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How U.S. states are improving care delivery by giving nurses full practice authority

More than 20 states enacted laws in 2017 to equip nurses with full practice authority.

Jeff Lagasse, Associate Editor

As 2017 comes to a close, many states have signed laws and regulations expanding access to healthcare provided by advanced practice registered nurses.

Hospital executives involved with attracting, hiring and retaining top talent will want to track the trend of enabling nurses to practice at the top of their license because doing so makes them more accessible to a wider array of patients.

[Also: Physician groups close gap, prepare for potential shortage by utilizing nurse practitioners, advanced practice clinicians]

"In 2017, over 20 states reported passage of legislation positively impacting access to and delivery of healthcare nationwide," wrote Susanne Phillips of the University of California, Irvine, in her annual report on legislative developments affecting APRN practice in the January issue of The Nurse Practitioner.

Phillips highlighted national efforts to move individual states toward providing full practice authority (FPA) to APRNs: nurses with advanced degrees and clinical experience who have the potential to improve access to healthcare in a number of settings.

[Also: Nurse practitioners now make more than $100,000, survey finds]

Phillips noted in particular the "substantial and successful" efforts in moving toward FPA in South Dakota and Illinois. With some important differences, both states expand the scope of practice for APRNs who meet criteria for training and clinical experience.

With these changes, APRNs now have full, autonomous practice and prescribing authority in 25 states and the District of Columbia, in some cases after a period of supervision or collaboration with a physician. In the remaining states, APRNs continue to practice under the supervision or in collaboration with physicians.

[Also: Nurse practitioners want insurers to add them to HIX plans]

Reflecting intensified efforts to respond to the ongoing opioid crisis, several states have enacted new laws or regulations on the prescribing of controlled substances. Two states, California and Oregon, passed legislation bringing nurse practitioners' role into line with the federal Comprehensive Addiction and Recovery Act. These laws clarify the role of nurse practitioners in prescribing buprenorphine, an important part of treatment for opioid use disorders.

Other new legislation affecting APRN practice includes changes in practice authority, including several states where APRNs are now authorized to recommend -- though not prescribe -- medical marijuana for patients with a qualifying condition. Different states broadened APRNs' "signature authority" for specific purposes, notably including the authority to sign death certificates.

Advanced practice registered nurses -- including nurse practitioners, clinical nurse specialists, nurse anesthetists and nurse midwives -- are a critical part of efforts to ensure and expand access to high-quality, cost-effective healthcare, according to Phillips' assessment.

Twitter: @JELagasse
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