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What Is Scope Of Practice For Nurse Practitioners

UT Health Provider Profile: Meagan Smith, APRN, MSN, FNP-C

The American Nurses Association defines scope of practice as the services that a qualified health professional is deemed competent to perform, and permitted to undertake in keeping with the terms of their professional license.

The three types of practice regulations for NPs are:

FULL: NPs can prescribe, diagnose, and treat patients without physician oversight. Nurse practitioners who operate in full-practice states are also allowed to establish and operate their own independent practices in the same way physicians do.

REDUCED: NPs can diagnose and treat patients but need physician oversight to prescribe medications.

RESTRICTED: NPs need physician oversight to prescribe, diagnose, and treat patients.

Independent Nps: What’s The Evidence

Christina Bennett

In 2020, Florida and California passed legislation to relax scope-of-practice laws for nurse practitioners .

Florida’s new law went into effect July 1 and allowed NPs to practice independently, after completing 3000 hours of practice supervised by a physician in the past 5 years. The bill in California, which will take effect in January 2023, requires NPs to work under the supervision of a physician for 3 years before practicing independently.

Florida and California join 12 other states that require similar transition periods before allowing NPs to practice independently, and 14 others that allow full practice authority. Previously, states that expanded scope-of-practice laws tended to have more rural patient populations.

Currently, 22 states continue to have scope-of-practice laws that restrict NPs from practicing independently, though one, Massachusetts, is exempting advanced practice registered nurses who have completed 2 years of supervised practice from the state’s requirement for physician supervision during the current state of emergency because of COVID-19.

Can A Nurse Practitioner Have Their Own Practice In Hawaii

Hawaii allows all nurse practitioners to have FPA.

This allows them the freedom to diagnose and evaluate patients, manage their treatment plans and analyze tests.

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Hawaii is purported to have the narrowest pools of licensed NPs, yet they offer some of the most attractive salaries in the nation. An NPs average salary in Hawaii is over $120,000 annually.

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Current Progress Towards Independent Practice

Slowly but surely, nurse practitioner authority continues to increase. The VA recently granted full authority to advanced-practice nurses, including NPs. South Dakota also recently authorized full autonomous practice. There is also the APRN Campaign for Consensus that is working to assist states in standardizing their NP laws and regulations-including independent practice and prescribing.

Nurse Practitioner Practice Regulations

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  • Full Practice Autonomy: State licensure allows NPs to evaluate patients including examination, diagnosis, ordering and interpretation of diagnostic tests, establishing a treatment plan, and prescribing medication.
  • Reduced Practice Autonomy: NPs are limited in at least one area of patient evaluation and must collaborate with other medical professionals, such as physicians, to care for patients. They are not permitted to provide all levels of care independently, often including prescribing controlled substances, and must coordinate with other medical professionals.
  • Restricted Practice Autonomy: State practice authority limits the ability of NPs to provide patient care and requires them to work under the delegation or team management of another medical professional throughout their career. NPs in restricted practice autonomy states must have the direction of a medical supervisor, such as a leading physician, to deliver care to patients.

States with full practice authority for nurse practitioners allow nurses to streamline care for patients. While the healthcare system does not function without collaboration and teamwork between medical professionals, granting additional authority to NPs allows them to provide direct care to patients, eliminating some of the backlog for physicians and increasing the efficiency of care delivery. With advanced certifications, NPs can provide optimal long-term care to their patients.

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Pros Of Being A Nurse Practitioner With Fpa

  • We already mentioned the lucrative salary associated with the role, which makes this a solid job choice.
  • NPs receive the same professional recognition as physicians and perform many of the same roles. Nurse practitioners can head departments, serve on boards, teach, and become provosts.
  • There are tangible and intangible rewards for working in medicine and those who want to give to others can truly make a difference. As an RN, there is much to gain from transitioning to a nurse practitioner role, including a wider scope of practice.

Where Can Nurse Practitioners Work Without Physician Supervision

Since the inception of the first nurse practitioner education program in 1965, men and women in the profession have experienced great success and heated opposition. Physician organizations have openly opposed the use of nurse practitioners as primary care providers, claiming that educational gaps render NPs unsafe and unqualified to care for patients independently.

Even though the decades-old debate continues, research has proven time and again that nurse practitioners are indispensable primary care providers with the ability to treat a wide variety of conditions. Moreover, the Kaiser Family Foundation indicates that 58 million Americans live in areas in which the supply of primary care physicians doesnt meet federal standards with the appropriate ratio of providers to patients. The gap is widening as legislation expands access to medical care, and the Association of American Medical Colleges predicts the physician shortage could reach up to 139,000 physicians by 2033. Nurse practitioners are gaining independence and establishing autonomy as they provide medical care without the oversight or management of a physician.

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Utah Nurse Anesthetist Salary

Considering a career as a nurse anesthetist? In Utah, anesthetists earn an average salary of $127,130 annually. That rate only goes up with experience. The top 10 percent report making $188,650 or more per year.

