authorized to deliver depends on the state where they practice. For aspiring NPs, understanding what full practice authority for nurse practitioners means, along with its benefits and where it’s permitted, is crucial.

What Is the Role of a Nurse Practitioner in Primary Care?

According to the most recent AANP data, 88% of NPs are certified in primary care, while approximately 70% serve as primary care providers. While NPs aren’t equivalent to physicians, both are trained and qualified to deliver primary care services to patients. In states that permit it, nurse practitioners serve as many patients’ primary care providers.

Millions of Americans use NPs as their primary care providers because they’re a cost-effective alternative to physicians. Additionally, NPs may have more availability in their schedule to see patients. NPs have been critical in helping meet the nation’s rising demand for high-quality health care services, especially in full-practice authority states, where they’re allowed to provide a wide range of services without direct physician oversight.

The role of a nurse practitioner in primary care is to deliver primary care services to a diverse patient demographic. These services include the following:

  • Examining and diagnosing patients
  • Updating the medical history of patients
  • Ordering and performing tests
  • Operating medical equipment
  • Interpreting test results
  • Creating treatment plans for patients and monitoring them
  • Prescribing medication
  • Consulting with physicians and other health care professionals
  • Referring patients to specialists (when applicable)
  • Educating patients and their families

Their state of practice and the state’s practice authority regulations determine the scope of primary care services that NPs can provide.

What Is Full Practice Authority?

Full practice authority is what formally authorizes nurse practitioners to provide their patients with a complete offering of health care services, including prescribing medication. Since practice authority is handled at the state level, state boards of nursing have licensure authority over NPs.

Nurse practitioners with full practice authority can examine, diagnose, and treat patients without any sort of direct oversight. Full practice authority states grant NPs the authority to work in a hospital, in private practice, and in various other health care facilities without restrictions. To understand the significance of full practice authority and how it impacts NPs, it’s helpful to examine reduced and restricted practice environments for NPs.

  • Reduced practice states limit the ability of NPs to engage in at least one aspect of NP practice. For example, an NP may be able to diagnose and provide treatment to a patient, but may need physician oversight to prescribe medication. Additionally, NPs in reduced practice states are legally required to enter into a collaborative agreement with a physician or health care provider.
  • Restricted practice is similar to reduced practice in that NPs have at least one element of practice restricted. However, instead of having a collaborative relationship with a physician or health care provider, these NPs must be closely supervised for the duration of their career. Because of this requirement, restricted practice states afford NPs the least amount of autonomy.

What Are the Full Practice Authority States?

State laws and regulations ultimately determine what services NPs can provide to patients, the terms of their collaborative agreements (if applicable), and the degree of supervision they practice under. According to the latest reporting from AANP, more than half of all states grant full practice authority to nurse practitioners.

Aspiring NPs who want to maximize their ability to treat patients may want to seek licensure in the following full practice authority states: Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, and Wyoming, as well as the District of Columbia.

Reduced and Restricted Practice States

The following are reduced practice states: Alabama, Arkansas, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Jersey, Ohio, Pennsylvania, Utah, West Virginia, and Wisconsin.

The following are restricted practice states: California, Florida, Georgia, Michigan, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, and Virginia.

It’s worth noting that regulatory changes and new legislation can alter the level of practice authority granted to NPs. California, for example, has recently voted to approve new rules that would expand the practice authority of nurse practitioners.

Additionally, during the COVID-19 pandemic, many states issued executive orders to temporarily grant full practice authority to NPs to expand access and ease some of the burden on the nation’s health care system. However, a number of those orders have since expired, and advocates in some states are petitioning lawmakers to permanently expand NP practice authority, highlighting the many benefits of full practice authority.

What Are the Benefits of Full Practice Authority for Nurse Practitioners?

The benefits of full practice authority for nurse practitioners are numerous, from expanding access to care — particularly for underserved populations — to reducing health care costs. Below are some of the main benefits of full practice authority.

NPs Help Offset the Primary Care Provider Shortage

Nearly 100 million Americans live in primary care health professional shortage areas, according to the nonprofit KFF, which reports on national health issues. With their advanced education and training in primary care, NPs can help fill the primary care provider gap in many places in the U.S. With full practice authority NPs operating in 26 states, primary care services are more accessible to patients.

