Nurse Practitioner’s Scope of Practice/Autonomy

Executive Summary

Nurse practitioners (NPs) are an essential component in meeting the increasing demand for quality care in society. NPs’ autonomy, which is limited in current regulatory framework, enhances their participation in care delivery hence alleviating challenges in access to care where there are physician shortages. Regulatory barriers contributing to limitations on autonomous practice for NPs include limitations on prescription authority and requirement for physician-supervision. Currently, NPs’ scope of practice varies from state to state with state regulations that determine such scope differing among states. Whereas in some states NPs can perform various healthcare services autonomously, in other states such as Alabama and Florida NPs are not allowed to prescribe controlled medications, and in other states, NPs require physician’s supervision to perform most of their roles.

As of 2007, only 11 states allowed NPs to practice independently i.e. to diagnose, treat and prescribe medications without supervision by or collaboration with a physician (Keough et al., 2011). Most states require the documentation of a relationship between a NP and a physician for the NP to practice. For NPs to have more autonomy in performing roles within their scope of practice, education, certification and accreditation standards need to be unified across all the states. The uniformity of education, certification and accreditation standards can be achieved through a consensus model where professional bodies and accreditation authorities agree on the threshold required for nurses to acquire specific skills and qualification required to grant a specific practicing license. Through such an approach, the system would provide NPs who can perform care activities autonomously across all states without a concern of lowering the quality of care provided. The enhanced autonomy in performing their roles enhances NPs’ satisfaction with their work thus reducing their turnover, which, in turn, enhances the access to quality care even in an environment of increasing demand.

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