2020 US Bureau of Labor Statistics job market trends and salary figures for 1) Nurse Anesthetists, Nurse Practitioners, Nurse Midwives 2) Medical and Health Services Managers 3) Registered Nurses and 4) Postsecondary Nursing Instructors and Teachers reflect state data, not school-specific information. Conditions in your area may vary. 2019 US Census Bureau figures for state median household income provided for comparison. Data Accessed December 2021.

Nurse Practitioners Beginning Work In Private Practice

Lisa Miconi-Correa, FNP – South Ogden Center for Family Medicine

Carolyn Zaumeyer, an NP and the author of How to Start an Independent Practice: The Nurse Practitioners Guide to Success, said NPs must identify their strengths and weaknesses before opening the doors to their independent practice. The best way to do so is to work under the supervision of a doctor or other FNPs initially.

Zaumeyer, in an interview on XM satellite radio station ReachMD, said FNPs should be comfortable and confident in their role before taking on the added responsibility of the private practice.

You want to practice safely and know that you are doing the right thing for your patient as well as yourself, Zaumeyer told show host Lisa DAndrea.

Filling the role as a private practice FNP requires a strong educational background that includes classroom and clinical expertise. Duquesne Universitys online MSN FNP program prepares APRNs to become primary care providers. Students engage in coursework that covers management, leadership, and business concepts, the transition to independent practice, and issues exclusive to the FNP role.

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Nurse Practitioner Scope Of Practice

While it would be reasonable to think that NP scope of practice would be consistent nationwide as a result of the physician shortage, this is unfortunately not the case. Nurse practitioners have faced an uphill battle when lobbying for more independent practice, and scope of practice differs between states. According to the American Association of Nurse Practitioners, twenty-three states allow the independent practice of NPs. Sixteen states have reduced practice, and twelve states have restricted practice.

In the 1980s, states with more rural and remote areas were among the first to allow nurse practitioners more independent practice, as physicians were few and far between. More states granted NPs autonomy in the 1990s, and with the passage of the Affordable Health Care Act, states are slowly but consistently joining the list. However, some of the larger states such as California, Florida, and Texas still have restrictions on NP practice. If or when these states allow full independent practice, a considerable number of patients will have greater access to care.

States With Full Practice Authority For Nurse Practitioners

What degree program are you interested in?

Earning a nurse practitioner degree and becoming a nurse practitioner is a rewarding career path for many nurses. However, some states grant NPs much more autonomy than others do. While some states grant NPs partial autonomy, others offer full practice authority , which enables them to practice without the oversight of a physician.

For nurse leaders, this means that they have both more opportunities and options to provide care to patients and the authority to take on senior-level roles and the higher salaries that accompany them. By earning an advanced degree that prepares students for an NP role, nurses working in states with full practice authority for nurse practitioners are able to gain the wealth of knowledge they need to treat patients and take on more responsibility while working toward their professional goals.

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Full Practice Authority States/territories

    Samoa does not have a Board of Nursing or a nurse practice act. In 2017, the House of Representatives introduced the American Samoa Nurse Practice Act.
    Indiana does not issue nurse practitioner or clinical nurse specialist licenses, though it issues other APRN licenses.
    In February 2021, Pennsylvania State Bill 25 was introduced. The measures in this bill include expanding the scope of practice for certified nurse practitioners.
    The APRN Modernization Act 2021 is currently in legislation.

Nurse Practitioner Autonomy: A Shift To More Independent Practice


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The United States is currently in the midst of a physician shortage. In fact, the Association of American Medical Colleges estimates a shortfall of between 46,100 and 90,400 physicians by 2025. Meanwhile, the demand for healthcare services continues to increase due to an aging baby-boomer population and recent healthcare legislation. Because the supply of healthcare providers is not meeting the demand, nurse practitioners are stepping up to the plate to provide high-quality, cost-effective care.

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Can A Nurse Practitioner Have Their Own Practice In New York

New York seems to fall between the two extremes, while the state law does not require an NP to work under the supervision of a Physician, they are held independently responsible for diagnosing and treating their patients.

Despite the fact that they are held independently responsible and do not need to act under physician supervision.

They are not allowed to practice independently. They are required to follow a written practice agreement and written practice protocols and with a collaborating physician.

As of Jan 1st, 2015 nurse practitioners with over 3600 hours of practical qualifying experience have the option to do the following:

  • A) They can continue working under a collaborating physician in accordance with their written practice agreement and written practice protocols.
  • B) They can form collaborative agreements with one or more health care facilities licensed by the New York State Health Department or with one or more qualified physicians. This law means NPs can operate with a greater level of autonomy, but as yet are not considered independent practitioners.

What states can nurse practitioners have their own practice then? Thats coming up next.

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What Is Scope Of Practice

Scope of practice refers to the professional activities that each state authorizes nurses or other clinical staff to perform. A nurse practitioner’s scope of practice can include assessing a patients condition, ordering tests, interpreting results and making diagnoses, prescribing medication, and ordering treatments. However, the details vary by state. For example, in some states, nurse practitioners must work under a physicians supervision or in collaboration with a physician, while others are full practice authority states, in which nurse practitioners can practice without this supervision or collaboration.

