Full Practice Authority for Nurse Practitioners

Table of Contents

The modern healthcare system of the US can be characterized by numerous attempts to improve treatment outcomes and increase the efficiency of care delivery. For this reason, there are multiple innovations, including better training for health workers, the extensive use of technologies, and reconsideration of outdated practices. Under these conditions, the question about nurses authorities also becomes topical as they remain one of the main contributors to positive results. That is why nurse practitioners should be provided with the full practice authority to ensure higher accessibility of care for patients, increase their degree of independence, and better outcomes. The paper will present a discussion of the advantages and disadvantages of providing full practice authority for NPs.


For decades, practicing nurses faced many difficulties when they tried to provide the best comprehensive health care for patients, including pharmacological therapies. Also, they struggle to remove all restrictions for the ability to work at their full potential (Kaplan and Brown 28). The problem laid in the inability of some professional, social, and political entities to recognize nurse practitioners as specialists who can provide primary health care autonomously. However, in a dynamic health care system, they are indeed crucial players in the provision of medical services to the economically disadvantaged and underserved population groups (Weiland 352).

The adoption of the Affordable Care Act (ACA) and Patient Protection in 2010 led to the transformation of health services in the United States (Lathrop and Hodnicki). These documents stimulate a preventive health care model that emphasizes primary medical care, finances public health care initiatives, and promotes quality medical treatment. These changes increase the need for well-trained and competent medical professionals. Advanced Practice Registered Nurses are ready to meet this growing need by providing leadership in public health care centers, acting in interdisciplinary groups, advocating and directing future policymakers.

Nowadays, the situation regarding the issue of full practice authority for NPs is quite complicated. Nursing practitioners can prescribe medications, including controlled substances and drugs, in Washington DC and all states (ANA 23). Also, they can work in many areas of healthcare, from primary health care to emergency aid, and provide a variety of services the same as doctors do, including taking patient history, assigning therapies, medications, and diagnostic tests as well as managing the overall health of patients. However, the degree of their independence varies because of differences in NP authority.

Three broad categories regulate the power of nurses to prescribe medicines with different levels of physicians’ supervision – restricted, reduced, and full practice (ANA 20). In the largest states of the USA, NPs have to act under the restricted authority, which significantly reduces their efficiency and ability to provide patients with the needed care.

Thus, the full practice authority can be considered a strong solution to the problem of limited access to care and reduced nurses’ efficiency. It presupposes that all NPS are provided with the right to prescribe all medications regardless of their status without physicians’ supervision or oversight (ANA 24). It means that this category of health workers acquires the opportunity to directly impact the health status of the community by providing appropriate treatment without consultations with other specialists. This degree of independence also means that nurses’ functions become similar to physicians’ ones as they can select among various ways of treatment.


Supporters of the necessity to provide nurse practitioners with the full practice authority emphasized the fact that it will help to solve a lot of problems in the health care system. Researchers note that removing the barriers will enable NPS to achieve positive changes in the healthcare system (VanBeuge and Walker 313). The lack of full practice authority for registered nurses is an obstacle to the provision of high-quality, efficient, comprehensive, and cost-effective medical services for some of the most vulnerable Americans.

First of all, providing the full practice authority for NPs can result in improved accessibility of health care. Patients in distant regions will have the chance to receive the needed medical treatment without waiting for the approval of a physician (Taylor et al. 88). Secondly, such a shift of priorities can become a potent stimulus for the professional and personal growth of nurses because of the necessity to possess the broad knowledge to guarantee positive results and the increased level of responsibility (Taylor et al. 111). Providing full practice to nursing practitioners allows them to use all their abilities to help other people.

In addition to that, it can become a practical approach for saving money as nurses will be able to perform some new functions without the radical reconsideration of their salaries or spending to pay physicians for their consultations. It can be considered a significant advantage as the need to reduce costs is one of the fundamental concerns of the health care system of the US (Taylor et al. 97).

