State responses to COVID-19: Potential benefits of continuing full practice authority for primary care nurse practitioners

Abstract

A sudden growth in the need for health care services during the COVID-19 pandemic has exposed the vulnerabilities of our health care system, particularly a shortage of adequately trained health care providers. Federal and state governments responded by removing the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure. However, the changes to support full practice authority that were enacted to address COVID-19 are temporary and will be reversed when the executive orders expire. To support policy makers’ efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline specific recommendations for policy, practice, and research.

State‐level scope of practice regulations for nurse practitioners impact work environments: Six state investigation

“…Removing state‐level policy restrictions on NPs can have implications for care delivery across the country. During the COVID‐19 pandemic, many states issued emergency executive orders to remove SOP restrictions on NPs to meet surging patient care demand (American Association of Nurse Practitioners, 2020; Poghosyan et al, 2022). Many of these orders have since expired; policymakers should act to make full SOP for NPs permanent to support improvements in patient access and quality of care and to ensure the workforce is optimized for future emergency response (Fraher et al, 2020).…”

Advocating, implementing, and supporting the journey to full-practice authority in a large healthcare system

“…In the next decade, demand for primary care clinicians is expected to rise by 20% with continued struggles to fi ll the void. 2 This is coupled with COVID-19-related stress on healthcare providers, further impacting supply and demand with one out of fi ve physicians indicating an intent to leave their position within the next 2 years. 6 As a result of these combined forces and the recent expansion of roles and scope of practice (SOP) during the pandemic, APRNs experienced a surge in FPA via state practice waivers allowing for unprecedented expansion and increased control over practice.…”

“…7 FPA validates and optimizes APRN knowledge, skills, and abilities, improving patient access and streamlining care while decreasing costs, protecting patient choice, and improving outcomes. 2 Historically, legislative activities addressing FPA span more than 3 decades with implementation varying greatly between states. 8 ■ Barriers to FPA Notwithstanding these strides, FPA barriers continue, which include administrative issues, therapy restrictions, physician signature requirements and ongoing opposition (including lack of collegiality), prescribing concerns, uneven reimbursement, physician-only procedures, telehealth problems, and the end of emergency waivers.…”

“…The pandemic has illuminated the fragile state of healthcare delivery in our country. In the next decade, demand for primary care clinicians is expected to rise by 20% with continued struggles to fill the void 2. This is coupled with COVID-19-related stress on healthcare providers, further impacting supply and demand with one out of five physicians indicating an intent to leave their position within the next 2 years 6.…”

“…As a result of these combined forces and the recent expansion of roles and scope of practice (SOP) during the pandemic, APRNs experienced a surge in FPA via state practice waivers allowing for unprecedented expansion and increased control over practice 7. FPA validates and optimizes APRN knowledge, skills, and abilities, improving patient access and streamlining care while decreasing costs, protecting patient choice, and improving outcomes 2. Historically, legislative activities addressing FPA span more than 3 decades with implementation varying greatly between states 8…”