Nurse Practitioners Making Strides, Including at the VA


Although some of the most populous states still restrict nurse practitioner scope of practice, NPs have made significant progress toward full-practice authority, including in 21 states. But most important may be the movement forward by the U.S. Veterans Affairs Department to fully empower advanced practice registered nurses, including nurse practitioners.

“We currently have about 40% of states providing patients with full and direct access to nurse practitioners by their state licensure structure,” said Tay Kopanos, DNP, NP, Vice President of State Government Affairs for the American Association of Nurse Practitioners (AANP). “We are working toward 100%, so that patients, no matter where they are, can get access to NP services.”

VA Proposes Full Authority for NPs

The Department of Veterans Affairs recently proposed granting full-practice authority, without the clinical supervision of a physician, to advanced practice registered nurses (APRN), including certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists and certified nurse-midwives. This proposal is in response to the critical need to increase veterans’ access to VA healthcare -- and to use the department’s healthcare workforce more effectively.

The proposal would mean that, even in restrictive states such as California, Texas and Florida, NPs could practice autonomously in VA facilities. Such a rule change could be a lengthy process. The VA received more than 177,000 comments on the proposal; comments are considered before a final rule is issued by the Veterans Health Administration, which is the veterans’ patient care system.

“The VA has the potential to influence other states,” Kopanos said. “What we are seeing with the VA is a realization that nurse practitioners – if utilized to their full capacity -- have the potential to improve healthcare and make outcomes better.”

Legislation Advances in Many States

In the last five years, seven states have adopted full-practice authority. More states have introduced legislation, and Kopanos expects other states to begin modernizing their licensure laws. In states that have full-practice authority, models like team-based care and other innovations in healthcare delivery are thriving, she said.

Driving the increased scope of practice for NPs and other advanced practitioners are physician shortages, increased emphasis on preventive care, increasing patient demand for healthcare services, an aging population that needs more care and particularly chronic care, and rising retirements among physicians and nurses that will require replacements. NPs also function effectively at full scope of authority in accountable care.

Research has shown nurse practitioners provide quality care. A 2014 analysis of Medicare and dual-eligible beneficiaries by Gina Oliver, PhD, APRN, FNP-BC, CNE, at the Sinclair School of Nursing at the University of Missouri, found that in states where NPs have full-practice authority, beneficiaries had lower rates of hospital admissions and improved health outcomes.

Although many states still restrict their scope of authority, NPs are authorized to prescribe in all 50 states and the District of Columbia. Florida was the last state to grant authorization to prescribe controlled substances with the passage of legislation this year. NPs prescribe more than 733 million prescriptions annually, according to AANP.

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