NPs Deliver Streamlined Care That’s More Convenient for Patients

One of the benefits of seeing an NP who has full practice authority is that patients can get the primary care services they need without being referred to a physician. This helps streamline the process and keep the number of appointments to a minimum.

NPs Expand Health Care Access for Medicare and Medicaid Patients

According to AANP, more than 80% of full-time NPs treat Medicaid and Medicare patients, which has greatly expanded access to care for these patient populations. According to the most recent enrollment data (September 2022), 83.9 million people were enrolled in Medicaid. And KFF reports that in 2022, approximately 28.4 million people were enrolled in Medicare.

NPs Help Reduce Health Care Costs

Nurse practitioners with full practice authority can help limit the duplication of services between NPs and physicians, help reduce office visits, and help avoid unnecessary tests or repeat orders — all of which can help minimize the cost of care for both patients and providers.

NPs Are Critical in Serving Rural and Underserved Communities

In some rural and underserved communities, access to health care services isn’t as readily available as it is in cities with dense populations. As a result, people in these communities are less likely to get the primary care services they need, making them more vulnerable to illness or injury. Fortunately, NPs have stepped up to address these types of disparities. AANP reports that NPs provide a larger share of primary care services to patients in these areas, accounting for approximately 25% of health care providers in rural areas.

NPs Rank High in Key Areas of Patient Care

According to AANP, historical data collected on nurse practitioners and how they work with patients reveals the following:

  • Patients cared for by NPs were less prone to unnecessary hospital readmissions.
  • Patients under the care of NPs had fewer hospitalizations and unnecessary emergency room visits than those under the care of physicians.
  • NPs were rated higher in patient satisfaction than physicians.

NPs Help Protect Patient Choice

NPs with full practice authority remove anti-competitive licensing restrictions, resulting in far more choices for individuals who are looking for a primary care provider.

NPs Are a Rapidly Growing Role

One of the core benefits of full practice authority for nurse practitioners is the job demand that it’s helped create. Considering the essential role that NPs play in delivering primary care, it’s no surprise that they represent one of the most in-demand professions in the health care industry. According to the U.S. Bureau of Labor Statistics (BLS), employment of nurse practitioners is projected to grow by 46% (112,700 new NPs) by 2031. This is much faster than the 5% average growth rate that the BLS projects for all occupations.

NPs Earn Competitive Salaries

Compared with other types of nurses, NPs generally earn relatively high salaries. The BLS reports that registered nurses made approximately $77,600 annually in 2021. By comparison, NPs earned approximately $120,680. Additionally, three of the top-paying states for nurse practitioners are states with full practice authority: Massachusetts, New York, and Washington.

How to Become a Nurse Practitioner with Full Practice Authority

Becoming a nurse practitioner with full practice authority is a matter of following the right educational path and completing some key steps along the way. These steps include the following:

Step 1: Earn a Bachelor’s Degree in Nursing

A Bachelor of Science in Nursing (BSN) provides the foundational education and skills that an individual needs to practice as a registered nurse (RN). BSN coursework covers all the main subjects that appear on the National Council Licensure Examination for Registered Nurses (NCLEX-RN), including the following:

  • Anatomy and physiology
  • Chemistry
  • Microbiology
  • Pathophysiology
  • Human development
  • Health assessment
  • Clinical pharmacology
  • Nursing clinical practice

Step 2: Pass the NCLEX-RN Exam

The NCLEX-RN exam determines if a student has the minimum level of knowledge and skills to practice as an entry-level RN. The test is divided into the following main sections:

  • Client needs
  • Integrated processes
  • Clinical judgment

Test takers are allotted five hours to answer as many as 150 questions. At minimum, 85 questions must be answered for the exam to be deemed complete. The NCLEX-RN is scored using three different methods, the most common of which falls under the “95% Confidence Interval Rule.” Using this rule, the system will stop administering questions when it’s at least 95% certain that the test taker is clearly above or below the standard to pass.

After passing the exam, individuals can apply for licensure with their state board of nursing.

