Results of a National Survey: Ongoing Barriers to APRN Practice in the United States

Abstract

Limited information is available on the barriers to practice for advanced practice registered nurses (APRNs) among states with full, restricted, and reduced practice. The purpose of this study is to identify practice barriers in relationship to United States (U.S.) state practice authority, APRN type, area of practice (rural, suburban, urban), and nature of practice (outpatient, inpatient, and both). An electronic survey of a convenience sample of APRNs was conducted to assess barriers to practice. Identified barriers were examined based on state practice environment, APRN role, practice setting, and location. Data were analyzed using thematic analysis for qualitative data and descriptive analysis for quantitative data. Over 7,000 APRNs representing all 50 states participated. Themes that were identified and reported by respondents, included licensure and administrative barriers, therapy restrictions, physician signature requirements, a lack of collegiality, prescribing barriers, uneven reimbursement, physician only procedures, and telehealth issues. Barriers were identified in all states, regardless of the type of practice authority. All four APRN role types identified practice barriers, some of which were more frequent for some roles than others. Restrictions for home health approval and the requirement for a physician signature for durable medical supply orders were identified by over 40% of respondents practicing in rural areas. Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with full practice authority. Continued efforts to reduce barriers to APRN practice are needed to ensure patient access to care, especially in rural areas.

Early implementation of full-practice authority: A survey of Massachusetts nurse practitioners

“…The formal practice agreement remained a requirement for 75% of NPs almost 2 years after the initial executive order. Others have also found that formal practice agreements and lack of hospital admitting privileges are the most common NP practice restrictions, which continue to persist despite permanent FPA (Schorn et al, 2022). Required physician signature on hospice/home health orders was most affected in our survey, which was likely a reflection of the federal 2020 CARES Act, rather than the state policy change to FPA.…”

Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19

“…These practices interfere with the ability of APRNs to provide patient care follow-up, limit patients’ choice of providers, and limit APRNs’ visibility in care ( Poghosyan et al, 2013 ; Anen & McElroy, 2015 ). Nonregulatory barriers may vary by practice or geographically within a single state as well as among states ( Schorn et al, 2022 ).…”

Hospital-Based Credentialing and Privileging

“…Regulatory barriers are those that are determined through federal or state laws, regulations, statutes, and policies 16 . Examples include the requirement for physician supervision or limitation of the types of services an APRN can provide 15 . Organizational and institutional policies comprise nonregulatory barriers 16 and can vary by facility or practice within a state.…”

“…A variety of barriers continue to limit APRNs, including CNSs, from practicing to the highest level of their education and training. 15 Regulatory barriers are those that are determined through federal or state laws, regulations, statutes, and policies. 16 Examples include the requirement for physician supervision or limitation of the types of services an APRN can provide.…”