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Nurse Practitioner Programs Utah

Nurse practitioners are advanced nurses whose educational preparation allows them to manage health conditions and prescribe treatments. They are not doctors but are able to fill some of the needs traditionally met by doctors.

Nurse practitioner is the most common advanced practice registered nurse, or APRN, category. In Utah, more than three in four APRNs are nurse practitioners. Nurse practitioners can provide primary care much like doctors do. Most have a population focus that is broader than that of nurse midwives. Family practice is the most common nurse practitioner designation. Nurse practitioners with this designation may see patients across the lifespan. Some patients, though, will have needs that are too complex for the family nurse practitioner to meet. Referral is a very common practice in the modern healthcare world.

Nurse practitioners may have any of the following population foci: family, pediatric, neonatal, adult-gerontology, womens health, or psychiatric mental health. Some have an acute care focus. Utah has a slightly larger percentage of nurse practitioners who are certified in family practice than does the average state . There is a significantly smaller percentage of Utah nurse practitioners certified in adult nurse practitioner categories.

Definition: What Is Practice Authority

APRN Independent Practice in Florida

Full practice authority is the highest level of practice granted to NPs in the states that allow them to practice without physician supervision. According to the American Association of Nurse Practitioners , there are three distinct categories of FPA versus supervised practice authority, as follows:

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Regulatory Theory And Full Practice Authority Legislation

We found a two-fold increase in states that adopted FPA for NPs post-ACA passage compared with the previous decade. As per the regulatory theory, the interest group who are able to be most influential are able to influence regulatory legislation in their favor. Organized medicine remains a strong interest group advocating against FPA for NPs. However, in this analysis, despite medicines influence, eight states were able to make legislative changes, which resulted in FPA for NPs.

Medical organizations voiced many concerns over FPA. For example, the Connecticut Medical Society and Nebraska Medical Association opposed FPA because of concerns of decreased quality and consumer confusion over the type of provider seen . The Nevada State Medical Association was concerned that elimination of collaborative agreements would result in NPs feeling isolated from physicians, leading to decreased teamwork in patient care . The North Dakota State Board of Medical Examiners advocated for collaborative agreements because from their perspective, these documents ensured patient protection .

Restricted Practice Authority States

    As of July 1, 2020, under HB 607, ARNPs in Florida who have completed 3000 hours under the supervision of an MD or DO in the last five years can apply for an unrestricted license.
  • Nursing Statutes and Regulations
  • In 2018, South Carolina removed the previous requirement that collaborating or supervising physicians be located within a 45-mile radius of the NPs practice and raised the number of NPs that a physician can supervise or collaborate with from three to six.

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More States Should Allow Nurse Practitioners To Practice Independently And To The Full Extent Of Their Training

The COVID-19 pandemic has highlighted some of the shortcomings in our health care system, but a longer-term crisis is also lurking around the cornera national shortage of physicians. According to the U.S. Department of Health and Human Services, 37 states are projected to have a shortage of primary care physicians in 2025. California alone could experience a shortage of 1,550 primary care physicians by 2025.

Allowing non-physician providers like nurse practitioners to practice independently and to the full extent of their training can help alleviate the coming shortage. Fortunately, the California Legislature recently passed and Gov. Gavin Newsom signedAssembly Bill 890, which does just that.

About half of the states across the country already allow nurse practitioners to practice independently. Unfortunately, many physician groups strongly oppose this sensible solution to the crisis. The American Medical Association , a group representing physicians and medical students, tried to get Gov. Newsom to veto the bill and will likely continue to fight similar reforms in other states.

The AMA claimed that eliminating supervision requirements would fail to address problems with rural access, raise health care costs, and threaten public safety. However, the bulk of evidence refutes each of these claims.

Expanding Access to Health Care

Reducing Costs

Quality of Care

Opening An Independent Fnp Practice

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Business and healthcare leaders say entrepreneurial FNPs should first look to their state regulations when considering opening a private practice. In almost half of the states in the nation and the District of Columbia, FNPs have the legal authority to open private practices to provide primary care services and prescribe medications and controlled substances. In the other states, FNPs must practice under the supervision of a physician and may not have full prescriptive authority.

Experts say independent FNPs should consider these tips before opening their businesses:

  • Draw up a business plan: In developing a document that outlines business objectives and strategies, FNPs can narrowly focus their goals. The U.S. Small Business Administration said a good business plan guides entrepreneurs through the many stages of starting and managing a business. The traditional plan contains an executive summary of intent, a market analysis, an outline of the organization and marketing plan, and financial projections.
  • Finance startup costs: An FNP practice has financial considerations that include leasing office space, purchasing office furniture, getting property and malpractice insurance, and acquiring medical equipment. Other overhead costs include hiring an office manager and support employees and purchasing or leasing electronic health record systems, medical billing services, transcription services, and credit card processors.

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