Nurse Practice Authority Gains to Benefit Patient Access to Care

More states across the country are enabling full practice authority for advanced practice registered nurses (APRNs), according to new data in The Nurse Practitioner, which nursing leaders have contended will improve patient access to care and overall patient health.

Particularly, this year’s Annual Legislative Update revealed that many states codified the temporary, emergency flexibilities for APRN full practice authority. The report, informed by nationwide surveying of state boards of nursing, made the argument that those once-temporary flexibilities had an ultimate long-term payoff for both APRNs and the patients who need broader care access.

"Relaxation of existing regulations in supervision, collaboration, license renewal, and portability due to the continuing COVID-19 pandemic improved practice authority for APRNs in reduced- and restricted-practice states," Susanne J. Phillips, DNP, APRN, FNP-BC, FAANP, FAAN, of the University of California, Irvine, wrote in the introduction to the report.

In some states, legislatures made moves to fully expand scope of practice. In 2021, Massachusetts and Delaware passed legislation that would accomplish that goal. The Massachusetts law granted full practice authority APRNs, while the Delaware legislation removed the transition to practice (TTP) policy from six years, 4,000 of full-time hours, and a collaborative agreement with a physician, podiatrist, or health system.

Delaware also joined North Dakota in the APRN compact, which allows APRNs who hold full practice authority the ability to practice in other Compact states.

In Arkansas, legislation shortened nurse practitioners’ time period to full practice authority from five years to two years. Florida, Illinois, Louisiana, North Carolina, and Oklahoma all also passed laws improve practice authority for APRNs.

States are also expanding practice authority in non-traditional settings, like home health and telehealth. NPs and clinical nurse specialists (CNSs) can now order home healthcare services, codifying legislation originally proposed as a pandemic-era emergency flexibility.

“Like home healthcare advances, many states reported adoption of statutes in 2021 related to the delivery of telehealth services by APRNs, including reimbursement for those services,” Phillips said of telehealth laws. “As a result of the COVID-19 pandemic, many states implemented emergency orders, rules, and legislation authorizing APRNs, among other healthcare providers, to provide healthcare services through audio and audiovisual visits.”

Finally, some states passed laws regarding APRNs and reimbursement. In Arkansas, legislation now requires Medicaid to acknowledge APRNs as primary care providers, primary care case managers, team leaders of family practice professionals, and patient-centered medical homes.

The law also created some requirements around Medicaid reimbursement for some services and costs of labs ordered or conducted by APRNs.

Louisiana law now states that health payers must include certified nurse midwife services in maternity benefits. Maine now requires coverage for certified nurse anesthetists (CRNAs), while Washington passed a law requirement a Medicaid reimbursement increase.

This improved practice authority should be of benefit to patients, particularly in states where patient access to care is limited either by staffing shortages or other care access barriers. APRNs are poised to address social determinants of health and health equity obstacles that often keep traditionally underserved patients from getting the care they need.

“Further supporting [full practice authority] legislation and regulatory changes, a new study published by Yang et al. provides a systematic review of state NP practice regulations and care delivery outcomes,” Phillips wrote in the report. “Their findings suggest that states with FPA are associated with improved access to care in underserved and rural communities without compromising quality of care.”