Full Practice Authority

What Does This Mean for our Patients? 

By: Mona Williams-Gregory, Ph.D., DNP, APRN

In 1965, the role of the NP was created by Loretta Ford. In this fledgling role, she functioned as a pediatric NP in collaboration with a pediatrician. For several years, the role of the NP remained relatively unchanged and ill-defined with physicians acting in supervisory capacities. In 1971, Idaho was the first state to formally recognize the role and the expansive scope of NPs¹. Increasingly since then, the contributions made by NPs have been well documented and are rich in the literature. By 1994, five states had adopted full practice authority for NPs. Since then, full practice authority has been sweeping the US and has been adopted by 26 states, DC, and two US territories¹.

What does full practice authority mean for our patients? Head-to-head studies have compared clinical and quality outcomes of patients cared for by NPs with patients cared for by physicians. Patients cared for by NPs have equivalent, positive clinical outcomes when compared to similar patients cared for by physicians^2,3,4,5,6. When caring for patients, the clinical safety among NPs is equivalent to that of physicians⁶. Care provided by an NP has demonstrated improvement in several clinical indicators. Inpatients cared for by NPs have lower mortality rates³. Outpatients cared for by NPs have fewer ED visits⁵ and fewer hospitalizations^2,5. Overall, the care provided by NPs is associated with lower total healthcare expenditures⁵. Patients cared for by NPs consistently report greater patient satisfaction than when cared for by other health care practitioners⁶. NPs provide superior education and more counseling than any other healthcare provider^4,6. Full practice authority means reduced costs and improved access to quality healthcare services^5,7.

References:

1. Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. J Am Assoc Nurse Pract, 30(3), 120-130.doi: 1-.1097/JXX.000000000000023

2. Liu, C-F., Hebert, P. L., Douglas, J. H., Neely, E. L., Sulc, C. A., Reddy, A., Sales, A. E., & Wong, E. S. (2020). Outcomes in primary care delivery by nurse practitioners: Utilization, cost and quality of care. Health Services Research, 55(2),1 78-189. doi: 10.1111/1475-6773.13246
3. Gupta, S., Balachandran, M., Bolton, G., Pratt, N., Molloy, J., Paul, E., & Tiruvoipati, R. (2021). Comparison of clinical outcomes between nurse practitioner and registrar-led medical emergency teams: a propensity-matched analysis. Critical Care, 25(117). https://doi.org/10.1186/s13054-021-03534-4
4. Kurtzman, E. T., & Barnow, B. S. (2017). A comparison of nurse practitioners, physician assistants, and primary care physicians’ patterns of practice and quality of care in health centers. Med Care, 55(66), 615-622. doi: 10.1097/MLR.0000000000000689
5. Morgan. P. A., Smith, V. A., Berkowitz, T, Edelman, D., Van Houtven, C., Woolson, S. L., Hendrix, C. C., Everett, C. M., White, B. S., & Jackson, G. L. (2019). Impact of physicians, nurse practitioners, and physician assistants on utilization and costs for complex patients. Health Affairs, 38(6). https://doi.org/10.1377/hlthaff.2019.00014
6. Carranza, A. N., Munoz, P., & Nash, A. J. (2020). Comparing quality of care in medical specialties between nurse practitioners and physicians. J Am Assoc Nurse Pract, 33(3), 184-193. doi: 10.1097/JXX.0000000000000394
7. Dillon, D., & Gary, F. A. (2017). Full practice authority for nurse practitioners. Nursing Administration Quarterly, 41(1), 86-93. https://www.researchgate.net/publication/312009196