Report Calls for Countrywide Full Practice Authority for Nurse Practitioners


Restrictions that hold nurses at all levels back from practicing to the full scope of their education and training should be removed in all US states.  This was one of the most significant recommendations in the National Academy of Medicine’s Future of Nursing 2020-2030 which was released on May 11.

As the largest profession in the health workforce, the report emphasized that nurses are often the first point of contact for those in need of health services. As part of the communities they serve, they have a critical role in achieving health equity and access to quality health care.  

Nurse practitioners, however, need the regulatory authority to practice autonomously. Furthermore, the necessary payment structures and supportive work environments need to be put in place.

Barriers to nursing practice

Full practice authority allows advanced practice registered nurses (APRN) to consult, diagnose, prescribe and treat without supervision by a medical practitioner.

In March 2020, around 80 million people in the US – nearly one-quarter of the country – lived in areas with a shortage of healthcare professionals. These are mainly rural areas and more impoverished underserved communities.  

Nurses can fill this gap, especially in providing primary health care, if they are allowed to do so.  

Currently, regulations in 23 US states allow APRNs to practice independently. However, 27 US states still restrict full practice authority.  A 2018 study found that an additional 31 million people would have access to primary health care in these states if APRNs were permitted to practice to the full extent of their education and training.

In response to the COVID epidemic, eight states temporarily lifted practice barriers, and this has been made permanent now in California and Massachusetts.

Recommendations to remove restrictions on nursing practice

In its report on the future of nursing, the National Academy of Medicine (NAM) recommended that:


 “All relevant state, federal and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality, and value.”

NAM further recommended that all laws which were adopted in response to COVID-19 be made permanent by 2022. This applies to regulations that address nurses’ scope of practice and those that relate to insurance coverage and telehealth services.  They also recommended that federal law should be used to supersede the restrictive state laws in these areas.

These recommendations were welcomed by the Association of Advanced Nurse Practitioners, who have worked unceasingly for legislative changes for over two decades. “We commend NAM for recognizing the urgency of this moment and implore federal and state authorities to permanently authorize NPs to work at the top of their profession – including payment parity for all services delivered to patients,” said Sophia Thomas, President of AANP.

Further recommendations for the future of nursing

Besides removing barriers to practice for APRNs, action was also required to enable nurses in all settings to make full use of their education and training.

Government agencies and all levels of service providers should take action to “enable the nursing workforce to address social determinants of health and health equity more comprehensively, regardless of practice setting.”

To this end, the following recommendations were included:

  • Nursing schools should foster diversity that reflects the populations the students will be serving. Nursing education should include exposure to nursing in the full range of community settings.
  • Nurse leaders should be representative of the diverse communities that they serve. They should consider the importance of equity in health care as well as the social determinants of health.  
  • Nurses should be prepared for their role in disasters with regard to both disaster response and public health emergency management.
  • The health and well-being of nurses must be supported. The COVID epidemic highlighted the effects that current workplace demands, policies, and systems have on the physical and mental health of the nursing workforce.

Power of nurses

Victor Dzau, president of NAM, hoped that the recommendations contained in the report would be used to unleash the power of nurses, bringing about greater health equity and well-being for the communities they serve.

“Nurses are powerful in number and in voice, and the world needs their dedication and persistence more than ever,” said Dzau. “The pandemic has taught us that health care organizations will be made stronger when nurses’ knowledge, skills, and contributions are valued and appreciated, and when nurses are given the tools, resources, and institutional support to do their jobs the best way possible.”


Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.

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