full practice authority for nurse practitioners

Exploring Full Practice Authority: Empowering Nurse Practitioners for Enhanced Care

With the looming physician shortage, which is expected to reach 124,000 by 2034, nurse practitioners(NPs) can play an important role in bridging the gap of healthcare disparities. With their knowledge and expertise, NPs can ensure that patient care outcomes do not suffer in the time it takes for the medical workforce to compensate for the lack of physicians. But, there’s a catch—limitations on their full practice authority (FPA) could get in the way. That’s why it’s crucial that we understand what FPA is and how it can further empower NPs.

What is full practice authority?

The American Association of Nurse Practitioners defines that “Full Practice Authority (FPA) is the authorization of nurse practitioners (NPs) to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments — including prescribing medications — under the exclusive licensure authority of the state board of nursing.”

This implies that with the necessary licensure and certification, NPs do not need to work under the supervision of a physician while treating patients. Their advanced training and clinical experience deem them capable of seeing patients independently and treating them.

Why is FPA important for nurse practitioners?

Nurse practitioners can actively contribute to decreasing healthcare disparities and streamlining the delivery of medical services. FPA can empower nurse practitioners to exercise their authority as permitted by their licenses. They can positively impact the American healthcare scenario by:

  • Improving healthcare in rural areas: With approximately 46 million Americans living in rural areas, it becomes crucial to negate the shortage of primary care affecting these areas. NPs can perform an essential role in increasing healthcare access within these areas. According to Dr. Joanne Spetz, NPs have greater flexibility in pursuing their educational pathways from remote areas, as opposed to a physician’s training and education that is usually centered around urban areas. This can prompt them to consider a wider number of options while deciding upon their area of practice. They are also more likely to find greater job satisfaction in rural areas than physicians as their difference in pay in rural and urban areas isn’t as significant.
  • Decreasing costs: When full practice authority is coupled with increased access to care, NPs can play a huge part in preventive healthcare. More frequents office visits can help in detecting and controlling symptoms of chronic diseases before they reach a stage that requires more serious medical attention. Besides, FPA also eliminates the cost of practice revenues that NPs have to pay collaborating physicians, which can help reduce the costs of visits and treatment.
  • Protecting patient choices: NPs with reduced or restricted practice authority can’t prescribe medication or bill for services independently. This can create a greater workload for physicians, and patients must make multiple visits to get their treatment approved. Granting FPA to nurse practitioners can simplify this process and make it easier for patients to navigate the healthcare system.
  • Contributing to a more efficient healthcare system: The need for a physician to approve most clinical decisions can cause unnecessary delays in receiving medical services. In certain cases, this can have unforeseen impacts on patient care outcomes. However, NPs with full practice authority can streamline these processes and improve medical efficiency.

States that have adopted FPA for NPs

There are three different levels of practice authority granted to nurse practitioners across states. Some states allow them to practice independently without needing to collaborate with a state-licensed physician (this is known as FPA), while some states allow them to practice independently after a conditional ‘transition to practice’ (this is known as ‘reduced practice authority). States that don’t participate in either of these two and require NPs to have the supervision of a physician, have adopted a stance known as ‘restricted practice authority.’

States allowing nurse practitioners to practice independently include:

  • Alaska
  • Arizona
  • Delaware
  • Hawaii
  • Idaho
  • Iowa
  • Kansas
  • Kentucky
  • Maryland
  • Massachusetts
  • Montana
  • Nevada
  • New Hampshire
  • New Mexico
  • North Dakota
  • Oregan
  • Rhode Island
  • Utah
  • Washington
  • West Virginia
  • Wyoming

14 other states allow nurse practitioners to practice independently after a specified amount of time  of supervised practice. These hours can range from a minimum of 750 hours to a maximum of 4,000 hours. These states are:

  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Florida
  • Illinois
  • Maine
  • Minnesota
  • Nebraska
  • New Jersey
  • New York
  • South Dakota
  • Vermont
  • Virginia

Resistance to granting FPA to NPs

While the arguments in favor of granting FPA to NPs have been gaining momentum with support from organizations like the American Nursing Association, the American Association of Nurse Practitioners, and the Institute of Medicine, several states only grant restricted practice authority to nurse practitioners. The stance to restrict nurse practitioner authority is hugely supported by the AMA, which has stated that ‘nurse practitioners are valuable members of this team, but they are not a replacement for physicians.’ The resistance to granting FPA to nurse practitioners is rooted in: 

  • Tradition: According to the supporters of the physician-led model, the historical practice of healthcare has outlined the roles and perceptions of medical professionals. Every member of a healthcare team has clearly defined roles, and one cannot encroach upon or replace the authority of the other. 
  •  Educational differences: The education and training of physicians and nurse practitioners vary greatly. The stance that favors this argument believes that physicians are better equipped to lead healthcare teams instead of NPs because they serve three to seven years in residency which equips them with better clinical judgement. 
  • Bureaucratic factors: If NPs operate with complete practice authority, it could potentially result in an economic impact on the healthcare system. Key players like healthcare facilities, pharmaceutical companies, and insurance providers might find their revenue margins affected by the emergence of a different healthcare model and prescription patterns. 

Also read: 7 Careers in Healthcare You Should Be Considering

Why regulatory changes on FPA are necessary

The American healthcare system can greatly benefit from nurse practitioners having full practice authority as they are well-equipped to provide holistic patient-centric care. As for the question of their competence, the ANA’s Principles on FPA mentions that NPs “are prepared at the graduate level and are deemed competent clinicians upon graduation and passage of national certification.”

It is important to understand the notion of full practice authority for nurse practitioners doesn’t mean they will replace physicians. FPA only means that NPs will be able to practice to the complete extent of authority that their licensure grants. This will not only improve the access and effectiveness of the healthcare system but also create a wider scope for NPs and physicians to work together to benefit patients.


  1. AAMC Report Reinforces Mounting Physician Shortage | AAMC
  2. Issues at a Glance: Full Practice Authority (aanp.org)
  3. Selected rural statistics for the United States (ruralhealthinfo.org)
  4. A Policy Perspective: How NPs Expand Healthcare Access to Rural Areas | Healthforce Center at UCSF
  5. Welcome to the American Nurses Association | ANA (nursingworld.org)
  6. AANP | The American Association of Nurse Practitioners
  7. Home – National Academy of Medicine (nam.edu)
  8. Turf wars heat up after pandemic blurred provider treatment lines (axios.com)
  9. ANA Principles for Advanced Practice Registered Nurse (APRN) Full Practice Authority (nursingworld.org)

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