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Should Nurse Practitioners Have Full Practice Authority Nationwide?

Nursing Matters Your Voice Matters - Nurse Practitioners and Physician Assistants

The role of Nurse Practitioners (NPs) has expanded significantly over the past few decades, with NPs providing high-quality healthcare services in various settings. The question of whether NPs should have full practice authority nationwide remains a contentious issue. Full practice authority would allow NPs to evaluate patients, diagnose conditions, interpret diagnostic tests, and initiate treatment plans independently, without physician oversight. This article explores both perspectives of the debate, offering a comprehensive look at the viewpoints for and against nationwide full practice authority for NPs.

Should Nurse Practitioners Have Full Practice Authority Nationwide?

Perspective in Favor of Full Practice Authority

Improving Access to Care

One of the strongest perspectives for granting full practice authority to NPs is the potential to improve access to healthcare, particularly in underserved and rural areas. According to the American Association of Nurse Practitioners (AANP), NPs are more likely than physicians to practice in rural areas, where healthcare providers are often scarce (AANP, 2021). Granting NPs full practice authority could significantly increase the availability of primary care services, helping to address the shortage of healthcare providers and ensuring that patients in these areas receive timely care.

High-Quality, Cost-Effective Care

Studies have shown that NPs provide care that is comparable in quality to that of physicians. Research published in the Journal of the American Medical Association found that patient outcomes for those treated by NPs were similar to those treated by physicians, with no significant differences in health status or mortality rates (JAMA, 2018). Additionally, NPs often provide care at a lower cost, which can lead to significant savings for both patients and the healthcare system. By reducing the need for costly specialist referrals and hospital admissions, NPs can help to lower overall healthcare expenditures.

Supporting Preventive Care and Chronic Disease Management

NPs are well-positioned to provide preventive care and manage chronic diseases, both of which are critical components of effective healthcare. Preventive care can help to detect and address health issues before they become severe, while effective management of chronic diseases can improve patients' quality of life and reduce healthcare costs. A study in the Journal of Nursing Scholarship highlighted that NPs excel in patient education, preventive care, and chronic disease management, often resulting in better patient adherence to treatment plans and improved health outcomes (Journal of Nursing Scholarship, 2017).

Perspective Opposed to Full Practice Authority

Concerns About Training and Experience

Those opposed to full practice authority for NPs often cite concerns about the level of training and experience NPs receive compared to physicians. Physicians undergo extensive education and training, including medical school, residency, and often fellowship programs, which can span over a decade. In contrast, NPs typically complete a nursing degree followed by a master's or doctoral program, along with clinical training that is significantly shorter than that of physicians. Critics argue that this discrepancy in training may impact the ability of NPs to handle complex medical cases independently (American Medical Association, 2020).

Potential for Fragmented Care

Another concern is the potential for fragmented care. Critics argue that allowing NPs to practice independently may lead to a lack of coordination between healthcare providers, resulting in fragmented care for patients. This fragmentation can occur if there is insufficient communication and collaboration between NPs and physicians, potentially leading to duplicated tests, conflicting treatment plans, and overall lower quality of care (American Academy of Family Physicians, 2019).

Safety and Quality Concerns

Some opponents also raise safety and quality concerns, arguing that full practice authority could lead to variations in the standard of care provided. Without the oversight of a physician, there may be inconsistencies in how NPs manage complex or high-risk patients. While studies have shown that NPs provide high-quality care, opponents argue that these studies often focus on primary care settings and may not fully capture the complexities of patient care in other settings, such as emergency medicine or specialized surgical care (American Medical Association, 2020).

Enhancing Nurse Residency Programs and Collaborative Practice

Given the mixed opinions on full practice authority, enhancing nurse residency programs and fostering collaborative practice models can be effective strategies to address concerns and improve the transition from education to practice for NPs.

Standardizing and Expanding Training

Standardizing NP residency programs and expanding training opportunities can help bridge the gap between NP and physician education. Residency programs can provide NPs with additional clinical experience and mentorship, ensuring they are well-prepared to handle complex medical cases independently. Expanding these programs can also help standardize the quality of NP training across different institutions (National Nurse Practitioner Residency and Fellowship Training Consortium, 2021).

Promoting Collaborative Practice Models

Promoting collaborative practice models, where NPs and physicians work together as part of an integrated healthcare team, can enhance patient care and address concerns about fragmented care. These models encourage regular communication and collaboration between healthcare providers, ensuring that patients receive coordinated and comprehensive care. Collaborative practice agreements can outline the roles and responsibilities of each provider, fostering a team-based approach to healthcare (Institute of Medicine, 2010).

Leveraging Technology for Better Coordination

Leveraging technology, such as electronic health records (EHRs) and telemedicine, can also improve care coordination between NPs and physicians. EHRs facilitate the sharing of patient information, reducing the risk of duplicated tests and conflicting treatment plans. Telemedicine can enhance access to specialist consultations and ensure that NPs have the support they need to manage complex cases effectively (, 2020).

Guidance for Nurse Practitioners

For NPs advocating for full practice authority or navigating their roles within collaborative practice models, the following strategies can help ensure success:

Pursue Advanced Training and Certifications

Continuing education and advanced certifications can enhance clinical skills and knowledge, preparing NPs for independent practice. Specializing in areas such as family practice, acute care, or geriatrics can also provide NPs with the expertise needed to manage specific patient populations effectively (American Nurses Credentialing Center, 2021).

Engage in Professional Organizations and Advocacy

Joining professional organizations, such as the AANP, can provide NPs with access to resources, networking opportunities, and advocacy efforts. These organizations work to advance the NP profession and advocate for policies that support full practice authority and improved training programs (AANP, 2021).

Foster Collaborative Relationships

Building strong collaborative relationships with physicians and other healthcare providers can enhance patient care and professional development. Regular communication, joint continuing education, and participation in team-based care initiatives can foster a collaborative environment and address concerns about fragmented care.


The debate over whether Nurse Practitioners should have full practice authority nationwide is complex and multifaceted. While full practice authority can improve access to care, reduce costs, and support preventive care and chronic disease management, concerns about training, care fragmentation, and quality must be addressed. Enhancing NP residency programs, promoting collaborative practice models, and leveraging technology can help bridge the gap between education and practice, ensuring NPs are well-prepared to provide high-quality, independent care. By pursuing advanced training, engaging in professional advocacy, and fostering collaborative relationships, NPs can play a crucial role in transforming healthcare delivery.

Further Reading

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American Association of Nurse Practitioners. (2021). Full Practice Authority. Retrieved from

American Medical Association. (2020). Physician residency training experience. Retrieved from

American Nurses Credentialing Center. (2021). ANCC Certifications. Retrieved from (2020). Benefits of Health IT. Retrieved from

Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing Health. Retrieved from

Journal of Nursing Scholarship. (2017). The Role of Nurse Practitioners in Primary Care. Retrieved from

National Nurse Practitioner Residency and Fellowship Training Consortium. (2021). NNPRFTC. Retrieved from



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