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Full Practice Authority (FPA) as defined by the American Association of Nurse Practitioners (AANP) is “the collection of state practice and licensure laws that allow for nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including the ability to prescribe medications—under exclusive licensure authority of the state board of nursing.”1 AANP supports the modernization of state licensure laws. This licensure model, Full Practice Authority, is supported by decades of evidence and is recommended by the National Council of State Boards of Nursing (NCSBN), the National Academy of Medicine (formerly the IOM), and other leading health policy experts. The country continues to experience a restriction in scope of practice for nurse practitioners (NPs) which remains costly to the economy and presents a barrier to patient care. Currently states, plus the District of Columbia, and two US territories (Guam and the Marianas Islands). permit NPs to diagnose, treat, and prescribe medications without physician oversight—Full Practice Authority (Figure 12-1). In 2008, the Robert Wood Johnson Foundation (RWJF) partnered with the Institute of Medicine (IOM)* to establish an Initiative on The Future of Nursing: Leading Change, Advancing Health.


AANP 2021 Nurse Practitioner State Practice Environment

Source: State Nurse State Practice Acts and Administration Rules, 2017 ©American Association of Nurse Practitioners, 2017 Update: 1.2021

In 2010 the committee released its landmark report that recommended scope-of-practice (SOP) barriers should be removed to allow advanced practice registered nurses (APRNs) to practice to the full extent of their education and training.2

Assessments have been made on the IOM report, The Future of Nursing.2 In 2011, the American Nurses Association (ANA) released a statement in which the organization and its members were actively pursuing change, such as the efforts of state nursing associations to make state-level changes to SOP laws.3 In 2014, the Federal Trade Commission (FTC) released a paper stating, “physician supervision requirements may raise competition concerns because they effectively give one group of health care professionals the ability to restrict access to the market by another, competing group of health care professionals, thereby denying health care consumers the benefits of greater competition.”4 The American Association of Retired Persons (AARP) supports FPA, with additional recommendations to states to amend current SOP laws and regulations to allow nurses and APRNs to perform duties for which they have been educated and certified.1–5 Additional health policy and consumer advocacy organizations support removing SOP barriers. These groups include, but are not limited to, the National Governors Association, Bipartisan Policy Center, and the Josiah Macy Foundation.1

*The IOM is now known by its new name the National Academy of Medicine.


The NCSBN undertook several new efforts, including ...

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