Full practice authority (FPA) is definitely on the minds of most APRNs. This is a very state dependent issue and here is some current info.
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I recently received the AACN Critical Care Newsletter and was looking thru it casually. One of the articles that caught my eye was from the Hamilton Project and the subject was full practice authority (FPA). This is always a hot topic with my fellow APRNs. Although I live in a state where FPA is practiced, there are still limitations to my practice authority:
Can order home health but can't sign the admitting orders. Same with PT/OT/ST.
I can pronounce a patient deceased but can't sign a death certificate.
Only recently was able to sign off on handicapped placards for the Department of Motor Vehicles.
Just little things to be sure but they impede my ability to care for my patients.
From the American Association of Nurse Practitioners here is a map showing the status of all US states regarding full practice authority.
We all know that the cost of healthcare in the US continues to rise; for some care; to astronomical levels. For instance, its estimated that hemodialysis provided for 3-4 hours per week three times per week costs $89,000 per year.
There are many thoughts as to how to reduce our healthcare costs. However, one that is gaining favor rapidly is expanding the role of APRNs to allow them to practice to the full extent of their licensure. For those of us in the trenches; providing healthcare to our patients on a daily basis and faced with restrictions on our scope of practice, we are actually increasing healthcare costs as well as decreasing productivity.
One example that I'm personally involved in is ordering home care for my patients. When a patient is hospitalized for any period of time, especially a patient who is already chronically ill, they tend to lose some degree of functionality. Many, perhaps most, want to return home if at all possible. Home care is essential to achieving this goal. So, I order the home care; nursing, therapy or other care and the home care agency sends out someone to do the evaluation. Then, they come up with a plan of care. However, they now need orders to start the care. Calling me on my cell phone and having me quickly fax them an order is simple, easy and time-saving. But...that's not what happens. Nope, I have to then call the physician, explain the care needed and then hope he has time to sign the orders that I have written and faxed to him. Sometimes these are physicians that haven't even seen the patient. At the very least we are delaying care by one day. However, if the physician is busy or has further questions, it can involve more prolonged communication and delay in care.
We are all concerned with our employment opportunities and this is another area where growth potential for NPs is high and expected to continue to increase. This graph shows an increase in employment opportunities for APRNs from 2016 to 2026 from the Bureau of Labor Statistics.
You only have to glance thru the APRN and NP forums for the subject of full practice authority. There are many many threads on this. "Opponents contend that quality of care may suffer under the direction of a nonphysician practitioner, citing the shorter length of training and clinical experience required. Their arguments that restrictions are necessary to protect public health." Here is an extensive summary of multiple studies done regarding full practice authority. This is the first table with multiple studies regarding the efficacy of full practice authority for NPs that I've seen recently. It bears reading for all APRNs. Even if you live in a state where you already have full practice authority, this is an important issue for all of us.
