Achieving full practice authority for nurse practitioners requires a 2-pronged approach that includes promoting health equity and removing barriers to nursing practice, said Winifred V. Quinn, PhD, FAANP(H), FAAN(H), at the Gerontological Advanced Practice Nurses Association (GAPNA) 2022 Annual Conference held September 15 to 17 in Orlando, Florida.
Dr Quinn gave the audience a roadmap on what to say and what not to say when speaking with legislators to advocate for full practice authority for advanced practice registered nurses (APRNs). Dr Quinn is director of Advocacy and Consumer Affairs at the Center to Champion Nursing in America, which coordinates the Campaign for Action initiative from the AARP Foundation and Robert Wood Johnson Foundation. The Campaign is a network of state and national coalitions including GAPNA working with more than 200 organizations to support nurses as essential partners in providing care and promoting health equity and well-being.
Promoting the Health Equity Case for Full Practice Authority
The Campaign works to implement key recommendations in The Future of Nursing 2020-2030 from the National Academy of Medicine. One of the takeaways messages from the report relevant to achieving full practice authority is that nursing schools need to prepare nurses to advance health equity for all patients by incorporating the following measures:
- Cultivate an inclusive environment
- Recruit and admit diverse students
- Provide students with support and mentorship
- Ensure that all nurses practice cultural humility and are aware of their biases
- Integrate content about the drivers of health, health inequities, and population health concepts throughout the curriculum
- Expand community learning opportunities
- Increase the number of nurses with PhDs who focus on health equity and nurse well-being
“A good example of nursing education program that is effectively preparing students to address the social determinants of health is a program at Washburn University in Topeka Kansas,” Dr Quinn said. In 2017, the university partnered with the Topeka Housing Authority to open Pine Ridge Family Health Center, which is led by an NP. The center provides care to a primarily low-income population with low access to care. The university uses the community-based center as an educational forum for students including nursing students, and its curriculum ranges from social justice to trauma-informed care, Dr Quinn said.
A Health Equity Toolkit is available from Campaign for Action and provides action-based strategies for individuals and health care facilities to promote and sustain a culture of health.
Modernizing Scope of Practice Laws
The second key takeaway message from The Future of Nursing 2020-2030 report is the need to permanently remove nurse practice barriers by modernizing scope of practice laws and regulations and removing restrictions. Considerable progress has been made on this front with 13 states granting nurse practitioners full practice authority since the Campaign was initiated in late 2010, adding to the 13 states plus the District of Columbia that had already granted full practice authority.
The 2 most recent wins were in New York and Kansas. Dr Quinn noted that New York passed full practice authority for NPs through the state budget process. “And, Kansas has one of the best laws that I have ever seen passed on full practice authority,” Dr Quinn explained. The legislation includes all 4 APRN professions and has no transition to practice hours required. “Now, we just need to make sure that the regulations are finalized and reflect the spirit of the law. There is some debate going on in Kansas about regulations,” she said.
The Business Argument for Full Practice Authority
A fundamental argument that physicians make in trying to prevent full practice authority for APRNs is that physicians have more education than NPs and therefore are more skilled and more knowledgeable. At face value, that argument sounds practical to those who don’t know the intricacies of health care education, Dr Quinn explained.
On the nursing side, many arguments that nurses were taking involved messaging around how frustrating it is for nurses to do their job by needing to have a collaborative agreement with a physician. “But, that doesn’t make a case for policymakers. What does that mean for their constituents?,” Dr Quinn said. AARP recommends that nurses emphasize patient impact when talking about this practice barrier.
Do’s and Don’ts of Messaging Around Full Practice Authority
“Don’t talk about yourself or complain about physicians,” she said. “Talk about how these barriers contribute to the lack of care that your patients are getting and how problematic that is for families. Talk about clinician shortages hitting hard and how NPs are poised and ready to fill that gap. Don’t talk about ‘collaborative agreement’ when it is a ‘contract’ that is unnecessary red tape that gets in the way of patient care. Explain how this red tape affects the policymaker’s constituents.”
She referred to nursing groups in West Virginia as a good example of how to make the business case for full practice authority, she said. These groups made the case that full practice authority leads to opportunities for economic development in the state. “With NPs being able to practice to the full extent of their education and training and not needing to contract with physicians, they could open businesses in the rural and underserved areas of the state,” Dr Quinn explained. “What does that do? That improves the health and well-being of people in those areas and it helps people in those areas achieve financial security.”
Case in point, West Virginia just received $1.3 million from federal government to help nurses open health-related businesses.
Dr Quinn encouraged attendees who would like to advocate for full practice authority in their state get involved with their state nurses association or contact her to be connected to resources.
Campaign for Action Advocacy Resources
|Health Equity Toolkit|
|Nursing Innovations Fund|
|Learning Collaboratives https://campaignforaction.org/resource/learning-collaboratives/|
Visit Clinical Advisor’s meetings section for complete coverage of GAPNA 2022.
Quinn W. Full practice authority framing: the business case and the health equity position. Presented at: GAPNA 2022; September 15-17, 2022; Orlando, Florida.