Step 3: Earn a Master of Science in Nursing Degree

A Master of Science in Nursing (MSN) degree is a graduate-level nursing degree that expands upon the skills and knowledge gained in a BSN degree program. For example, advanced pathophysiology and advanced clinical pharmacology are two courses typically taught in an MSN program.

Additionally, MSN programs provide the opportunity for students to specialize in an area of medicine or in treating a specific patient population. The most common MSN concentrations include the following:

  • Adult Gerontology – Primary Care Nurse Practitioner (AGPCNP)
  • Adult Gerontology – Acute Care Nurse Practitioner (AGACNP)
  • Pediatric Nurse Practitioner (PNP)
  • Psychiatric Mental Health Nurse Practitioner (PMHNP)
  • Women’s Health Nurse Practitioner (WHNP)
  • Family Nurse Practitioner (FNP)

Importantly, the FNP specialization is best suited for those who wish to focus on primary care delivery. However, one of the distinct advantages of advanced nursing education is that it allows students to specialize in serving a distinct patient population or focus on a specific area of medicine.

Pass the National NP Certification Board Exam

Similar to how students must pass the NCLEX-RN exam to become an RN, aspiring NPs must pass the National NP Certification Board Exam. Since MSN programs offer multiple concentrations, students will take their exam through one of the following certification boards based on their specialty:

  • American Nurses Credentialing Center
  • American Association of Nurse Practitioners
  • Pediatric Nursing Certification Board
  • American Association of Colleges of Nursing
  • American Association of Critical-Care Nurses
  • National Certification Corporation

NPs who wish to have licensure for full practice authority must sit for their exam in a full practice authority state.

Pursue Your Goal of Becoming an NP

Nurse practitioners with full practice authority play a vital role in health care. They afford patients greater access to health care services, streamline care delivery, and help cut down costs. Although NPs are a valued resource in any health care environment, they’re most effective in full-practice authority states.

At Regis College, aspiring nurse practitioners can develop the necessary skills and knowledge they need to deliver primary care to a broad base of patients. Our online Master of Science in Nursing program covers the most in-demand subjects and competencies, including the following:

  • Health Assessment. This course teaches students how to properly assess the health status of patients of all ages in various settings.
  • Nursing Theory. This course teaches students the historical development of key ideas in nursing, how these theories were constructed, and their relationship to research and evidence-based practice.
  • Concepts in Nurse Leadership. This course teaches students the skills and qualities needed for effective nurse leadership.
  • Health Promotion – Disease Prevention. This course teaches students how to discuss and convey the importance of preventive health best practices and strategies to patients.

The MSN program at Regis is specifically designed to help students qualify to sit for their NP certification exams, so they can enter the workforce with confidence. Pursue your goal of becoming an NP by learning more about the MSN program at Regis. 

Recommended Reading

Nursing Continuing Education: Importance, Options, and Resources for Getting Started

How Technology and Isolation May Affect Mental Health

What Impact Does Parental Mental Health Have on Children? 

Example Sources:

American Academy of Nurse Practitioners Certification Board, Family Nurse Practitioner (FNP)

American Association of Nurse Practitioners, Issues at a Glance: Full Practice Authority

American Association of Nurse Practitioners, NP Fact Sheet

American Association of Nurse Practitioners, Nurse Practitioners in Primary Care

American Association of Nurse Practitioners, The Path to Becoming a Nurse Practitioner (NP)

​​American Association of Nurse Practitioners, Quality of Nurse Practitioner Practice

American Association of Nurse Practitioners, State Practice Environment

CalMatters, “Nurse Practitioner Requirements Are Changing, Allowing Them to Practice Without Physician Supervision”

KFF, “Medicare Advantage in 2022: Enrollment Update and Key Trends”

KFF, Primary Care Health Professional Shortage Areas (HPSAs)

Medicaid.gov, September 2022 Medicaid & CHIP Enrollment Data Highlights

NCLEX, Frequently Asked Questions

Patient Engagement HIT, “States Weigh Laws for Nurse Practitioner Full Practice Authority”

U.S. Bureau of Labor Statistics, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners

U.S. Bureau of Labor Statistics, Registered Nurses