Finally, nowadays, there are more and more patients requiring the services of critical medical care, and the number of doctors does not meet this growing need (Deborah and Faye 86). So the workload of physicians will be reduced, which also means an increase in their efficiency. Providing full practice authority for NPs can give advantages not only for healthcare workers and the physical well-being of citizens but also for the country itself.

Disadvantages and Risks

However, there are several problems, disadvantages, and risks associated with the providing of full practice authority to nursing practitioners. While NPS offers holistic and comprehensive patient care, some people are committed to independent practice. Many specialists believe that the medical care provided by NPS cannot be comparable with the treatment of a doctor due to differences in clinical training and schooling.

Some doctors even regard a growing number of NPs as a threat to their profession. First of all, the introduction of full practice authority might lead to an increased number of errors made by nursing practitioners (Taylor et al. 99). According to the statistics, about 65% of all nurses make mistakes while prescribing pills or other drugs, and without supervision, this number can increase (Potter et al. 87). Another issue is the risk of inappropriate or poor knowledge among nurses who will be provided with the right to prescribe pills and impact the treatment process.

Although public health professionals are well-informed in health policy, prevention, and behavioral health, they may lack clinical training and the opportunity to work directly with patients who need prevention measures. Nevertheless, medical schools have begun to recognize the need to strengthen primary health care; the individual-based medical model still prevails in the US healthcare system (Lathrop and Hodnicki).

It can pose a significant threat to patients’ health and undermine their well-being. Furthermore, the provision of the full practice authority to NPs can undermine the current health care system due to the absence of efficient techniques and methods to monitor all prescriptions made by nurses regarding their new abilities (Taylor et al. 87). Another problem connected with full practice authority is payer policies.

Many NPS report that the payer’s policy has a significant impact on their ability to practice licensing and training. Payer policies are often associated with government regulations and licenses. Restrictive practice can lead to stiffening the demands of payers, limiting the ability of NPs to practice independently (Lathrop and Hodnicki). They essentially have to practice as employees of doctors, hospitals, or other organizations. The payment policy for a health insurance plan may differ and often does not recognize an NP as a primary health care provider.

Government insurance mandates are important for HPs practice, as they affect the ability of nurses to practice independently and pay for services. Mandate legislation varies from bill to bill and from state to state and can significantly increase the cost of health insurance. The problem is that some states do not establish a specific reimbursement mandate for practicing nurses as primary health care providers (Hain and Fleck). In such a way, the transition to a new model can be associated with multiple fears about the emergence of critical problems that will deteriorate the quality of care and its provision to various patients’ groups demanding assistance or pharmacological treatment.

These problems remain a significant barrier to the implementation of a new approach in the health care system of the US. However, some potent interventions can help to mitigate risks and solve these problems. First of all, the state should make significant changes in the way medical workers are trained so that patients can receive appropriate, high-quality, and cost-effective health care from qualified medical personnel (Pohl et al.).

To remove problems associated with the full practice authority for nurse practitioners, the strict procedure of certification should be introduced. It will help to analyze NPs’ level of knowledge and their competence to make prescriptions and provide patients with the needed medication. It will also promote a significant minimization in the number of mistakes preconditioned by the poor competence and mitigate risks associated with it.

Although many nursing colleges and schools are already struggling to meet the requirements of the dynamic US healthcare system, ensuring that nurses are ready to become important members of the American medical care team (Hain and Fleck). Moreover, the Affordable Care Act also provides opportunities for nurses to meet primary health care needs by using technology as a means of improving medical treatment and evaluating results; to develop, identify, and implement quality improvement projects, and improving evaluation and operational thinking.

The use of electronic databases, electronic medical records, evidence-based Internet searches, and electronic applications are technological advances that can improve the delivery of medical care and the evaluation of care outcomes. Synthesis and analysis of electronic data and the subsequent identification of problems that need to be solved can be enhanced with the use of technology. Nurse practitioners can use their educational background to provide leadership in the use of technology during a country’s transition to a model for the prevention of medical services offered through interdisciplinary collaboration to meet the needs of primary health care.

Secondly, an effective monitoring tool should be implemented to ensure that all nurses cope with the new level of independence and contribute to the improved results. Thirdly, to ensure the absence of ethical problems associated with the lack of trust in nurses among patients, they should be taught about the new competencies and authorities that rest on the outstanding knowledge and experience.

Finally, an important step towards enhancing the role of NPs is rethinking how to provide high-quality and effective primary assistance in an environment with a labor shortage. Collaboration between doctors and NPs as members of interprofessional teams is an important aspect of achieving the goal of health care. As NPs seek independent practice, collaboration can be used as a tool to educate physicians about the role of NPs and to help strengthen relationships to achieve best practice.

Collegiality, respect, and care for patients are the main attributes of cooperation between doctors and NPs. Researchers note that adopting an intellectual approach rather than letting emotions take control in conflicts with physicians is consistent with interprofessional collaboration concepts (Hain and Fleck). Such actions in the field of healthcare guarantee the improved accessibility and results of medical treatment.

The future of the practice authority for nursing practitioners and the public health system in principle is unpredictable. It is true that today, more and more Americans are in need of greater access to medical care. Nursing practitioners have more authority, offering comprehensive and high-quality patient care. The American health care system should strive to ensure patients with full access to medical professionals.


To sum up, the problem of providing the full practice authority for NPs remains crucial for modern healthcare services. Barriers at the national and state levels prevent qualified health care workers from providing medical treatment to patients who need it. Furthermore, these regulations deprive specialists of practicing to the full extent as their education and training prepared them for numerous complicated situations that should be solved to improve individuals’ states (Potter et al. 76).

Because the provision of efficient and high-quality medical treatment to patients is one of the major concerns of the modern healthcare sector, it is very important to eliminate these barriers to ensure that all patients will be provided with the needed assistance to improve their health status. Guaranteeing the full practice authority to nurses can be considered a practical solution to many problems peculiar to the sphere. It is an innovative, cost-reducing, and potent way to align the continuity of medical treatment and the gradual improvement of the health care of the nation.

Works Cited

ANA. Nursing: Scope and Standards of Practice. 3rd ed., American Nurses Association, 2016.

Deborah, Dillon, and Gary Faye. “Full practice authority for nurse practitioners.” Nursing Administration Quarterly, vol. 41, no. 1, 2017, pp. 86-93.

Hain, Debra, and Laureen M. Fleck. “Barriers to NP practice that impact healthcare redesign.” The Online Journal of Issues in Nursing, vol. 19, no. 2, 2014. Web.

Kaplan, Louise, and Marie-Annette Brown. “Prescriptive authority and barriers to NP practice.” The Nurse Practitioner, vol. 29, no. 3, 2004, pp. 28-35.

Lathrop, Breanna, and Donna R. Hodnicki. “The Affordable Care Act: Primary Care and the Doctor of Nursing Practice Nurse.” The Online Journal of Issues in Nursing, vol. 19, no. 2, 2014. Web.

Pohl, Joanne M., et al. “Health Affairs, vol. 29, no. 5, 2010. Web.

Potter, Patricia, et al. Fundamentals of Nursing. 9th ed., Mosby, 2016.

Taylor, Carol, et al. Fundamentals of Nursing. 8th ed., LWW, 2014.

VanBeuge, Susan S., and Tomas Walker. “Full practice authority — Effecting change and improving access to care: The Nevada journey.” Journal of the American Association of Nurse Practitioners, vol. 26, no. 6, 2014, pp. 309-313.

Weiland, Sandra A. “Reflections on independence in nurse practitioner practice.” Journal of the American Association of Nurse Practitioners, vol. 20, no. 7, 2008, pp. 345-352.

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